Buccal Mucosa Graft in Urological Surgery: A State-of-the-Art Review and Expert Opinion

Treatment of Urethral Defects: Skin, Buccal or Bladder Mucosa, Tube or Patch? An Experimental Study in Dogs

BackgroundThe 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.MethodsWe conducted a retrospective cohort study of boys undergoing BMG urethral reconstruction. Preoperative and perioperative characteristics and postoperative outcomes were evaluated.ResultsTwenty-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.ConclusionsWe 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.

The Tongue as an Alternative Donor Site for Graft Urethroplasty: A Pilot Study

One-Stage Buccal Mucosal Graft Urethroplasty for Lichen Sclerosus-Related Urethral Stricture Disease: A Systematic Review and Pooled Proportional Meta-Analysis.

Comparable outcomes were published using a buccal mucosa graft (BMG) from the cheek and a lingual mucosa graft (LMG) from the sublingual area, for urethral augmentation or substitution. To date, no histological comparison between both grafts has been conducted. We histologically assessed BMG and LMG harvested during urethral surgeries, aiming to compare graft properties and vascular support. We conducted a prospective single cohort study, including oral mucosa urethroplasty patients. During surgery, graft dimensions and donor sites were collected, and a 0.5 × 0.5 cm sample was obtained from the prepared graft. Formalin-fixed paraffin-embedded samples were sliced at 4 micrometres (µm) and hematoxylin-eosin stained. Using a telepathology tool, all slides were digitalized and measured from 10× to 40× magnification. In each graft, global and individual layers thicknesses were assessed, including vascular density and area. Descriptive and comparative (parametrical and non-parametrical) statistical analysis occurred. We collected 57 grafts during 33 urethroplasties, with 30 BMG and 22 LMG, finally, included. The mean age was 56.6 (SD 15.2) years, and the mean graft length was 5.8 (SD 1.7) cm and the width was 1.7 (SD 0.4) cm. The median graft thickness was 1598.9 (IQR 1200–2100) µm, the mean epithelium layer was 510.2 (SD 223.7) µm, the median submucosa was 654 (IQR 378–943) µm. the median muscular was 477.6 (IQR 286–772) µm, the median vascular area was 5% (IQR 5–10), and the median adipose tissue area was 5% (IQR 0–20). LMG were significantly longer and narrower than BMG. Total graft thickness was similar between LMG and BMG, but the epithelium and submucosa layers were significantly thinner in LMG. The muscular layer was significantly thicker in LMG. Vascular density and vascular areas were not significantly different between both types of grafts. LMG showed significantly less adipose tissue compared with BMG. Our findings show LMG and BMG for urethroplasty surgeries share the same thickness and blood supply, despite having significantly different graft sizes as well as mucosal and submucosal layers thickness.

Introduction: Different types of grafts have been described in urethral reconstruction (UR), with penile skin graft (PSG) and buccal mucosa graft (BMG) as the most frequently used ones. It still remains unclear whether one graft is superior in terms of success when compared to the other. Material and Methods: A systematic review of the literature was performed searching the MEDLINE database with the following search strategy: ‘urethroplasty’ AND ‘penile skin’/ ‘urethroplasty’ AND ‘buccal mucosa’. 266 and 144 records were retrieved for urethroplasty with PSG and BMG, respectively. These records were reviewed to identify papers where PSG and BMG were used in UR and where individualized data on success were available within the same series. Results: 18 papers were found eligible for further analysis. In total, 428 and 483 patients were respectively treated with PSG or BMG. If available, follow-up duration was 64.1 versus 42.1 months (p < 0.0001) and stricture length 6.2 versus 4.6 cm (p < 0.0001) for PSG and BMG, respectively. Success of UR with PSG was 81.8 versus 85.9% with BMG (p = 0.01). Conclusions: Success of UR using BMG is significantly better compared to PSG. Results might be seriously biased by a longer follow-up duration and stricture length for PSG compared to BMG.

Single Stage Reconstruction of Complex Anterior Urethral Strictures: Combined Tissue Transfer Techniques

Buccal Versus Lingual Mucosa Graft in Anterior Urethroplasty: A Prospective Comparison of Surgical Outcome and Donor Site Morbidity

Robot-assisted posterior bladder neck (BN) reconstruction is a key technique in complex urological surgery. The posterior BN presents unique challenges due to its narrow anatomical access and lack of surrounding spongiosum. Grafts enhance structural integrity in posterior BN reconstruction, particularly in cases of significant tissue loss, stenosis, or scarring. These challenges require precise graft placement and tissue handling, which we have outlined the best techniques within the existing literature in this review. This article provides a detailed review of robot-assisted posterior BN reconstruction, focusing on graft types, surgical techniques, and outcomes to optimize reconstruction and patient recovery. A literature search was conducted on January 30th, 2025, utilizing PubMed, Medline, Web of Science, and Embase databases. The search focused on terms related to urethral reconstruction, posterior urethral stenosis (PUS), graft types, and grafting techniques in adult populations. Articles were screened for relevance at the title, abstract, and full-text levels, with reference lists of included manuscripts also reviewed. Independent reviewers conducted the selection process. Management of PUS varies based on stenosis length, location, and severity. Robotic-assisted techniques, such as vesicourethral anastomotic reconstruction (VUAR), demonstrate high success rates for complex cases. Grafts provide durable options for substitution urethroplasty, with graft selection tailored to patient-specific factors. Buccal mucosal grafts (BMGs) remain the first choice for many urologists. Robotic systems offer enhanced precision, reduced morbidity, and shorter recovery times, making them a valuable tool in reconstructive urology. Robotic-assisted posterior urethral reconstruction offers a highly effective solution for managing PUS and restoring urinary function. Advancements in surgical techniques and tissue engineering will continue to optimize outcomes and expand treatment options. Future research should focus on long-term studies, patient-centered innovations, and standardized protocols to enhance the quality of care in reconstructive urology.

DORSAL ONLAY GRAFT URETHROPLASTY USING PENILE SKIN OR BUCCAL MUCOSA IN ADULT BULBOURETHRAL STRICTURES

Bulbar Urethral Stricture Repair with Buccal Mucosa Graft Urethroplasty

Hypospadias is an embryological disorder that results in an abnormal ventral positioning of the urethral meatus. Among multiple surgical techniques described to correct this anomaly, the use of buccal mucosa grafts has gained popularity among pediatric urologists, pediatric surgeons and plastic surgeons. Buccal mucosa grafts have shown favorable histological changes that result in an excellent scaffold for urethral reconstructive surgery. This review describes the evolution of the use of buccal mucosa grafts in hypospadias repair.

Management of complex and recurrent ureteral stricture disease remains one of the more challenging aspects of reconstructive urology. While standard techniques such as ureteroureterostomy, psoas hitch, Boari flap, and ileal ureter creation serve as the foundation of ureteral reconstruction, each technique has limitations, particularly when faced with recurrence, long strictures, and previously irradiated fields. Two alternative techniques—buccal mucosal graft (BMG) ureteroplasty and appendiceal onlay/interposition—have been previously described and are now being utilized more frequently in recent years. Furthermore, the advancement of robotic-assisted laparoscopic surgery has allowed for even more reconstructive capabilities. BMG ureteroplasty and appendiceal onlay/interposition can serve as valuable augmentations to the aforementioned surgical techniques. BMG has now long been established in urethral reconstruction and serves as a viable graft option for longer segment ureteral strictures, given its panvascular lamina propria and epithelium well-suited to a wet environment. Similarly, the appendix has other uses in urologic surgery, including the Mitrofanoff channel in pediatric surgery, and is chiefly used in right-sided ureteral stricture repair. Both of these techniques allow the surgeons to take on more complex ureteral stricture cases and avoid the morbidity of bowel harvest. In this perspective, we argue for a broader recognition and adoption of BMG and appendiceal onlay/interposition in ureteral reconstructive surgery. In this article, we highlight the rationale for use, technical considerations, outcomes, and clinical evidence suggesting their advantages over traditional approaches. By incorporating these techniques into practice, urologists can expand their ability to manage more complex ureteral stricture cases with improved outcomes.

