Objective: To determine the effect of closure versus nonclosure of the buccal mucosal graft harvest site in men undergoing bulbar urethroplasty in a randomized prospective study. The optimal postoperative management of the buccal mucosal graft donor site remains unknown. Methods: A total of 50 consecutive patients were randomized to either donor site closure or leaving the donor site open. Postoperatively, questionnaires assessing pain, diet, salivation, perioral sensation, and mouth opening were completed daily for the first week and then monthly for 6 months. The primary endpoint was postoperative oral pain. The secondary endpoints were the interval to a regular diet, perioral numbness, changes in salivation, and interval to full mouth opening. Results: Of the 50 patients, 24 and 26 were randomized to the open and closed groups, respectively. The early postoperative pain scores demonstrated a trend favoring the nonclosure group until day 3 (4.1 vs 2.2; P = .07). At 6 months, no difference was found in the pain scores between the 2 groups (0.2 vs 0.3; P = .63). The return to a regular diet also favored the nonclosure group (70.8% vs 19.2% on day 1; P = .01) as did the return to full mouth opening (79.1% vs 15.3% on day 1; P = .001). Nonclosure resulted in less early perioral numbness (62.5% vs 92.3% on day 1; P = .008) and reduced the occurrence of bothersome numbness at 6 months (4.2% vs 23.2%; P = .05). Conclusion: The results of the present randomized prospective trial suggest that leaving the buccal mucosa graft harvest site open leads to lower reported early pain scores, an earlier return to a full diet, an earlier return to full mouth opening, and a decrease in bothersome perioral numbness at 6 months postoperatively. [ABSTRACT FROM AUTHOR]