Donor site morbidity and impact on oral health following buccal mucosal graft harvesting for urethroplasty: a prospective study.

Abstract

Purpose: To evaluate patient-reported oral health and pain and buccal donor site complications in adults who underwent BMG harvesting utilizing two validated questionnaires.

Materials and methods: An ethics-approved prospective observational study was conducted among a cohort of 40 adults who had a BMG urethroplasty between June 2020 and October 2021. All cases were performed by one fellowship-trained genitourinary reconstructive surgeon. Oral health was appraised before and after BMG harvesting via the validated Oral Impacts of Daily Performance (OIDP) questionnaire. Post-operative pain at the BMG donor site was assessed by administering the Visual Analogue Scale for pain (VAS) both pre-and post-operatively. Statistical analysis was undertaken to identify risk factors for increased post-operative pain and decreased oral health.

Results: The cohort included sub-meatal, penile, bulbar, and pan-urethral strictures. Most cases (36/40) were a primary urethroplasty, but 4 cases were a re-do urethroplasty. Only 5 participants (12.5%) experienced complication(s) at the donor site such as bleeding (2/40, 5%), infection (1/40, 2.5%), hyper granulation tissue (1/40, 2.5%), and long-term difficulty with mouth opening (3/40, 7.5%). Most participants (32/40, 80%) had at least one daily oral performance affected by BMG harvesting. Eating, speaking, and cleaning teeth were the most impacted domains. However, there was no statistically significant decrease in oral health at either 3- or 6 months post-BMG harvesting (p < 0.05). Almost all participants (38/40, 95%) reported no pain at the donor site before BMG harvesting. Pain at the donor site peaked at 1 week post-operatively (28/40, 70%), but the majority were pain-free by 3 months post-BMG harvesting (35/40, 87.5%).

Conclusion: BMG harvesting is an effective means of procuring a suitable graft for urethroplasty. Whilst pain at the donor site is experienced in the immediate post-operative period, long-term pain is a rare complication. Overall oral health is not detrimentally impacted by BMG harvesting.