Buccal Mucosa Urethroplasty : When to avoid and look for alternatives

Although Buccal mucosa is the preferred graft material for Urethral reconstruction in stricture urethra, there are certain circumstances where it may provide inferior results.

Poor oral mucosal quality leads to inferior urethroplasty outcomes. (Kutzman and colleagues 2021 https://pubmed.ncbi.nlm.nih.gov/33904760/)

Long term tobacco exposure of the oral mucosa (either because of pan masala chewing or because of smoking) may alter the properties of the mucosa and render it unsuitable for grafting. Tobacco use is extremely common in the Indian subcontinent

Also, sub-mucus fibrosis (a condition where mouth opening is already decreased due to effects of tobacco use), makes oral mucosa unsuitable for use.

Previous use of buccal mucosa for urethroplasty, does not leave enough healthy mucosa for re-use in most cases, should the stricture re occur.

As the graft retrieval from oral cavity may temporarily affect mouth opening (for initial few months) in most patients and permanently in few patients, Stricture patients who play wind instruments such as shehnai, saxophone or flute may not like to let their oral cavities be a source of graft for obvious reasons