The use of bladder mucosa and combined bladder mucosa/preputial skin grafts for urethral reconstruction.

Autologous bladder mucosa was used as a free graft for urethral reconstruction in 47 patients. However, in some cases the graft extended to the tip of the penis and became exposed to air. The resultant columnar metaplasia and hypertrophic changes in the mucosa produced stickiness and occlusion of the meatus. As a result a combined graft has superceded the simple mucosal graft for urethral substitution extending to the tip of the penis. The terminal few millimeters of such a graft are fashioned from preputial or penile skin, and they prevent exposure of the bladder mucosa to air. Our initial results are encouraging, although followup is short.