PD22-09 THE IMPACT OF PREOPERATIVE ORAL HEALTH ON BUCCAL MUCOSAL GRAFT HISTOLOGY

Abstract

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) II (PD22)1 Sep 2021PD22-09 THE IMPACT OF PREOPERATIVE ORAL HEALTH ON BUCCAL MUCOSAL GRAFT HISTOLOGY Jane Kurtzman, Sun-Ming Pan, Shawn Mendonca, Shyam Sukumar, Yue Lai, and Steven Brandes Jane KurtzmanJane Kurtzman More articles by this author , Sun-Ming PanSun-Ming Pan More articles by this author , Shawn MendoncaShawn Mendonca More articles by this author , Shyam SukumarShyam Sukumar More articles by this author , Yue LaiYue Lai More articles by this author , and Steven BrandesSteven Brandes More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002011.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Oral mucosa is the first choice for urethral augmentation in patients undergoing urethroplasty for stricture disease. Previous studies have elucidated the unique anatomic and histologic properties of oral mucosa which make it a viable and durable graft, as well as established criteria and contraindications for selecting patients for oral graft harvesting. However, no prior literature has investigated the impact of preoperative oral health on buccal mucosal histology and graft take. METHODS: We analyzed all consenting patients who underwent buccal mucosal graft (BMG) urethroplasty at our institution from 2018-2020. Validated oral health surveys, the Oral Health Impact Profile (OHIP-14) and the Kayser-Jones Brief Oral Health Status Exam (BOHSE) were completed preoperatively. A staff pathologist analyzed BMG histology and quantified oral mucositis (OM) using a modified Oral Mucosa Rating Scale. Each patient underwent a retrograde urethrogram (RUG) at postoperative week 3 to assess for a urinary leak. Individual age-adjusted linear regression models were used to explore the association between BOHSE, OHIP-14 and OM and BMG epithelial thickness, lamina propria thickness and delta stretch. RESULTS: We analyzed 51 patients, median age 40 years (IQR 31–58). Mean BOHSE score was 1.1 and OHIP-14 score was 1.4. 37 grafts were assessed in pathology. Median epithelial thickness was 530 microns and lamina propria thickness was 150 microns. Age-adjusted linear regression demonstrated that as BOHSE score, OHIP-14 score and OM score increased (i.e. oral health worsened), average epithelial thickness of the grafts decreased (p=0.001; p=0.01; p=0.05, respectively). Higher BOHSE scores also significantly correlated with thinner average lamina proprias (p=0.05) and decreased delta stretch lengthwise (p=0.028). The two patients with postoperative urine leaks and pathology available for review had elevated OM scores and lamina propria thicknesses well-below the cohort median, 50 microns and 60 microns, respectively. CONCLUSIONS: This is the first study to demonstrate that oral health conditions impact graft histology and stretch. Though much remains to be learned, our finding that worse oral health conditions correlate with adverse histology emphasizes the importance of optimizing preoperative oral health and raises the question of if preoperative mucosal biopsy could help inform surgical decision making and discussions regarding surgical success. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e383-e383 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jane Kurtzman More articles by this author Sun-Ming Pan More articles by this author Shawn Mendonca More articles by this author Shyam Sukumar More articles by this author Yue Lai More articles by this author Steven Brandes More articles by this author Expand All Advertisement Loading ...