Construction of female urethra using buccal mucosa graft

Purpose: We reviewed our experience with buccal mucosa grafts for reconstru cting difficult female urethral problems. Materials and Methods: Since 1994, we have used a buccal mucosa graft to re construct the urethra in 7 girls 3 to 13 years old. The underlying patholog ical condition was a fibrotic urethra after previous operations for cloacal exstrophy, cloacal malformation, iatrogenic urethral stricture, and multip le false passages in a previously reconstructed urethra of vaginal mucosa t hat made clean intermittent catheterization difficult. A full-thickness buc cal mucosa graft was tubularized in situ as the neourethra to the base of t he clitoris. In patients with cloacal exstrophy and cloacal malformation th e bladder neck and urethra were widely exposed transabdominally by splittin g the pubic symphysis. The fibrotic mucosa was excised and the tubularized buccal mucosa graft was wrapped with periurethral tissues. Other patients u nderwent transvaginal surgery in the prone position and the graft was cover ed with a buttock flap. Results: Patients were followed for 12 to 58 months (mean 34.7). Those with cloacal exstrophy and cloacal malformation had been completely incontinent before urethral reconstruction but all attained complete continence postop eratively. They and the girl who underwent urethral reconstruction for diff icult catheterization performed clean intermittent catheterization easily. The patient with urethral stricture voided via the urethra without difficul ty. Conclusions: In select female patients with difficult urethral reconstructi ve problems a tubularized free graft obtained from the buccal mucosa may be effectively used when local tissue is fibrotic and unsuitable for creating a supple new urethra.