Substitution Urethroplasty with Closure Versus Nonclosure of the Buccal Mucosa Graft Harvest Site: A Randomized Controlled Trial with a Detailed Analysis of Oral Pain and Morbidity

• Published in: European urology 2018-06, Vol.73 (6), p.910-922
• Main Authors: Soave, Armin, Dahlem, Roland, Pinnschmidt, Hans O., Rink, Michael, Langetepe, Jessica, Engel, Oliver, Kluth, Luis A., Loechelt, Birte, Reiss, Philip, Ahyai, Sascha A., Fisch, Margit
• Format: Article
• Language: English
• Subjects: Adult; Aged; Buccal mucosa; Cheek; Edema - etiology; Humans; Hypesthesia - etiology; Middle Aged; Mouth Mucosa - transplantation; Pain; Pain Measurement; Pain, Postoperative - etiology; Postoperative Hemorrhage - etiology; Randomized controlled trial; Reconstructive Surgical Procedures - adverse effects; Salivation; Surgical Wound - complications; Surgical Wound - surgery; Surveys and Questionnaires; Taste Disorders - etiology; Time Factors; Tissue and Organ Harvesting - adverse effects; Urethra; Urethra - surgery; Urethral stricture; Urethral Stricture - surgery
• ISSN: 0302-2838; 1873-7560
• DOI: 10.1016/j.eururo.2017.11.014

Optimal surgical management of the buccal mucosa harvest site in patients with urethral stricture disease during buccal mucosa graft urethroplasty (BMGU) remains controversial. To analyze in detail intensity and quality of pain as well as oral morbidity following closure (C) versus nonclosure (NC) of the donor site. Randomized controlled trial on 135 patients treated with BMGU between October 15, 2014 and December 18, 2015. Following computer-based randomization, 63 and 72 patients, respectively, received C and NC of the donor site at the inner cheek. Preoperatively, on days 1, 5, and 21 as well as at 3 and 6 mo postoperatively, patients completed standardized questionnaires, including validated questions on intensity and quality of pain as well as oral morbidity. The coprimary end points were intensity and quality of oral pain. Secondary end points included oral morbidity and intensity of pain of the perineogenital region. Generalized linear mixed models evaluated the effect of various covariates on intensity and quality of oral pain, oral morbidity, as well as intensity of pain of the perineogenital region. There was noninferiority for NC versus C in intensity and affective quality of oral pain at every time point following BMGU. Oral morbidity and complications included pain, bleeding, swelling, numbness, alteration of salivation and taste, as well as impairment of mouth opening, smiling, whistling, diet, and speech. Time from BMGU had significant effects on intensity (p