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BMC Urology
Published in: BMC Urology 1/2014

Open Access 01-12-2014 | Research article

Use of buccal mucosa grafts for urethral reconstruction in children: a retrospective cohort study

Authors: Emilie K Johnson, Spencer I Kozinn, Kathryn L Johnson, Sohee Kim, David A Diamond, Alan B Retik

Published in: BMC Urology | Issue 1/2014

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Abstract

Background

The use of buccal mucosa grafts (BMG) for urethral reconstruction has increased in popularity over the last several decades. Our aim was to describe our institutional experience with and outcomes after BMG urethroplasty.

Methods

We conducted a retrospective cohort study of boys undergoing BMG urethral reconstruction. Preoperative and perioperative characteristics and postoperative outcomes were evaluated.

Results

Twenty-nine patients (median age 8.2 years) underwent BMG urethroplasty from 1995–2012. Of the 10 patients undergoing 1-stage repairs, 6 had tubularized grafts, the last of which was performed in 2000 due to an unacceptably high revision rate (100%). A 2-stage approach was elected for 19 patients (median follow-up 21.3 months). Complications including stricture, fistula, or chordee were seen in 60% of patients completing both stages and 32% required ≥1 revision. However, 71% of 2-stage patients were free of significant problems at last follow-up.

Conclusions

We found BMG to be a reasonable option for use in complex pediatric urethral reconstruction. Tubularized grafts had poor results, and we no longer use them. We favor a 2-stage approach for all patients except those with “simple” non-hypospadiac strictures. Although revision procedures were not uncommon, the majority of patients were ultimately free of long-term problems.
Literature
1.
Snodgrass W: Tubularized, incised plate urethroplasty for distal hypospadias. J Urol. 1994, 151 (2): 464-465.PubMed
2.
Wright JL, Wessells H, Nathens AB, Hollingworth W: What is the most cost-effective treatment for 1 to 2-cm bulbar urethral strictures: societal approach using decision analysis. Urology. 2006, 67 (5): 889-893. 10.1016/j.urology.2005.11.003.CrossRefPubMed
3.
Borer JG, Bauer SB, Peters CA, Diamond DA, Atala A, Cilento BG, Retik AB: Tubularized incised plate urethroplasty: expanded use in primary and repeat surgery for hypospadias. J Urol. 2001, 165 (2): 581-585. 10.1097/00005392-200102000-00075.CrossRefPubMed
4.
Snodgrass WT, Bush N, Cost N: Tubularized incised plate hypospadias repair for distal hypospadias. J Pediatr Urol. 2010, 6 (4): 408-413. 10.1016/j.jpurol.2009.09.010.CrossRefPubMed
5.
Wilcox D, Snodgrass W: Long-term outcome following hypospadias repair. World J Urol. 2006, 24 (3): 240-243. 10.1007/s00345-006-0059-1.CrossRefPubMed
6.
Morey AF, McAninch JW: When and how to use buccal mucosal grafts in adult bulbar urethroplasty. Urology. 1996, 48 (2): 194-198. 10.1016/S0090-4295(96)00154-9.CrossRefPubMed
7.
Mangera A, Patterson JM, Chapple CR: A systematic review of graft augmentation urethroplasty techniques for the treatment of anterior urethral strictures. Eur Urol. 2011, 59 (5): 797-814. 10.1016/j.eururo.2011.02.010.CrossRefPubMed
8.
Markiewicz MR, Lukose MA, Margarone JE, Barbagli G, Miller KS, Chuang SK: The oral mucosa graft: a systematic review. J Urol. 2007, 178 (2): 387-394. 10.1016/j.juro.2007.03.094.CrossRefPubMed
9.
Brock JW: Autologous buccal mucosal graft for urethral reconstruction. Urology. 1994, 44 (5): 753-755. 10.1016/S0090-4295(94)80222-X.CrossRefPubMed
10.
Duckett JW, Coplen D, Ewalt D, Baskin LS: Buccal mucosal urethral replacement. J Urol. 1995, 153 (5): 1660-1663. 10.1016/S0022-5347(01)67497-4.CrossRefPubMed
