Alternative grafts: Beyond buccal mucosa

Dr. Morey, a member of the Urology Times Editorial Council, is professor of urology at the University of Texas Southwestern Medical Center, Dallas.

Dr. Ordorica and colleagues from the University of South Florida have demonstrated excellent outcomes with mucosal grafts from the tongue and lower lip in 59 urethral stricture patients. Our pediatric urologists have long been fans of the lower lip as a donor site for hypospadias salvage surgeries, and several groups internationally have published similar favorable results.

One thing that has not been clearly articulated in prior reports is the advantage of alternative oral mucosa grafts. To me, they seem flimsy and thin. I have not harvested either labial or lingual grafts in years for several reasons, namely: cheek grafts are robust and easy to handle and position; by extending the template beyond Stenson’s duct, we can often extend the length of cheek grafts up to 10 cm such that we rarely have a need for other tissue; and cosmetic deformities of the lower lip after harvesting are a theoretical risk that I want to avoid.

Like any other type of surgery performed frequently, we have standardized our buccal mucosa harvesting methodology such that it is safe, well tolerated, and reproducible. Although we can usually avoid the need for using a second cheek, occasional patients-who have had both cheeks harvested previously-present with lengthy strictures. It is for this reason that this contribution from USF is of great importance-it gives us further evidence of the viability of these alternative graft choices that can be used on a rainy day.

In recent years, regenerative medical technologies have progressed to the point where availability of an “off-the-shelf” urethral graft is becoming a reality. Going forward, the question arises whether a void actually exists in the clinical urethroplasty armamentarium. This paper provides further clinical evidence that collectively, the gamut of oral mucosa grafts comprise a gold standard that will be hard for any regenerative urethral substitution tissue to beat.UT

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