Buccal mucosal grafts: Lessons learned from an 8-year experience

Purpose: We evaluated our 8-year experience with buccal mucosal grafts in c omplex hypospadias and epispadias repair. Materials and Methods: We reviewed the records of 29 patients in whom a tot al of 30 buccal mucosal grafts were placed as part of urethral reconstructi on between 1991 and 1999. At surgery 16 tubes and 14 onlays were constructe d and 24 of 30 repairs involved the meatus. All patients were followed at l east 6 months postoperatively (median 5.3 years). Beginning in 1995 meatal design was enlarged to a racquet handle shape and patients were asked to pe rform meatal self-dilation for 6 months postoperatively. Results: Complications developed in 17 of our 30 cases (57%) and reoperatio n was done in 10 (33%). All complications were evident by 11 months postope ratively except 1 that presented as recurrent stricture disease at 3 years. Complications developed in 5 and 12 of 15 patients who underwent surgery b etween 1995 and 1999, and before 1995, respectively (p = 0.027). No patient has had meatal stenosis since 1995. Complications included meatal stenosis in 5 cases, stricture in 7, glanuloplasty, meatal and complete graft break down in I each, and fistula in 2. Onlays were more likely to result in stri cture than tube grafts (6 of 14 cases versus 1 of 16, p = 0.034). Conclusions: The complication and reoperation rates of buccal mucosal graft s are 57% and 33% at 5 years of followup. Changes in meatal design and temp orary postoperative meatal dilation have improved the outcome in the last 5 years. Buccal mucosa remains a good choice in patients who require extrage nital skin for urethral reconstruction.