BMG urethroplasty

Buccal Mucosa Graft (BMG) Urethroplasty is a surgical technique used to repair urethral strictures by replacing the diseased segment with a graft harvested from the buccal mucosa (inner lining of the cheek). It is highly effective for managing long or complex strictures, particularly those involving the anterior urethra.

Indications

BMG urethroplasty is indicated for:

1. Long Urethral Strictures:
   • Typically longer than 2 cm.
2. Recurrent Strictures:
   • After failed minimally invasive procedures like dilation or urethrotomy.
3. Complex Strictures:
   • Associated with infections, trauma, or prior surgeries.
4. Hypospadias Repair:
   • For urethral reconstruction in cases of failed repairs.

Preoperative Preparation

1. Diagnostic Workup:

   • Retrograde Urethrogram (RUG): To evaluate the location and length of the stricture.
   • Voiding Cystourethrogram (VCUG): To assess urethral function.
   • Urethroscopy: For direct visualization of the stricture.
   • Blood and Urine Tests: To ensure no active infection and assess kidney function.

2. Buccal Mucosa Assessment:

   • Inspection of the oral cavity to confirm the suitability of the buccal mucosa for grafting.

3. Patient Counseling:

   • Explanation of the procedure, including the dual surgical sites (mouth and urethra), risks, benefits, and expected outcomes.

4. Anesthesia:

   • General anesthesia is typically used for this procedure.

Surgical Procedure

1. Harvesting the Buccal Mucosa Graft:

   • A small incision is made inside the cheek to harvest a strip of buccal mucosa.
   • The donor site is closed or left to heal naturally.

2. Urethral Reconstruction:

   • The stricture segment is accessed through a perineal or penile incision.
   • The scarred portion of the urethra is removed or opened (stricturotomy).
   • The buccal mucosa graft is tailored to the required size and sutured to the opened urethral segment.

3. Catheter Placement:

   • A urethral catheter is inserted to allow urine drainage and support the repair during healing.

4. Closure:

   • The surgical site is closed in layers, ensuring proper alignment and no tension.

Postoperative Care

1. Hospital Stay:

   • Patients are typically discharged after 1-3 days, depending on recovery.

2. Pain Management:

   • Analgesics are provided for discomfort in both the perineum and oral cavity.

3. Catheter Management:

   • The catheter remains in place for 2-3 weeks to allow the graft and urethra to heal.
   • A follow-up urethrogram is performed before catheter removal.

4. Dietary Adjustments:

   • Soft or liquid diet may be recommended initially to reduce discomfort from the buccal graft site.

5. Activity Restrictions:

   • Avoid strenuous activities and sexual intercourse for 4-6 weeks.

Benefits

• High success rates (80-90%) for long or complex strictures.
• Buccal mucosa is well-suited for grafting due to its resistance to urine and high vascularity.
• Durable and long-lasting results with minimal recurrence.