Introduction

The optimal surgical management of the donor site 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 non-closure (NC) of the donor site.

Methods

This randomized controlled trial included 135 patients who were treated with BMGU between 2014 and 2015. The buccal mucosa graft was harvested from the inner cheek. Following computer-based randomization, 63 and 72 patients received C and NC of the donor site. Preoperatively, at postoperative day (POD) one, 5, 21 as well as 3 and 6 months postoperatively, patients completed standardized questionnaires. The intensity of oral pain and of the perineogenital region, respectively, was assessed with a numeric rating scale (NRS). The quality of oral pain was evaluated using the Short-Form McGill Pain Questionnaire (SF-MPQ), consisting of a sensory and affective pain subscale. The co-primary endpoints were intensity and quality of oral pain. Secondary endpoints included oral morbidity as well as intensity of pain of the perineogenital region. Generalized linear mixed models evaluated the effect of C versus NC on intensity and quality of oral pain, oral morbidity as well as intensity of pain of the perineogenital region.

Results

Oral pain intensity mean scores on the NRS were 0.15 (standard deviation (SD): 0.531; range: 0-3), 3.16 (SD: 2.10; range: 0-10), 2.89 (SD: 2.16; range: 0-9), 1.30 (SD: 1.72; range: 0-8), 1.00 (SD: 1.42; range: 0-6) and 0.77 (SD: 1.33; range: 0-6), respectively, at baseline, POD one, 5, 21 as well as 3 and 6 months. The most frequent sensory dimension of pain was &[prime]tender&[prime]. The most common affective dimension of pain was &[prime]tiring-exhausting&[prime] on POD one, 5 and 3 months. On POD 21 and 6 months, the most frequent affective pain was &[prime]fearful&[prime]. Oral morbidity and complications included pain, bleeding, swelling, numbness, alteration of salivation and taste, as well as impairment of mouth opening, smiling, diet and speech. C versus NC of the donor site had no effect on intensity and quality of oral pain as well as morbidity and complications. Time from BMGU and length of buccal mucosa graft had significant effects on intensity and quality of oral pain (p-values<0.042). Mean NRS cores of the pain intensity of the perineogenital region were 0.86 (SD: 1.74; range: 0-8), 3.94 (SD: 2.24; range: 0-10), 2.70 (SD: 2.08; range: 0-8), 1.81 (SD: 1.63; range: 0-8), 1.37 (SD: 1.71; range: 0-8) and 1.18 (SD: 1.76; range: 0-7), respectively, at baseline, POD one, 5, 21 as well as 3 and 6 months. C versus NC had no effect on intensity of pain of the perineogenital region. Time from BMGU, length of the buccal mucosa graft and perioperative analgesic medication had significant effects on the intensity of pain of the perineogenital region (p-values<0.035).

Conclusions

In conclusion, C versus NC of the donor site has no effect on intensity and quality of oral pain, morbidity and complications. Both, C and NC of the buccal mucosa harvest site, are feasible and safe procedures.

Funding

None