The Impact of Preoperative Oral Health on Buccal Mucosa Graft Histology.

PURPOSE Previous studies have elucidated the unique macroscopic and histologic properties of buccal mucosa that make it a viable and durable graft for urethral augmentation. However, no prior literature has directly investigated the impact of preoperative oral health on these features. MATERIALS AND METHODS We analyzed all consenting patients who underwent buccal mucosal graft (BMG) urethroplasty at our institution from 2018-2020. Validated oral health surveys, the Oral Health Impact Profile (OHIP-14) and the Kayser-Jones Brief Oral Health Status Exam (BOHSE) were completed preoperatively. A staff pathologist analyzed BMG histology and quantified oral mucositis (OM) using a modified Oral Mucosa Rating Scale. RESULTS We analyzed 51 patients, median age 40 years (IQR 31-58). Mean BOHSE score was 1.1 and OHIP-14 score was 1.4. Median epithelial thickness was 530μm and lamina propria thickness was 150μm. On age-adjusted analysis, increasing BOHSE and OHIP-14 were associated with decreasing epithelial thickness (p-values <0.05). Higher BOHSE scores also correlated with thinner lamina proprias (p=0.05) and increased graft stretch (p=0.03). The two patients with postoperative urine leaks and available graft histology had lamina propria thicknesses well-below the cohort median, 50μm and 60μm, respectively. CONCLUSIONS This is the first study to demonstrate that oral health conditions impact graft histology and stretch. Though much remains to be learned, our findings shed light on the potential importance of optimizing oral health prior to BMG urethroplasty and raises the question of if preoperative mucosal biopsy could help inform surgical decision making and discussions regarding surgical success.