Buccal versus lingual mucosal grafts for anterior urethral stricture management: A prospective surgical outcome and morbidity comparison

Background: Urethral stricture is characterized by long-term scarring and narrowing of the urethral canal caused by acute trauma, inflammation, or medical procedures, such as urethral instrumentation or surgery. Despite the widespread use of both buccal and lingual mucosal grafts (LMG) in urethroplasty, few prospective studies have directly compared their surgical outcomes and donor site morbidity. This study aims to fill that gap. Objective: This study compares the use of buccal and LMG in managing anterior urethral stricture with surgical outcomes and donor site morbidity evaluations. Methods: This case–control comparative study was conducted at Ain Shams University Hospital. Patients who attended the urology outpatient clinic, presenting with lower urinary tract symptoms secondary to stricture anterior urethra and underwent surgical management by urethroplasty with a dorsal onlay technique, were selected as cases. Results: No statistically significant differences were observed between the studied groups regarding age, smoking status, comorbidities, related urinary conditions, or the presence of a urinary catheter. In addition, the groups had no significant differences concerning stricture characteristics, graft details, or operation specifics. Similarly, general and urethral outcomes showed no statistically significant variation between the groups. Problems with drinking, soft food consumption, solid food consumption, dysgeusia, and speaking were significantly less frequent in the buccal mucosal graft (BMG) group than in the LMG group. In contrast, oral tightness was significantly more frequent in the BMG group than in the LMG group. Conclusion: The study concluded that buccal and LMG effectively repair anterior urethral stricture, showing similar success rates. However, LMG patients experience earlier oral complications, while BMG patients face more long-term oral tightness, making graft choice dependent on patient-specific tolerances.
- Al Mamun AM, Rasul MA, Karmekar U, Das PK, Paul AK. Comparison between lingual mucosal graft urethroplasty and buccal mucosal graft urethroplasty in the management of anterior urethral stricture. KYAMC J. 2022;13(2):108-114. doi: 10.3329/kyamcj.v13i2.61341
- Wood DN, Allen SE, Andrich DE, Greenwell TJ, Mundy AR. The morbidity of buccal mucosal graft harvest for urethroplasty and the effect of nonclosure of the graft harvest site on postoperative pain. J Urol. 2004;172(2):580-583. doi: 10.1097/01.ju.0000132846.01144.9f
- Awad SMT, Ahmed MAM, Abdalla YMO, Ahmed MEIM, Gismalla MD. Buccal mucosal graft urethroplasty for anterior urethral stricture, experience from a low-income country. BMC Urol. 2021;21(1):171. doi: 10.1186/s12894-021-00918-0
- Simonato A, Gregori A, Lissiani A, et al. The tongue as an alternative donor site for graft urethroplasty: A pilot study. J Urol. 2006;175(2):589-592. doi: 10.1016/S0022-5347(05)00166-7
- Wang A, Chua M, Talla V, et al. Lingual versus buccal mucosal graft for augmentation urethroplasty: A meta-analysis of surgical outcomes and patient-reported donor site morbidity. Int Urol Nephrol. 2021;53:907-918. doi: 10.1007/s11255-020-02720-7
- Lumen N, Vierstraete-Verlinde S, Oosterlinck W, et al. Buccal versus lingual mucosa graft in anterior urethroplasty: A prospective comparison of surgical outcome and donor site morbidity. J Urol. 2016;195(1):112-117. doi: 10.1016/j.juro.2015.07.098
- Pal DK, Gupta DK, Ghosh B, Bera MK. A comparative study of lingual mucosal graft urethroplasty with buccal mucosal graft urethroplasty in urethral stricture disease: An institutional experience. Urol Ann. 2016;8(2):157-162. doi: 10.4103/0974-7796.172214
- Chauhan S, Yadav SS, Tomar V. Outcome of buccal mucosa and lingual mucosa graft urethroplasty in the management of urethral strictures: A comparative study. Urol Ann. 2016;8(1):36-141. doi: 10.4103/0974-7796.165715
- Kumar A, Das SK, Trivedi S, Dwivedi US, Singh PB. Substitution urethroplasty for anterior urethral strictures: Buccal versus lingual mucosal graft. Urol Int. 2010;84(1):78-83. doi: 10.1159/000273471