Upper lip graft (ULG) for redo urethroplasties in children. A step by step video



      Lower lip and cheek are commonly used sources of buccal mucosa grafts for urethroplasty. In recent years, aiming to improve the donor site morbidity, our preference changed to the use (ULG). The aim of this video is to illustrate the technical details of the ULG harvesting for children.

      Material and methods

      The inner surface of the upper lip is exposed by two stay sutures. The frenulum is spared, the mucosa to be harvested is marked and local submucosal infiltration is done with a solution of bupivacaine plus epinephrine. The edges are incised ant the submucosa plane created with a scissor. The graft is detached, defatted, and applied with quilting stitches over the recipient site with the standard technique. Hemostasis is secured and the donor site is left open.


      From 2015 to 2018, 25 ULG harvests were done in 24 patients. Only one (5%) presented local pain associated to the procedure in the first 24 h. After minimum 2 months after surgery, none of the patients presented perioral nubmness, difficulty with mouth opening, contraction of the donor site or changes in salivation.


      ULG harvest is easy and a suitable alternative source of oral mucosa for urethroplasty in children.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Cimador M.
        • Vallasciani S.
        • Manzoni G.
        • Rigamonti W.
        • De Grazia E.
        • Castagnetti M.
        Failed hypospadias in paediatric patients.
        Nat Rev Urol. 2013 Nov; 10: 657-666
        • Leslie B.
        • Lorenzo A.J.
        • Figueroa V.
        • Moore K.
        • Farhat W.A.
        • Bägli D.J.
        • et al.
        Critical outcome analysis of staged buccal mucosa graft urethroplasty for prior failed hypospadias repair in children.
        J Urol. Mar 2011; 185: 1077-1082
        • Pippi Salle J.L.
        • Sayed S.
        • Salle A.
        • Bagli D.
        • Farhat W.
        • Koyle M.
        • et al.
        Proximal hypospadias: a persistent challenge. Single institution outcomeanalysis of three surgical techniques over a 10-year period.
        J Pediatr Urol. 2016; 12 (28.e1e28.e7)
        • Kamp S.
        • Knoll T.
        • Osman M.
        • Häcker A.
        • Michel M.S.
        • Alken P.
        Donor-site morbidity in buccal mucosa urethroplasty: lower lip or inner cheek?.
        BJU Int. 2005; 96: 619-623
        • Sakr A.
        • Elkady E.
        • Abdalla M.
        • Fawzi A.
        • Kamel M.
        • Desoky E.
        • et al.
        Lingual mucosal graft two-stage Bracka technique for redo hypospadias repair.
        Arab J Urol. 2017 Jul 19; 15: 236-241