# Bridging Surgical Outcomes and Patient Experience: A Questionnaire-Based Evaluation of Buccal Mucosal Graft Morbidity Following Substitution Urethroplasty

## TL;DR

This study evaluates patient-reported oral discomfort after using cheek tissue grafts for urethral surgery, finding low pain and high satisfaction.

## Contribution

The study introduces a dedicated questionnaire to assess donor site morbidity after buccal mucosal graft harvesting.

## Key findings

- Most patients reported low pain scores (≤2/10) after buccal mucosal graft harvesting.
- 84.3% of patients resumed normal diet by postoperative day two.
- Transient oral issues like trismus and paraesthesia resolved by day 10 with no significant association to graft characteristics.

## Abstract

Introduction

Urethroplasty remains the gold standard for managing complex urethral stricture disease (USD). Buccal mucosa grafts (BMG) are the preferred graft material due to low morbidity and ease of harvest. However, specific donor site morbidity remains underexplored. This study prospectively evaluates oral morbidity following BMG harvest through use of a dedicated questionnaire.

Methods

All patients undergoing urethral reconstruction with BMG were prospectively enrolled. Demographic data, stricture characteristics, graft dimensions and operative details were recorded. At postoperative day 10, a six-item questionnaire was utilised to assess oral pain scores, resumption of normal diet, paraesthesia, trismus, and overall patient satisfaction. Data was analysed using descriptive and inferential statistics.

Results

Sixty-four BMGs were harvested, including three bilateral cases. Procedures included bulbar urethroplasties (n = 28, 43.7%), staged graft urethroplasties (n = 23, 35.9%), augmented perineal urethrostomies (n = 8, 12.5%), Asopa technique urethroplasties (n = 4, 6.3%), and one meatoplasty (1.6%). Median stricture length was 2 cm; median graft dimensions were 4 x 1.5 cm (L x W). Most patients (n = 58, 90.6%) reported pain scores ≤ 2 out of 10, and 54 patients (84.3%) resumed normal diet by postoperative day two. Oral morbidity was transient, with 13 (20.3%) experiencing trismus, 11 (17.2%) reporting paraesthesia, and two (3.1%) having xerostomia, all resolving by day 10. All patients expressed willingness to undergo BMG harvesting again if required. No statistically significant association was found between graft characteristics and morbidity.

Conclusion

BMG harvesting in our unit is associated with low morbidity and high patient satisfaction. A dedicated questionnaire effectively captures patient-reported outcomes, supporting ongoing quality improvement.