Buccal mucosa graft (BMG) is often used as the primary graft in complex hypospadias surgery. It is not clear what the response of this BMG is during puberty androgen surge and whether or not differential penile growth occurs with secondary chordee as a result. These authors looked at 10 boys out of 137 meeting the inclusion criteria of BMG pre-pubertally and follow-up concluded post-pubertally and looked at initial meatal location, flow parameters postoperatively and complications. Of the 10 patients, mean age at BMG was eight years (range 5-11) with the graft harvested from the cheek in seven cases and lower lip in three cases. Mean follow-up was 40.6 months (range 9-66 months). One had a fistula and two had glanular dehiscence. None had secondary curvature at follow-up and all had maximum flow that was normal post-pubertally (mean 25.7ml/s). The authors concluded that although the study population was small the indications are that BMG grows proportionally to the phallus after the pubertal endogenous testosterone surge, supporting its use in the pre-pubertal population.