title: Buccal grafts for urethroplasty in pre-pubertal boys: what happens to the neourethra after puberty?
abstract: OBJECTIVE
  Buccal mucosa grafts (BMG) are often used in complex urethral reconstruction. Following pubertal endogenous androgen stimulation (EAS) in prepubertal boys, there are concerns that the neourethra may not grow proportionally to the phallus. To address the paucity of literature on the topic, this article reports on data for post-pubertal follow up after pre-pubertal BMG urethroplasties (BMGU).
  
  
  METHODS
  Retrospective chart review of boys who underwent staged BMGU before the age of 12 years at a single referral center between 2000 and 2010 and who were followed up until after puberty. Demographic information, initial meatal location, quality of graft before tubularization, flow rate parameters (FRP) and complications were captured.
  
  
  RESULTS
  Of the 137 patients who underwent staged BMGU during the study period, 10 satisfied the inclusion criteria. Mean patient age at first stage BMGU was eight years (range five to eleven years). The mean follow-up was 40.6 months (9-66 months). The grafts were harvested from the cheek and lower lip in seven and three cases, respectively. The mean interval between the first and second stage was 15.8 months (6-87 months). Complications included one urethro-cutaneous fistula and two cases of glanular dehiscence. The final position of the meatus was glanular in nine boys and coronal in one. Importantly, no recurrent ventral curvature (VC) was found during the second stage BMGU or reported after puberty. All patients demonstrated normal maximum flow after puberty (mean 25.7 ml/s).
  
  
  CONCLUSIONS
  Buccal mucosa grafts appear to grow proportionally to the phallus after pubertal EAS. No recurrent VC or inadequate FRP were observed in this series. Despite the small number of subjects, the results are reassuring and support continued use of BMG in the pediatric pre-pubertal population.
authors.affiliation: Division of Urology, The Hospital for Sick Children, Main Floor Black Wing Rm M299, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
authors.forename: V
authors.initials: V
authors.lastname: Figueroa
authors.affiliation: Division of Urology, The Hospital for Sick Children, Main Floor Black Wing Rm M299, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
authors.forename: L E
authors.initials: LE
authors.lastname: de Jesus
authors.affiliation: Division of Urology, The Hospital for Sick Children, Main Floor Black Wing Rm M299, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
authors.forename: R L P
authors.initials: RL
authors.lastname: Romao
authors.affiliation: Division of Urology, The Hospital for Sick Children, Main Floor Black Wing Rm M299, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
authors.forename: W A
authors.initials: WA
authors.lastname: Farhat
authors.affiliation: Division of Urology, The Hospital for Sick Children, Main Floor Black Wing Rm M299, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
authors.forename: A J
authors.initials: AJ
authors.lastname: Lorenzo
authors.affiliation: Division of Urology, The Hospital for Sick Children, Main Floor Black Wing Rm M299, 555 University Avenue, Toronto, ON M5G 1X8, Canada. Electronic address: pippi.salle@sickkids.ca.
authors.forename: J
authors.initials: J
authors.lastname: Pippi Salle
mesh_terms: D000293:Adolescent; D002648:Child; D005500:Follow-Up Studies; D006801:Humans; D007021:Hypospadias / Q000473:pathology / Q000601:surgery*; D008297:Male; D009061:Mouth Mucosa / Q000254:growth & development / Q000637:transplantation*; D011627:Puberty; D012189:Retrospective Studies; D019738:Surgically-Created Structures; D016896:Treatment Outcome; D014521:Urethra / Q000254:growth & development / Q000601:surgery*
keywords: Buccal mucosa; Follow up; Hypospadias; Puberty; Urethroplasty