Background: Stricture urethra is a frequent urological problem and substitution urethroplasty is the standard treatment for longer (&gt;2 cm) urerthral strictures, multiple urethral strictures and recurrent strictures. Currently, buccal mucosa graft (BMG) is the preferred donor site for substitution urethroplasty which is associated with donor site morbidities. The mucosa covering the lateral and undersurface of the tongue is identical to the rest of the lining of oral cavity and seems to be associated with less risk of donor site complications. The aim of the study was to compare the surgical outcome and donor site morbidity of buccal versus lingual mucosa graft in anterior urethroplasty. Methods: A prospective experimental study was done in the department of Urology Dhaka Medical College Hospital during the period of April 2017 to September 2018. Total 54 Patients were included by purposive sampling for the study as per inclusion and exclusion Criteria. Patients were than allocated into two groups. Group A consisted of 27 patients where Lingual mucosa graft (LMG) urethroplasty done and group B also consisted of 27 patients where Buccal mucosa graft (BMG) urethroplasty done. Results: In the present study, the baseline characteristics of the patients in group A and Group B were almost similar having no statistically significant difference. The overall surgical outcome between two groups was in group A 92% and in group B 88%. The inter-group difference was not statistically significant. Donor site complications more frequently occurred in Group B. Pain in oral cavity at 3rd week in Group A was in 1(4%) patient and in group B was in 9(36%) patients, at 6th month follow up, eating and drinking problem (Group A 4% versus group B 32%), peri-numbness (Group A 4% versus Group B 28%), oral tightness (Group A 0% versus Group B 32%), salivary disturbance (Group A 0% versus Group B 28%) were significant statistically (p&lt;0.05). Conclusion: We conclude that that lingual mucosa ....

Background Complex and recurrent urethral strictures present significant surgical challenges, with graft-based urethroplasty being the mainstay of treatment. Optimal graft selection remains controversial, particularly between buccal mucosa and penile skin grafts. Objective To compare clinical outcomes, complication rates, and patient-reported satisfaction following urethroplasty using buccal mucosa versus penile skin grafts. Methods This retrospective cohort study was conducted at Nishtar Hospital, Multan, Pakistan, from January 2022 to December 2024. A total of 178 male patients who underwent substitution urethroplasty were included in the study. Data were retrospectively extracted from electronic medical records and surgical logs. Collected variables included patient demographics (age, comorbid conditions like diabetes or smoking status), stricture characteristics (location, length, etiology, previous treatments), surgical details (graft type, operative time, perioperative complications), and postoperative outcomes. Data were analyzed using SPSS Version 26.0 (IBM SPSS Statistics for Windows, IBM Corp., Armonk, NY). Continuous variables were compared using t-tests and categorical variables using chi-square tests, with p < 0.05 considered statistically significant. Results Surgical success rates were higher in the buccal mucosa group at both 12 months (91 (87.5%) vs. 59 (80.2%)) and 24 months (88 (84.6%) vs. 56 (75.6%)), though differences were not statistically significant. Stricture recurrence and graft contracture were lower in the buccal mucosa group (11 (10.6%) vs. 14 (18.9%)) and (four (3.8%) vs. eight (10.8%)), respectively. International Prostate Symptom Score (IPSS) improvement was significantly greater with buccal mucosa grafts (p = 0.04), and patient satisfaction rates were also higher. Complication rates were low in both groups, but oral donor site morbidity was observed in 19 (18%) of buccal mucosa patients. Conclusions It is concluded that buccal mucosa grafts offer superior functional outcomes, lower complication rates, and greater patient satisfaction compared to penile skin grafts in the setting of complex or recurrent urethral strictures. Buccal mucosa should be considered the preferred graft material when feasible.