MP35-20 A HISTOLOGIC ANALYSIS OF BUCCAL MUCOSA, COLON MUCOSA AND PREPUCE SKIN GRAFTS: IS COLON MUCOSA THE IDEAL GRAFT?

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I (MP35)1 Apr 2020MP35-20 A HISTOLOGIC ANALYSIS OF BUCCAL MUCOSA, COLON MUCOSA AND PREPUCE SKIN GRAFTS: IS COLON MUCOSA THE IDEAL GRAFT? Shawn Mendonca*, Sun-Ming Pan, Jonathan Xu, Shyam Sukumar, Carlos Pagan, and Steven Brandes Shawn Mendonca*Shawn Mendonca* More articles by this author , Sun-Ming PanSun-Ming Pan More articles by this author , Jonathan XuJonathan Xu More articles by this author , Shyam SukumarShyam Sukumar More articles by this author , Carlos PaganCarlos Pagan More articles by this author , and Steven BrandesSteven Brandes More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000879.020AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Buccal mucosa (BMG) is considered the standard of care graft for urethroplasties. There are alternative grafts, such as colonic mucosa graft (CMG) and prepuce skin graft (PSG) that have been utilized as a substitute when conditions are not favorable for BMG use. The similarities and differences between each graft properties are unknown. In this study, we seek to investigate these properties from a histologic perspective. METHODS: 32 BMGs, 26 CMGs and 2 PSGs were collected prospectively. BMGs and PSGs were obtained from excess grafts used in urethral reconstruction cases. CMGs were obtained from colectomy specimens for any etiology except inflammatory bowel disease. BMG and PSG were harvested and prepped in the standard fashion and dimensions were based on reconstruction needs. CMG was initially harvested from an estimated 2 x 5 cm full thickness specimen of the uninvolved colon and the mucosa was dissected off the underlying muscularis propria. Histologic and physical properties of the grafts were obtained by a staff pathologist. RESULTS: BMGs and CMGs are histologically composed of a mucosal (epithelium + lamina propria) and submucosal layer. PSG is a skin graft with a flat epidermal and dermal layer. BMG has a flat mucosal layer, whereas CMG’s mucosal layer has crypts. The outer epithelial layers of BMG, CMG and PSG are stratified squamous, simple columnar and partially keratinized stratified squamous, respectively. CMG is the only graft with a muscularis mucosa layer, with a mean width of 32.5 μm [20 – 70]. PSG has the thinnest mucosa with a mean width of 105μm [90 – 130] relative to CMG 464μm [370 – 550] and BMG 731μm [150 – 1450]. CMG had the thinnest submucosa with a mean width of 670μm [200 – 1550] relative to BMG 1078μm [300 – 3270] and PSG 1700μm [1500 – 1900]. Mean size of BMG, CMG and PSG harvested were 4.8 x 2.0cm, 5.6 x 2.5cm and 6.85 x1.9cm with a mean delta stretch of 22.8 x 22.4%, 122 x 36.9% and 9.9 x 56.4%, respectively. CONCLUSIONS: BMG, CMG and PSG differ histologically in layer composition, width and architecture. CMG may be a favorable graft given its large delta stretch that can span long strictures and thin submucosa to enable easy nutrient diffusion to the mucosa. However, it has a muscularis mucosal layer that may be a barrier to imbibition. Further studies are needed to correlate histologic properties to clinical outcomes. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e520-e521 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shawn Mendonca* More articles by this author Sun-Ming Pan More articles by this author Jonathan Xu More articles by this author Shyam Sukumar More articles by this author Carlos Pagan More articles by this author Steven Brandes More articles by this author Expand All Advertisement PDF downloadLoading ...