title: Use of buccal mucosa grafts for urethral reconstruction in children: a retrospective cohort study.
abstract: BACKGROUND
  The use of buccal mucosa grafts (BMG) for urethral reconstruction has increased in popularity over the last several decades. Our aim was to describe our institutional experience with and outcomes after BMG urethroplasty.
  
  
  METHODS
  We conducted a retrospective cohort study of boys undergoing BMG urethral reconstruction. Preoperative and perioperative characteristics and postoperative outcomes were evaluated.
  
  
  RESULTS
  Twenty-nine patients (median age 8.2 years) underwent BMG urethroplasty from 1995-2012. Of the 10 patients undergoing 1-stage repairs, 6 had tubularized grafts, the last of which was performed in 2000 due to an unacceptably high revision rate (100%). A 2-stage approach was elected for 19 patients (median follow-up 21.3 months). Complications including stricture, fistula, or chordee were seen in 60% of patients completing both stages and 32% required ≥1 revision. However, 71% of 2-stage patients were free of significant problems at last follow-up.
  
  
  CONCLUSIONS
  We found BMG to be a reasonable option for use in complex pediatric urethral reconstruction. Tubularized grafts had poor results, and we no longer use them. We favor a 2-stage approach for all patients except those with "simple" non-hypospadiac strictures. Although revision procedures were not uncommon, the majority of patients were ultimately free of long-term problems.
authors.affiliation: Department of Urology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA. emilie.johnson@childrens.harvard.edu.
authors.forename: Emilie K
authors.initials: EK
authors.lastname: Johnson
authors.forename: Spencer I
authors.initials: SI
authors.lastname: Kozinn
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Johnson
authors.forename: Sohee
authors.initials: S
authors.lastname: Kim
authors.forename: David A
authors.initials: DA
authors.lastname: Diamond
authors.forename: Alan B
authors.initials: AB
authors.lastname: Retik
mesh_terms: D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D009061:Mouth Mucosa / Q000637:transplantation*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014525:Urethral Stricture / Q000175:diagnosis / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods