re: Buccal Mucosa Graft
I have unfortunately a LOT of experience in this area - let me share.
I am 53 and was born with hypospadeus. My urethral opening was near the top of the scrotum/base of penis. I had about 6 surgeries as a child <5 years old to correct this. It was supposed to be one surgery but complications added more, and of course technology was not where it is today. They used my foreskin as the graft material and reconstructed a urethra up my penis. I did have a fistula (second opening) that dripped a bit and was never fully fixed.
I went through life in my teens, 20s, and 30s just fine. I had kids. When I was about 43, I started seeing a declining stream. I went in to a urologist and he first tried medications for possible enlarged prostate. That didn't help, so he scheduled me for a cystoscopy under an general anasthesia. Waking up after surgery he said that he couldn't even get it in and I had a stricture. He wasn't very helpful about where to go. This was about 1999.
I found Dr. Jack McAninch at UC San Francisco. So I flew up to see him and he indicated that I would need a 2 stage urethroplasty. After I had operation #1, he had not grafted any skin as he felt I had enough good skin down there already. So the surgery was pretty easy - open up the original opening at the base of penis, cut out scar tissue, and put in catheter. Cath was in for about 5 days, then came out and back to work.
I waited 2 years to decide to do stage 2. Stage 2 is a pain because you're in a catheter for 3 weeks, plus all that time off work. I did this in 2002. Surgery was pretty easy, it was just the recovery. After cath came out I peed pretty well. However, it restrictured in about a year. My local urologist did a cystoscopy/urethrotomy to slice through the spot, but it restrictured in about 2 months. He repeated the surgery but was more aggressive with a bigger cath and then we went to aggressive dilations every 3 weeks or so in his office. This lasted about a year and it kept getting worse. I had one more cysto/urethro, now about 3 years after the stage 2 operation. I started self-cathing and kept that up for about 3 years. But I had 2 urinary tract infections during this time, which has its own risks.
I consulted again with Dr. McAninch. The issue is that when you cysto/urethro, you just increase scar tissue and the 5 year success rate is nearly zero. Even when you dilate you are stretching/tearing skin fibers and over time this builds up more tough scar tissue. Dr. McAninch indicated that in retrospect my remaining "good skin" was not good enough and so I have just a week ago completed a buccal mucosa graft. This surgery was quite a bit tougher as they cut out the entire "foreskin urethra" that I got as a child, and did the buccal graft. I was in a cath for 5 days and now am changing dressings to help the graft take well. The mouth is not to be ignored as one week post-surgery it still hurts quite a bit (like a boatload of canker sores on one side of the mouth) and it is hard to open the mouth all the way. I hear that this will get better over the next few weeks.
I'm not sure that I will even go through with stage 2; the 3 weeks in a cath are not a lot of fun. I need to wait at least a year so I wanted to make sure I at least had the option.
I've never experienced long term pain in the bladder or on ejaculation like I've read from some other posters.
My understanding is that this is very specialized and there are relatively few experts in the country. You should query for buccal mucosal grafts in these forums, as there was a thread that listed a bunch of the Doctors names that are most experienced. In my experience Dr. McAninch is a really nice and caring doctor and is probably the most experienced expert in the US. However, he appears to be at least in his 70's so I don't know how much longer he will be around. He seems to train a team of residents in his specialty every year, and I know there are other experts in the US as well.
Last edited by Administrator; 11-04-2009 at 03:27 PM.