Open surgical urethroplasty with a free graft from the oral mucosa represents another treatment option for urethral strictures. The success rate of this intervention is much higher compared to the previously mentioned procedures. Plastic reconstruction is mainly used in cases of long bulbar and all penile strictures, as well as after frustrating multiple urethrotomies or bougienage.^1,2 However, the removal of the mucosa from the patient’s oral cavity leads to postoperative complications.³

In urethroplasty, the urethra is opened longitudinally over the narrowed area and dilated with a graft from the oral mucosa. Depending on the length of the stricture, the size of the graft taken also varies. Oral mucosa can be harvested from the cheek, as well as from the patient’s tongue or lip.⁴.

According to Tritschler et al,⁵ urethroplasty with oral mucosa is recommended when slitting has not been successful or the stricture has an extension of more than 2.5 cm in length. It should be emphasized that preinterventional performance of two or more urethrotomies causes an increased risk of failure of urethroplasty.⁶ This procedure should therefore be used early, especially in younger patients and in multiple and high-grade, long-stretch strictures.⁷.

In individual cases, high success rates have been achieved with this method.⁸ However, only data from individual clinics from retrospective studies are available. The American Urological Association guideline for the treatment of urethral strictures in men also confirms the lack of evidence for this accepted procedure. Thus, at the current time, only studies with evidence class C, based on reports and opinions of experts and clinical trials by recognized authorities, respectively, are available.

The removal of the oral mucosa is also associated with side effects in some cases. The size of the graft also increases the risk of long-lasting sequelae. The larger the graft needed and the larger the oral defect caused, the more likely local complications will occur at the harvest site. Thus, the studies by Dublin and Stewart⁹ and by Wood et al.¹⁰ demonstrate the ongoing health consequences that developed from the side effects of oral surgery. In addition, scarring changes develop in the patients’ mouths, which pose an increased risk of cancer because of the constant irritation and risk of infection.¹¹.

The results of the study by Piemonte et al, which included a total of 406 patients, showed that in 75.56% of patients suffering from oral cancer, chronic injury to the oral mucosa had preceded the disease (p < 0.0001). These findings are similarly supported by Perry et al.¹². Furthermore, especially strictures with a length ≥ 5 cm pose an increased risk for sequelae and the formation of a recurrence.¹³