11.
Mokhless IA, Kader MA, Fahmy N, Youssef M: The multistage use of buccal mucosa grafts for complex hypospadias: histological changes. J Urol. 2007, 177 (4): 1496-1499. 10.1016/j.juro.2006.11.079. discussion 1499–1500CrossRefPubMed
12.
Cohen SD, Armenakas NA, Light DM, Fracchia JA, Glasberg SB: Single-surgeon experience of 87 buccal mucosal graft harvests. Plast Reconstr Surg. 2012, 130 (1): 101-104. 10.1097/PRS.0b013e318254b177.CrossRefPubMed
13.
Tolstunov L, Pogrel MA, McAninch JW: Intraoral morbidity following free buccal mucosal graft harvesting for urethroplasty. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997, 84 (5): 480-482. 10.1016/S1079-2104(97)90261-4.CrossRefPubMed
14.
Nelson CP, Bloom DA, Kinast R, Wei JT, Park JM: Long-term patient reported outcome and satisfaction after oral mucosa graft urethroplasty for hypospadias. J Urol. 2005, 174 (3): 1075-1078. 10.1097/01.ju.0000169421.27043.f2.CrossRefPubMed
15.
Meeks JJ, Erickson BA, Gonzalez CM: Staged reconstruction of long segment urethral strictures in men with previous pediatric hypospadias repair. J Urol. 2009, 181 (2): 685-689. 10.1016/j.juro.2008.10.013.CrossRefPubMed
16.
Ahmed S, Gough DC: Buccal mucosal graft for secondary hypospadias repair and urethral replacement. Br J Urol. 1997, 80 (2): 328-330. 10.1046/j.1464-410X.1997.00134.x.CrossRefPubMed
17.
Metro MJ, Wu HY, Snyder HM, Zderic SA, Canning DA: Buccal mucosal grafts: lessons learned from an 8-year experience. J Urol. 2001, 166 (4): 1459-1461. 10.1016/S0022-5347(05)65809-0.CrossRefPubMed
18.
Leslie B, Lorenzo AJ, Figueroa V, Moore K, Farhat WA, Bagli DJ, Pippi Salle JL: Critical outcome analysis of staged buccal mucosa graft urethroplasty for prior failed hypospadias repair in children. J Urol. 2011, 185 (3): 1077-1082. 10.1016/j.juro.2010.10.047.CrossRefPubMed
19.
Hensle TW, Kearney MC, Bingham JB: Buccal mucosa grafts for hypospadias surgery: long-term results. J Urol. 2002, 168 (4 Pt 2): 1734-1736. discussion 1736–1737CrossRefPubMed
20.
Fichtner J, Filipas D, Fisch M, Hohenfellner R, Thuroff JW: Long-term followup of buccal mucosa onlay graft for hypospadias repair: analysis of complications. J Urol. 2004, 172 (5 Pt 1): 1970-1972. discussion 1972CrossRefPubMed
21.
Djordjevic ML, Kojovic V, Bizic M, Majstorovic M, Vukadinovic V, Korac G: “Hanging” of the buccal mucosal graft for urethral stricture repair after failed hypospadias. J Urol. 2011, 185 (6 Suppl): 2479-2482.CrossRefPubMed
22.
Macedo A, Liguori R, Ottoni SL, Garrone G, Damazio E, Mattos RM, Ortiz V: Long-term results with a one-stage complex primary hypospadias repair strategy (the three-in-one technique). J Pediatr Urol. 2011, 7 (3): 299-304. 10.1016/j.jpurol.2011.02.024.CrossRefPubMed
23.
Manoj B, Sanjeev N, Pandurang PN, Jaideep M, Ravi M: Postauricular skin as an alternative to oral mucosa for anterior onlay graft urethroplasty: a preliminary experience in patients with oral mucosa changes. Urology. 2009, 74 (2): 345-348. 10.1016/j.urology.2009.02.065.CrossRefPubMed
24.
Nelson CP, Bloom DA, Kinast R, Wei JT, Park JM: Patient-reported sexual function after oral mucosa graft urethroplasty for hypospadias. Urology. 2005, 66 (5): 1086-1089. 10.1016/j.urology.2005.05.057. discussion 1089–1090CrossRefPubMed
Metadata
Title
Use of buccal mucosa grafts for urethral reconstruction in children: a retrospective cohort study
Authors
Emilie K Johnson
Spencer I Kozinn
Kathryn L Johnson
Sohee Kim
David A Diamond
Alan B Retik
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Urology / Issue 1/2014
Electronic ISSN: 1471-2490
DOI
https://doi.org/10.1186/1471-2490-14-46

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