[Substitution urethroplasties with free graft buccal mucosa].

OBJECTIVE: To present our experience with free graft buccal mucosa substitution urethroplasties.

METHODS: Between June, 1992 and December, 1997, we performed 18 urethroplasties with buccal mucosa in 17 patients (double urethroplasty in the same stage in one): 8 for the repair of urethral strictures, 9 for the repair of hypospadias cripples and one for epispadias repair, in an exstrophic boy. Only 3 patients had not undergone previous reconstructive operations. The mean age was 26.2 years (range 10-69). In 8 cases we harvested the graft from the inner cheek and in another 8 cases from the inner lower lip; in two cases we combined mucosa from the cheek and from the lip. In 14 patients we managed to preserve the urethral roof and the buccal mucosa was grafted as an onlay patch; 4 patients underwent full circumference tube replacement. The median follow-up of the series was 17.8 months, ranging from 1 month to 5.5 years.

RESULTS: In 15 out of 18 repairs (83.3%) the final outcome was satisfactory, while in three cases the graft failed and reoperation was necessary. In 10 of the 15 successful urethroplasties the end result was excellent: first intention healing no complications or sequelae; in the other 5, although the end result was good, fistulae requiring surgery for closure developed in 2 and meatal stenosis requiring autodilations in three patients. The best results were obtained in strictures of the bulbar urethra secondary to trauma with 100% success rate. In hypospadias the success rate was 77.7%. Onlay patch grafts never failed, with 10 out of 14 excellent results. Three out of 4 tubed grafts failed.

CONCLUSIONS: At short and medium term, the free grafts of buccal mucosa yield results comparable to those of other epitheliums in use for urethral repair, thus increasing the choice of techniques at our disposal for one-stage repairs. We consider that it is best suited for long strictures of the bulbar urethra.