Buccal Mucosal Graft Urethroplasty in Jaipur: Among the many remarkable advancements in urological reconstructive surgery, one technique stands out for its precision, durability, and success — Buccal Mucosal Graft (BMG) Urethroplasty. For men suffering from urethral stricture disease, this procedure offers not just relief, but a long-term cure that restores urinary flow, comfort, and confidence.
At the Institute of Urology, Jaipur, this procedure has become a cornerstone of reconstructive urology. With the expertise of Dr. M. Roychowdhury and Dr. Rajan Bansal, the technique is performed with refined skill, aided by cutting-edge laser and endoscopic technologies, ensuring optimal results for patients from across India.
Understanding Urethral Stricture
The urethra is the narrow tube that carries urine from the bladder to the outside of the body. When a segment of this tube becomes narrowed due to scarring or fibrosis, it leads to urethral stricture.
This condition causes:
- Weak urinary stream
- Difficulty in passing urine
- Incomplete bladder emptying
- Painful urination
- Recurrent urinary tract infections
- In severe cases, bladder or kidney damage
Urethral stricture can drastically affect a patient’s quality of life — making even simple acts like urination difficult and distressing.
Why Do Urethral Strictures Occur?
There are several causes of urethral stricture, including:
- Trauma: Pelvic fracture, perineal injury, or direct trauma to the urethra.
- Iatrogenic causes: Repeated catheterisation, endoscopic procedures, or previous surgeries.
- Inflammation or infection: Chronic infections such as urethritis or sexually transmitted infections.
- Lichen sclerosus: A chronic skin condition that can lead to scarring and narrowing of the urethra.
- Idiopathic: In many cases, the exact cause remains unknown.
Regardless of cause, once fibrosis sets in, the stricture rarely resolves on its own — surgical intervention is often required.
Diagnosis: The Foundation for Precision Surgery
Accurate diagnosis determines the success of treatment. At modern urological centers like the Institute of Urology, Jaipur, the following investigations are routinely performed before planning surgery:
- Retrograde Urethrogram (RUG): To determine the location and length of the stricture.
- Voiding Cystourethrogram (VCUG): To assess the urethral and bladder anatomy during urination.
- Cystoscopy: Direct visualization of the stricture with a fine endoscope.
- Uroflowmetry: Measures urine flow rate and evaluates obstruction severity.
Such detailed evaluation ensures that the treatment plan is tailored to each patient’s unique anatomy and not a one-size-fits-all approach.
Treatment Options: From Dilation to Reconstruction
Historically, urethral strictures were managed with urethral dilatation or Optical Internal Urethrotomy (OIU) — procedures that temporarily widen the stricture using instruments or a cold knife.
However, recurrence rates after such procedures remain high, especially in long or recurrent strictures. Over time, this has led reconstructive urologists to adopt urethroplasty, the surgical reconstruction of the urethra, as the definitive solution.
Among the various urethroplasty techniques, Buccal Mucosal Graft (BMG) Urethroplasty has emerged as the gold standard — combining durability, tissue compatibility, and excellent outcomes.
What is Buccal Mucosal Graft Urethroplasty?
Buccal mucosa refers to the inner lining of the cheek. It has unique properties that make it ideal for urethral reconstruction:
- It is non-hair-bearing, reducing the risk of stone formation.
- It has thick epithelium and rich vascularity, ensuring graft survival.
- It is resistant to infection and moisture, perfect for the urinary tract environment.
In Buccal Mucosal Graft Urethroplasty, a thin strip of tissue is harvested from the inside of the cheek and used to reconstruct the narrowed urethral segment. Over time, this graft becomes part of the urethra, restoring its normal diameter and function.
The Surgical Technique: Step-by-Step Overview
- Anesthesia and Positioning:
The patient is given regional or general anesthesia and positioned for optimal surgical access. - Harvesting the Graft:
A thin, precisely measured strip of mucosa is taken from the inner cheek or lip. The area heals quickly, with minimal discomfort. - Exposure of the Stricture:
The urethra is carefully opened at the site of narrowing. - Graft Placement:
The buccal mucosa graft is sutured into place — either as a patch (onlay) or tube (substitution) — depending on the stricture’s characteristics. - Reconstruction and Catheterisation:
A catheter is left in place temporarily to allow the urethra to heal. - Recovery:
The graft integrates seamlessly into the urethral wall, creating a wide, smooth channel for urine flow.
Types of Buccal Mucosal Graft Urethroplasty
- Dorsal Onlay BMG Urethroplasty:
The graft is placed on the dorsal (upper) surface of the urethra, ensuring excellent blood supply and long-term success. - Ventral Onlay BMG Urethroplasty:
The graft is placed on the ventral (lower) surface, suitable for specific anatomical conditions. - Two-Stage Urethroplasty:
For very long or complex strictures, the reconstruction may be done in two stages — first graft placement, then tubularization after healing.
The choice of technique depends on the length, site, and cause of the stricture, as well as the surgeon’s expertise.
Why Buccal Mucosa Works So Well
Studies have consistently shown that buccal mucosa offers excellent long-term results.
