1235 STRUCTURAL ALTERATIONS IN THE EXTRACELLULAR MATRIX OF HUMAN FORESKIN CAUSED BY CHRONIC SMOKING MAY EXPLAIN HIGH LEVELS OF URETHRAL RECONSTRUCTION FAILURE

Abstract

You have accessJournal of UrologyTrauma/Reconstruction: Trauma & Reconstructive Surgery IV1 Apr 20101235 STRUCTURAL ALTERATIONS IN THE EXTRACELLULAR MATRIX OF HUMAN FORESKIN CAUSED BY CHRONIC SMOKING MAY EXPLAIN HIGH LEVELS OF URETHRAL RECONSTRUCTION FAILURE Joao P. Rosado, Andre L. Cavalcanti, Luciano A. Favorito, Waldemar S. Costa, Luiz E. Cardoso, and Francisco J. Sampaio Joao P. RosadoJoao P. Rosado More articles by this author , Andre L. CavalcantiAndre L. Cavalcanti More articles by this author , Luciano A. FavoritoLuciano A. Favorito More articles by this author , Waldemar S. CostaWaldemar S. Costa More articles by this author , Luiz E. CardosoLuiz E. Cardoso More articles by this author , and Francisco J. SampaioFrancisco J. Sampaio More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.758AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It has been speculated by McAninch et al. (1), that smokers might experience worse results after urethral reconstruction, nevertheless, no structural evidence hasbeen reported to date. Therefore, we were prompted to investigate the extracellular matrix, smooth muscle and vascular density in the foreskin of smoker patients. METHODS Foreskin samples were obtained from 20 young adults (ranging in age from 23 to 36 years; mean ± SD, 27.2 ± 5.8) submitted to circumcision from July 2008 to October 2009. Of the patients analyzed, one group (n=10) had previous history of chronic smoking (3 to 13 packs/year, mean = 5.8 ± 3.2) i.e., one pack per day for 3 to 13 years. Control group had 10 non-smoker patients. Foreskin tissue samples were immediately fixed in formalin, embedded in paraffin and 5.0 μm sections were obtained. Masson's trichrome stain was used to quantify the connective tissue, smooth muscle and vessels. Weigert's Resorcin-fuchsin stain was used to assess the elastic system fibers and Picrosirius red stain to study the collagen arrangement. The images were captured with an Olympus BX51 microscope coupled to an ODP70 camera. A stereological analysis was performed using the Image J software, to determine the volumetric densities. For biochemical analysis, the total collagen was determined as μg of hydroxyproline per mg of dry tissue. Means were compared using the two-tailed t-test (p<0.05). RESULTS Elastic system fibers in the foreskin of smoker patients increased in 42.5% when compared to the control group (32 ± 6.3 vs 45.6 ± 10, respectively; p = 0.002). In contrast, smooth muscle fibers (p=0.42) and the vascular density (p=0.16) did not show any significant variation between groups. Qualitative analysis using Picrosirius red stain with polarized light evidenced the presence of type I and III collagen in the foreskin, without significant difference in its basic characteristics. Total collagen concentration did not differ significantly between smokers and controls (73.1μg/mg ± 8.0 vs. 69.2μg/mg ± 5.9, respectively, p=0.23). CONCLUSIONS Smoking is associated with a significant increase of elastic system fibers in foreskin tissue. These results could possibly explain the high failure rate of penile urethroplasty in smokers by using foreskin flaps. References 1 : Long-term efficacy of distal penile circular fasciocutaneous flaps for single stage reconstruction of complex anterior urethral stricture disease. J Urol2008; 179: 2259. Link, Google Scholar Rio de Janeiro, Brazil© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e477-e478 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joao P. Rosado More articles by this author Andre L. Cavalcanti More articles by this author Luciano A. Favorito More articles by this author Waldemar S. Costa More articles by this author Luiz E. Cardoso More articles by this author Francisco J. Sampaio More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...