Buccal Mucosa for Urethroplasty
If as a male or a female you are diagnosed with a urethral stricture I.e a narrowing of your urinary passage which is either too long or has recurred after endoscopic / minimally invasive means and you have been advised a buccal graft urethroplasty, then this blog will help to dissolve your fears.
Buccal mucosa has been extensively used for urethral reconstruction for more than 25 years now and has been the graft of choice for the procedure because of its resiliance to infections and its natural wetness.
What is BMG urethroplasty? Buccal mucosa is the slippery smooth layer over which you can roll your tongue. The lining on the undersurface of the tongue is the lingual mucosa. Both are considered equivalent for using as a substitution material for the urethra. Harvesting of the buccal mucosa can be done, depending on the length of stricture to be repaired, either from one or both sides of the cheek. Approximately 6 to 7 cm of BMG can be retrieved from one side of the cheek.
How long does it take for buccal graft to heal? After the surgery, all the bleeding points are sealed with a cautery and generally a pack is placed in the mouth. After the urologist completes the procedure, patient is wheeled in the recovery room with the pack. Generally, the patient is allowed liquids on the evening of surgery and can be shifted to semisolid diet the next day. Chewing is also possible from the other side if both sides have not been used. Gradually transition to normal diet can be made. One can expect some facial swelling on the next day which subsides in a couple of days. There may be slurring in your speech for a few days if your lingual mucosa has been harvested. Although a large raw area may be visible or felt with the tongue for many days but functionally, the mouth recovers with in 4-5 days as gradually the inner lining regrows over the raw area. There may be some numbness around the mouth or restriction in mouth opening which gradually recovers. I generally advise my patients to frequently blow one’s cheek as an exercise to minimise the restriction in mouth opening.
Is buccal mucosa the best for urethroplasty? Currently as of 2022, BMG is considered the best tissue for urethral replacement with success rates ranging from 70-90% at the end of 1 year depending upon the length of urethral stricture. But contrary to the claims, the outcomes decrease over the years as toxic effects of urine slowly damage the replaced tissue or new strictures develop in new areas of the urethra and that is why a strict follow up is required to identify the recurrences early and to deal with them (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857757/)