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El-Ghoneimi et al. Plast Aesthet Res 2022;9:39 https://dx.doi.org/10.20517/2347-9264.2021.101 Page 5 of 11

Figure 3. Harvesting of long BMG by minimal detrusotomy. (A) The detrusor is incised horizontally for 2 cm, and then two parallel
incisions of the exposed mucosa are extended as far as needed. (B) The mucosa is freed from the detrusor by blunt dissection. (C) A
long strip of bladder mucosa up to 16 cm can be retrieved. BMG: Bladder mucosa graft.

A compressive dressing was applied for five days and removed at the outpatient clinic. Anticholinergic
treatment is routinely used. We do not use antibiotic prophylaxis other than one shot at the beginning of
surgery.

After a delay of 21 days, the urethral catheter was removed, and the suprapubic catheter was closed. When
voiding was easily obtained for 48 h, the suprapubic was removed. If there was any dysuria, infiltration of
the perineal area, or excessive inflammation, the suprapubic was opened and antegrade urethrogram was
done for eventually inserting under general anesthesia a new urethral catheter for a supplementary period
until healing was obtained.

Follow up
The child was seen one month after surgery, then every three months for a year, and every year after that. At
every follow-up, a flowmeter is done, and when needed cystoscopy is done under general anesthesia.

RESULTS
The graft surgery was done at median age of 105 months (range 20-195 months). The graft was successfully
retrieved through the minimal detrusotomy approach for variable lengths of urethroplasty with a median
length 10.5 cm (range 8-16 cm). The median follow up was 61.7 months (range 18-160 months). TBMG was
the last surgery with no redo in five cases (50%) [Figure 6].