Currently, four preferred kinds of grafts for urethral reconstruction are used: full-thickness skin, split-thickness skin, bladder epithelium, and the buccal mucosa. To harvest full- or split-thickness skin grafts, an area with no or almost no hair growth is required. The method of full-or split-thickness skin graft harvesting may even require a two-stage surgery if the mesh graft technique of is used. One of the best materials, which can provide a one-stage procedure, is the foreskin but this material is limited because many male patients are already circumcised by the time urethral surgery is required.
The bladder epithelium graft requires at least one additional abdominal incision.
Since the late1990s, the buccal mucosal graft is preferred because of its high success rate and the best long-term results reported so far. However, its success very much depends on the skill of the surgeon and the highly specialized knowledge of harvesting the tissue from the mouth.
Many patients do not like the idea of two-stage surgery, multiple incisions, or harvesting tissue from their mouth. Additional procedures can be associated with prolonged hospitalization and even donor side morbidity.
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