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Lingual versus buccal mucosal graft for augmentation urethroplasty: a meta-analysis of surgical outcomes and patient-reported donor site morbidity

  • Urology - Review
  • Published:
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Abstract

Purpose

This study aimed at comparing surgical outcomes and patient-reported donor site morbidity between lingual mucosal graft (LMG) and buccal mucosal graft (BMG) through a meta-analysis of comparative studies.

Methods

A systematic literature search was performed in January 2019 including non-randomized comparative studies and randomized controlled trials (RCT). The assessed data included urethroplasty outcomes, complications, and donor site morbidities such as pain, bleeding, swelling, numbness, difficulty speaking, difficulty eating, mouth opening, and difficulty with tongue protrusion.

Results

A total of 632 patients (LMG 323, BMG 309) from 12 comparative studies (four RCTs and eight non-randomized) were included in the meta-analysis. Overall pooled effect estimates revealed no significant difference on reported surgical outcomes and operative stricture-related complications. The LMG group reported a higher proportion of patients with difficulty speaking (RR 6.96, 95% CI 2.04–23.70) and difficulty with tongue protrusion (RR 12.93, 95% CI 3.07–54.51) within 30 days post-op. In comparison, the BMG group had significantly more incidence of early post-procedural donor site swelling (RR 0.39, 95% CI 0.25–0.61) and numbness within 30 days post-op (RR 0.48, 95% CI 0.23–0.97) and 3–6 months (RR 0.52, 95% CI 0.30–0.90) post-op.

Conclusion

The evidence suggests no overall significant difference between LMG and BMG with regard to urethroplasty outcomes at 1-year follow-up. While patients undergoing LMG urethroplasty have a higher chance of experiencing difficulty with speech and difficulty with tongue protrusion within 1 month of surgery, the BMG group is more likely to experience early donor site swelling and mouth opening difficulty within 30 days post-op, as well as oral numbness for up to 6 months.

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References

  1. Chapple C, Andrich D, Atala A et al (2014) SIU/ICUD consultation on urethral strictures: the management of anterior urethral stricture disease using substitution urethroplasty. Urology 83:S31-47

    Article  Google Scholar 

  2. Korneyev I, Ilyin D, Schultheiss D, Chapple C (2012) The first oral mucosal graft urethroplasty was carried out in the 19th century: the pioneering experience of Kirill Sapezhko (1857–1928). Eur Urol 62:624–627. https://doi.org/10.1016/j.eururo.2012.06.035

    Article  PubMed  Google Scholar 

  3. Humby G, Higgins TT (1941) A one-stage operation for hypospadias. Br J Surg 29:84–92

    Article  Google Scholar 

  4. Bürger RA, Müller SC, El-Damanhoury H et al (1992) The buccal mucosal graft for urethral reconstruction: a preliminary report. JURO 147:662–664

    Google Scholar 

  5. Simonato A, Gregori A, Ambruosi C et al (2008) Lingual mucosal graft urethroplasty for anterior urethral reconstruction. Eur Urol 54:79–85

    Article  Google Scholar 

  6. Gulani A, Yadav SS, Tomar V et al (2019) The effect of closure versus nonclosure of lingual mucosa graft harvest site on postoperative morbidity in augmentation urethroplasty: a comparative study. Urol Ann 11:265–269

    Article  Google Scholar 

  7. Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928

    Article  Google Scholar 

  8. Moher D, Liberati A, Tetzlaff J et al (2020) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151:264

    Article  Google Scholar 

  9. The Cochrane Collaboration (2014) Review Manager (RevMan) [Computer program], version 5. The Nordic Cochrane Centre, Copenhagen

  10. Hongyong J, Shuzhu C, Min W et al (2017) Comparison of lingual mucosa and buccal mucosa grafts used in inlay urethroplasty in failed hypospadias of pre-pubertal boys in a Chinese group. PLoS ONE 12:e0182803-e182812 (Edited byAS Safwat)

    Article  Google Scholar 

  11. Maarouf AM, Elsayed ER, Ragab A et al (2013) Buccal versus lingual mucosal graft urethroplasty for complex hypospadias repair. J Pediatr Urol 9:754–758

    Article  CAS  Google Scholar 

  12. Lumen N, Vierstraete-Verlinde S, Oosterlinck W et al (2016) Buccal versus lingual mucosa graft in anterior urethroplasty: a prospective comparison of surgical outcome and donor site morbidity. J Urol 195:112–117

