Urethral Reconstruction Using Buccal Mucosa or Penile Skin Grafts: Systematic Review and Meta-Analysis

Abstract

Introduction: Different types of grafts have been described in urethral reconstruction (UR), with penile skin graft (PSG) and buccal mucosa graft (BMG) as the most frequently used ones. It still remains unclear whether one graft is superior in terms of success when compared to the other. Material and Methods: A systematic review of the literature was performed searching the MEDLINE database with the following search strategy: ‘urethroplasty’ AND ‘penile skin’/ ‘urethroplasty’ AND ‘buccal mucosa’. 266 and 144 records were retrieved for urethroplasty with PSG and BMG, respectively. These records were reviewed to identify papers where PSG and BMG were used in UR and where individualized data on success were available within the same series. Results: 18 papers were found eligible for further analysis. In total, 428 and 483 patients were respectively treated with PSG or BMG. If available, follow-up duration was 64.1 versus 42.1 months (p < 0.0001) and stricture length 6.2 versus 4.6 cm (p < 0.0001) for PSG and BMG, respectively. Success of UR with PSG was 81.8 versus 85.9% with BMG (p = 0.01). Conclusions: Success of UR using BMG is significantly better compared to PSG. Results might be seriously biased by a longer follow-up duration and stricture length for PSG compared to BMG.

Outcome of buccal mucosa urethroplasty in the management of urethral strictures

“…It is easy to obtain, readily available, compatible with wet environment, and butress the local immune status with its increased amount of IgA, resistant to infection and has better healing features as demonstrated by rapid healing of aphthous ulcers. A systematic review and meta-analysis of urethral reconstruction with buccal mucosa or penile skin graft (PSG) revealed a success rate of 85.9% with buccal mucosa and 81.8% with PSG (13). A 90% success rate has been reported when using buccal mucosa dorsal onlay free grafts for the management of bulbar urethral strictures.…”

“…Whilst substitution urethroplasty is an established and accepted treatment there is currently no clear consensus on the best graft material (2). Pedicled and free grafts have been used including split and full-thickness skin grafts (genital and extra-genital), bladder mucosa, colonic mucosa, tunica vaginalis, tissue-engineered grafts, and intra-oral mucosa (buccal or lingual) (3,4). Long-term results of scrotal and extra-genital skin are disappointing as non-hirsute full-thickness skin grafts ed.…”

Developing improved tissue-engineered buccal mucosa grafts for urethral reconstruction

“…Oral fibroblasts were seeded on the inside of a 1 cm diameter stainless steel ring at 1.5x10 5 after two days cultured, Euroskin was turned over and 3.0x10 5 oral keratinocytes were seeded. Grafts were cultured for 48 h submerged, and then cut…”

“…In carrying out an augmentation procedure, a range of materials have been used for grafting including penile skin, scrotal skin, oral mucosa, bladder mucosa, and colonic mucosa. From these, oral mucosa grafts have become the most clinically effectivedue to their short harvest time, lack of hair, low associated morbidity, and high clinical success rates (5)(6)(7)(8). Full-thickness oral mucosa is taken as most patients can provide an adequate donor area.…”

Urétroplastie avec greffe de muqueuse buccale : techniques de prélèvements et complications. Revue de la littérature et rapport d’un cas

“…La muqueuse buccale a des propriétés histologiques tout à fait adaptées pour ce type de chirurgie. Contrairement à la peau ou au scrotum, c'est une muqueuse qui n'a pas de système pileux, qui, développé dans la lumière urétrale, peut être à l'origine de lithiase [4]. Elle a un épithélium épais, elle est riche en fibres élastiques, elle a une lamina propria richement vascularisée, ce qui facilite la survie du greffon à court et à long terme [5].…”