LINGUAL MUCOSAL GRAFT URETHROPLASTY FOR ANTERIOR URETHRAL RECONSTRUCTION

Article infoArticle history:Accepted January 7, 2008Published online ahead ofprint on January 16, 2008Keywords:Buccal mucosaFree graftsHypospadiasOral mucosaTongueTransplantsUrethraUrethral strictureUrethroplastyAbstractObjective: Evaluate the use of lingual mucosal graft (LMG) in anteriorurethral strictures.Methods: FromJanuary2001toDecember2006,29men(meanage,48.5yr)withanteriorurethralstricturesunderwentgrafturethroplastywithLMG.The mean length of stricture was 3.6 cm. Patients with bulbar, penile, orbulbopenilestricturesreceivedone-stagedorsalfreegrafturethroplasties.In patients with failed hypospadias repair we performed a two-stageurethroplasty. Criteria for successful reconstruction were spontaneousvoiding with no postvoid residual urine and no postoperative instrumen-tation ofany kind.Clinical assessment includedthe donor sitemorbidity.Results: Mean follow-up was 17.7 mo. One-stage bulbar and penile ure-throplasties without meatal involvement had an 81.8–100% success rate.Bulbopenile urethroplasties were successful in 60% of the cases, whereasone-stage urethral reconstructions in patients with meatal involvementweresuccessfulin66.6%.Thetwocasesoftwo-stageurethralreconstruc-tionwithLMGand buccalmucosalgraftafterfailedmultiplehypospadiasrepairs were unsuccessful. The overall early recurrence rate was 20.7%.Patientswiththegraftharvestedfromthetonguereportedonlyslightoraldiscomfort at the donor site and difficulty in talking for 1 or 2 d.Conclusions: The mucosa of the tongue, which is identical to the mucosaof the rest of the oral cavity, is a safe and effective graft material in thearmamentarium for urethral reconstruction with potential minor risksof donor site complications. LMG may be used alone for short strictures(<5 cm) or in combination with buccal mucosa when longer grafts areneeded.