Reconstruction or substitution of the pediatric urethra with buccal mucosa: indications, technical aspects, and results.

The main indication for using buccal mucosa in the urinary tract is in those who require complex secondary hypospadias surgery. Twenty-two children had inner lower lip mucosa onlay patch to reconstruct the urethra after 1 to 20 prior failed hypospadias/epispadias repairs. The mucosa was harvested from the lower inner lip by microsurgical dissection using optical magnification. The donor site was not sutured but was sealed with fibrin glue. The patches were anastomosed to the urethral plate using 7/0 polyglactin suture. The neourethra was covered with a vascularized dartos fascia or tunica vaginalis graft tunneled under the penile shaft skin. Special attention was given to closure of the glans and positioning of the meatus to the tip. Follow-up was between 12 and 72 months (mean 44). Complications included meatal stenosis in 1, fistula in 6, and wound infection in 1. The fistula rate decreased after changing the suture material and with increased experience. Lip mucosa was easy to harvest, and healing of the donor site was uncomplicated.