    Article  CAS  Google Scholar 

  13. Elkady E, Teleb M, Dawod T, Shabana W, Salama N (2018) Buccal vs. lingual mucosa as ventral onlay grafts in substitution urethroplasty for bulbar urethral strictures. Can Urol Assoc J 12(6):S97

    Google Scholar 

  14. Elgamal S, Ragab M, Farhat Y, Abo Farha O, Elsharaby M (2010) 35 A prospective randomized study comparing buccal and lingual mucosal dorsal only graft for management of anterior urethral strictures. J Urol. https://doi.org/10.1016/j.juro.2010.02.080

    Article  Google Scholar 

  15. Abrate A, Gregori A, Simonato A (2019) Lingual mucosal graft urethroplasty 12 years later: systematic review and meta-analysis. Asian J Urol 6:230–241

    Article  Google Scholar 

  16. Sharma AK, Chandrashekar R, Keshavamurthy R et al (2013) Lingual versus buccal mucosa graft urethroplasty for anterior urethral stricture: a prospective comparative analysis. Int J Urol 20:1199–1203

    Article  Google Scholar 

  17. Chauhan S, Yadav SS, Tomar V (2016) Outcome of buccal mucosa and lingual mucosa graft urethroplasty in the management of urethral strictures: a comparative study. Urol Ann 8:36–41

    Article  CAS  Google Scholar 

  18. Wood DN, Allen SE, Andrich DE, Greenwell TJ, Mundy AR (2004) The morbidity of buccal mucosal graft harvest for urethroplasty and the effect of nonclosure of the graft harvest site on postoperative pain. J Urol 172(2):580–583. https://doi.org/10.1097/01.ju.0000132846.01144.9f

    Article  CAS  PubMed  Google Scholar 

  19. Muruganandam K, Dubey D, Gulia AK et al (2009) Closure versus nonclosure of buccal mucosal graft harvest site: a prospective randomized study on post operative morbidity. Indian J Urol 25(1):72–75. https://doi.org/10.4103/0970-1591.45541

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Shrivastava S, Songra M, Kewlani N (2016) Outcome and donor site morbidity of buccal versus lingual mucosal graft in substitution urethroplasty for anterior urethral stricture. Int Surg J 3:1465–1469. https://doi.org/10.18203/2349-2902.isj20162730

    Article  Google Scholar 

  21. Balshem H, Helfand M, Schünemann HJ et al (2011) GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 64:401–406

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Eastern Virginia Medical School, Devine-Jordan Center for Reconstructive Surgery and Pelvic Health Urology of Virginia, 225 Clearfield Avenue, Virginia Beach, Norfolk, VA, 23462, USA

    Andrew Wang, Michael Chua, Jessica DeLong, Ramón Virasoro, Jeremy Tonkin & Kurt McCammon

  2. Division of Urology, Hospital for Sick Children, University of Toronto, Toronto, Canada

    Michael Chua

  3. Institute of Urology, St. Luke’s Medical Center, Quezon City, Philippines

    Michael Chua

  4. Old Dominion University, Norfolk, VA, USA

    Vishal Talla

  5. Division of Urology, Seattle Children’s Hospital, University of Washington, Seattle, WA, USA

    Nicolas Fernandez

  6. Department of Surgery, Urology Division, University of New Mexico, Albuquerque, NM, USA

    Jessica Ming

  7. Reference Services, Brickell Medical Science Library, Eastern Virginia Medical School, Norfolk, VA, USA

    Esther May Sarino

Authors
  1. Andrew Wang
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  2. Michael Chua
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  3. Vishal Talla
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  4. Nicolas Fernandez
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  5. Jessica Ming
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  6. Esther May Sarino
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  7. Jessica DeLong
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  8. Ramón Virasoro
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  9. Jeremy Tonkin
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  10. Kurt McCammon
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Correspondence to Kurt McCammon.

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Wang, A., Chua, M., Talla, V. et al. Lingual versus buccal mucosal graft for augmentation urethroplasty: a meta-analysis of surgical outcomes and patient-reported donor site morbidity. Int Urol Nephrol 53, 907–918 (2021). https://doi.org/10.1007/s11255-020-02720-7

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  • DOI: https://doi.org/10.1007/s11255-020-02720-7

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