Biology of buccal mucosa in urological reconstruction

Buccal mucosa (BM) has been used as a source of tissue for reconstructive urological surgeries since the late 19th century, although its popularization and widespread use would only occur in the 1990s. Despite its widespread use and its “gold standard” status, histopathological and histochemical studies of BM grafts have rarely been reported. Numerous studies have been focused on the unique adaptability of oral mucosa to a multitude of injuries, but the secrets behind the remarkable regenerative capacity of oral mucosal tissues have eluded researchers for over half a century. In addition, crucial questions about the possibility of urothelium replacement of BM graft in a long-term basis and the BM biological changes induced on the host tissue after transplantation remain unanswered. More recently, there has been significant interest in the potential use of tissue engineered (TE) oral mucosal substitutes. While retaining the well-established advantageous aspects of the buccal mucosa grafts, the TE oral mucosa grafts have the potential to provide any size of graft often necessary in long strictures including those in patients with lichen sclerosis history. Furthermore, the use of TE-BM might provide an alternative approach in recurrent, complex urethral strictures which do not respond favorably to standardized treatments.