Closure versus Non-closure Buccal Mucosal Graft Site for Lowering Post-operative Morbidity in Patient with Urethral Stricture Underwent Urethroplasty: A Systematic Review and Meta-analysis

Abstract

BACKGROUND: Buccal mucosal graft (BMG) has been a widely known technique for anterior urethral reconstruction; however, the studies regarding its morbidity are still limited. AIM: The purpose of this study is to compare postoperative morbidity outcome between closure versus non-closure BMG harvest site in patients with urethral stricture underwent urethroplasty. METHODS: A systematic review and meta-analysis of randomized controlled trials and prospective cohort studies was conducted. Literature searching was done through electronic databases, including PubMed, Science Direct, EBSCO, ProQuest, and Google Scholar. The inclusion criteria were men diagnosed with urethral stricture and underwent urethroplasty procedure. The participants were two groups of patients divided based on whether their BMG harvest site was closed or left open. No exclusion criteria applied to the types of participants. The statistical analysis was performed using Review Manager version 5.3 software. Cochrane risk-of-bias tool was used to evaluate the quality of the study. RESULTS: We analyzed five studies qualitatively and three studies quantitatively. There was no significant difference between the closure and non-closure BMG in pooled standard mean difference (SMD) on the oral pain in day-1 and month-6 post-operation. However, pain score in day-1 post-operation was slightly higher in the closure group (SMD 0.49, 95% CI –0.31, 1.30). The incidence of perioral numbness in day-1 post-operation was significantly higher in the closure group (RR 1.48, 95% CI 1.04, 2.10, p < 0.05). The incidence of difficulty in opening mouth in day-1 post-operation also significantly higher in closure group (RR 1.48, 95% CI 1.14, 1.91, p = 0.003). There was no significant morbidity difference between two groups reported in five studies included after 6 months post-operation. CONCLUSION: There was no significant difference between closure and non-closure of BMG in the post-operative pain morbidity. However, the incidence of the early perioral numbness and difficulty in mouth opening was significantly lower in non-closure group.