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

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.