- Its resilience to urine prevents graft shrinkage.
- Its rapid healing allows quick recovery.
- It produces minimal donor-site morbidity — meaning patients experience only mild, temporary discomfort in the cheek.
A study in the Indian Journal of Urology (2018) found that success rates exceeded 90% for dorsal onlay BMG urethroplasty. Another in the Journal of Urology (2020) confirmed low recurrence rates and high patient satisfaction, even in complex or re-do cases.
Postoperative Recovery and Care
After surgery:
- The urinary catheter typically remains for 2–3 weeks.
- Patients are advised to maintain excellent oral hygiene.
- Follow-up uroflowmetry and imaging confirm healing.
Most patients resume normal activities within a few weeks, and the improvement in urinary flow is often dramatic and life-changing.
Advantages of Buccal Mucosal Graft Urethroplasty
- ✅ High Success Rate: Over 85–95% in most studies.
- ✅ Durable and Long-Lasting: Graft remains healthy for years.
- ✅ Minimally Morbid Donor Site: The cheek heals rapidly.
- ✅ Restores Natural Urine Flow: Relieves symptoms permanently.
- ✅ Safe and Well-Tolerated: Low complication rates.
Laser-Assisted Precision in Modern Urethroplasty
At advanced centers like the Institute of Urology, Jaipur, laser technology further enhances surgical precision. Holmium:YAG lasers are often used for initial stricture incision and scar tissue vaporization, creating a clean, healthy bed for graft placement.
This hybrid approach of laser plus graft has shown improved outcomes, reduced recurrence, and faster recovery — combining the finesse of reconstructive urology with the precision of laser energy.
Current Medical Studies and Trends
Recent literature strongly supports BMG urethroplasty as the preferred technique:
- Barbagli et al., 2021 (European Urology): Buccal mucosa remains the “gold standard” tissue for substitution urethroplasty.
- Kulkarni et al., 2019 (Indian Journal of Urology): Dorsal onlay BMG urethroplasty shows excellent results for panurethral strictures.
- Chapman et al., 2020 (Journal of Urology): Success rates remain consistent even in re-do cases or lichen sclerosus-associated strictures.
- Singh et al., 2022 (Urology Annals): Combining laser urethrotomy with BMG improves healing and reduces recurrence.
These studies reaffirm that modern urethral reconstruction, guided by experience and technology, can deliver near-permanent cures.
Excellence in Buccal Mucosal Graft Surgery at the Institute of Urology, Jaipur
At the Institute of Urology, Jaipur, Buccal Mucosal Graft Urethroplasty is performed with the highest standards of surgical precision, compassion, and care.
Led by Dr. M. Roychowdhury and Dr. Rajan Bansal, both renowned urologists known for their expertise in reconstructive, laser, and minimally invasive urology, the institute has established itself as a center of excellence in urethral surgery in North India.
The hospital combines:
- State-of-the-art laser and endoscopic technology
- Comprehensive diagnostic facilities under one roof
- Highly trained reconstructive surgeons
- Patient-centric care and ethical medical practice
Every patient receives individualized treatment, from diagnosis to follow-up, ensuring high success rates, minimal discomfort, and long-lasting results.
Beyond Urethroplasty: Mastery in All Laser and Paediatric Urological Surgeries
The Institute’s expertise extends far beyond urethral reconstruction.
It is also a leader in:
- Laser treatment for prostate enlargement (HoLEP)
- Laser lithotripsy for kidney and ureteric stones
- Laser management of urethral and ureteric strictures
- Paediatric urology, including congenital anomalies and reconstructive procedures
Every surgery is performed with the same commitment to safety, technology, and precision, making the Institute of Urology, Jaipur, one of the most trusted names in urology across India.
About the Institute of Urology, Jaipur
The Institute of Urology is a premier, fully equipped center offering consultation, diagnostics, investigations, and surgical treatments — all under one roof.
It features:
- Modular operating theatres
- Advanced imaging and endoscopic systems
- Holmium and Thulium laser platforms
- 24×7 comprehensive urology and general surgery facilities
Patients from across Rajasthan, Gujarat, and Madhya Pradesh visit the institute for its reputation for excellence, transparency, and outstanding outcomes.
Conclusion
Buccal Mucosal Graft Urethroplasty represents the finest union of surgical artistry and scientific precision.
It not only restores urine flow but also rebuilds confidence and quality of life for patients who once believed their condition untreatable.
At the Institute of Urology, Jaipur, under the guidance of Dr. M. Roychowdhury and Dr. Rajan Bansal, this procedure is performed with unparalleled expertise and compassion — setting new benchmarks in reconstructive urology.
Whether it’s urethral stricture, prostate enlargement, kidney stones, or paediatric urological disorders, the Institute continues to lead the way — where technology meets trust, and healing becomes an art.
References
- Barbagli G. et al. European Urology, 2021.
- Kulkarni S. et al. Indian Journal of Urology, 2019.
- Chapman D. et al. Journal of Urology, 2020.
- Singh P. et al. Urology Annals, 2022.
- Barbagli G, Lazzeri M. BJU International, 2018.
