WHEN AND HOW TO USE BUCCAL MUCOSAL GRAFTS IN ADULT BULBAR URETHROPLASTY

Objectives. To evaluate the efficacy of buccal mucosa in the repair of adult urethral stricture disease, we report our experience with its u se as a nontubularized onlay graft-during bulbar urethral reconstructi on. Methods. From June 1993 to January 1996, 75 men underwent anterior urethral reconstruction for stricture disease. Single-stage urethropl asty with an onlay patch graft of buccal mucosa was performed in 13 pa tients with complex, refractory strictures of the bulbar urethra. In a ll cases, a two-team approach was used in which one team harvested the graft from the mouth while the perineal team simultaneously exposed a nd calibrated the stricture. Results. The length of buccal mucosa rang ed from 3.5 to 17 cm (average length 6.2), In 8 patients, other recons tructive techniques were used concomitantly, including fasciocutaneous penile flap or stricture excision and primary anastomosis, depending on the length and severity of the scarred area. Median follow-up time was 18 months. Excellent results were obtained in all 13 patients, and none has required urethral dilation or instrumentation subsequently. Operative time was significantly less than with other forms of substit ution urethroplasty. Conclusions. Excellent results can be expected wh en buccal mucosa is used for urethral substitution in men with refract ory bulbar strictures. For patients with long or dense strictures, buc cal mucosal grafts may easily be combined with other reconstructive te chniques. In patients with less complex stricture disease, the reduced operative time of this two-team approach may be beneficial.