Oral Mucosa Graft: An Ideal Substitute for Urethroplasty

Abstract

Urethroplasty is both an art and science. The fact that over 200 different types of repair have been reported in the literatures confirms that it is a difficult surgery with many complications and frequently inadequate cosmetic and functional results. (1) There are two main principles of urethroplasty: • Anastomotic technique. • Tissue transfer. The use of vascularized local penile or preputial skin has been the mainstay of urethral reconstruction for a long time. Lacking of penile and preputial skin necessitated the search for new sources for tissue transfer. Resurgence of the use of free grafts for anterior urethral stricture reconstruction has renewed the search for the ideal urethral substitute. (1) Since 1909, a large variety of free extra genital graft tissues had been described in the literature for substitution urethroplasty e.g. ureter (2), tunica vaginalis (3), full thickness extragenital skin (4), and bladder mucosa. (5) For 100 years, oral mucosa had variously been utilized as a free graft in reconstructive plastic surgery. (6) The first report on the application of oral mucosa as a substitute for conjunctiva dated back to 1873 when Stellwag Von Carion used the lip mucosa to treat conjunctival defects. (6) It is generally accepted that Humby, a plastic surgeon, first proposed and reported the use of buccal mucosa in urethral surgery for hypospadias repair in 1941. (7) Whether owing to lack of suitable antibiotic prophylaxis or technical factors, the technique did not gain acceptance or widespread use at that time until almost 50 years later. Current enthusiasm for the technique was promoted by Duckett 1986, (8) Burger and associates 1992 (9), Dessanti and colleagues 1992 (10) and Elkasaby et al. (11) In the following years, numerous reports had described successful use of buccal mucosal graft in the repair of urethral defects associated with previously failed hypospadias surgery and those associated with urethral stricture. (12-19) Nowadays, buccal mucosa has become the mainstay of these tissue transfer techniques. (13) In February 2006, Simonato et al. (20) described the results of the first pilot study on the use of the tongue as an alternative donor site for graft urethroplasty with good functional and aesthetic results. (20) One year later in a dog model, Song et al (21) investigated the feasibility of the LMG urethroplasty. Macroscopic examination of the graft showed no ulceration, calcification, strictures, diverticulae or fistula formation. The junction between