Buccal Graft Research Articles

Non-transecting anastomotic augmented urethroplasty with dorsal onlay buccal graft for the treatment of bulbous urethral strictures: results and complications.

Urethroplasty is the gold standard for the management of urethral strictures. For obliterative bulbar strictures longer than 2cm, excision primary anastomosis (EPA) cannot be optimally performed, and staged urethroplasty is recommended. To minimize multiple interventions, Augmented Anastomotic Urethroplasty (AAU) was developed. Our hypothesis was that incorporating the vessel sparing approach would improve the results of urethroplasty. and limit complications. Our study aimed to assess the outcomes of non-transecting Anastomotic Augmented Urethroplasty with a buccal graft (ntAAU). From 2019 to 2023, 42 patients underwent ntAAU. Anatomical success was defined as the ability to pass a cystoscope (16,5 Fr) and functional success was determined by a maximum urinary flow rate (Qmax) greater than 15ml/s. Clinical outcomes were evaluated using patient reported outcome concerning urinary function (USP dysuria, VPPS, six items LUTS, questions 7, 9, 10 from USS-PROM) and erectile function (IIEF-5, EHS). Anatomical success rate was 90.5% and functional success was 83.3% with a median (IQR) follow-up of 18 (12.5-28.5) months. The complication (urinary infection, suprapubic catheter obliteration, abscess, bleeding) rate was 14.2%. Questionnaires were avaiblable for 31 patients. Median (IQR) USP dysuria score was 0 (0-1), VPPS score was 7 (3-12), and six-item LUTS score was 4 (2-9). The median (IQR) IIEF-5 score was 22 (15.5-25) and EHS score was 3.5 (2-4). Patients with treatment failure were managed with redo-urethroplasties. This technique shows good outcomes and appears to be a valuable option for managing strictures with an obliterative part.

Female Genital Mutilation Reconstruction: Surgical Technique.

Female Genital Mutilation (FGM) reconstruction has been shown to be a safe procedure that contributes to improvements in physical and emotional sexual health. Genital reconstructive procedures are increasing in demand, but access to these surgeries is severely limited. This represents an opportunity for plastic surgeons to leverage their reconstructive expertise in delivering both functional and aesthetic rehabilitation to FGM survivors. The accompanying educational video demonstrates FGM reconstructive surgery, which consists of adjacent tissue rearrangement of the bilateral vulva with buccal mucosal grafting and structural fat grafting. First, buccal mucosa grafts are designed and harvested to allow sufficient coverage of the defect to be restored. Local anesthetic infiltration and fat graft harvest are performed in the superior mons area. An inverted Y incision is used to create de novo labia minora flaps and dissect the clitoral remnant. Vaginal sulci are recreated with imbrication of labia majora. The buccal grafts are shaped to resurface the defects and secured using bolsters fashioned out of Doyle splints covered with antibiotic ointment. Fat grafting is performed bilaterally into the labia majora and mons region, to provide protection and a conductive environment for sensory regeneration of the clitoral remnant. This technique produces an excellent improvement in contour, release of scar tissue, and labia minora reconstruction with a low complication rate. Post-operatively, patients have experienced a return in natural pigmentation and clitoral sensation. This straightforward, effective approach has been shown to improve physical, sexual, and psychological health in FGM survivors.

History of urethral surgery: Lessons learnt from the past.

History of urethral surgery: Lessons learnt from the past.

DIFFERENTIATED VULVAR INTRAEPITHELIAL NEOPLASIA: A CLINICAL EXAMPLE OF INTERDISCIPLINARY PATIENT MANAGEMENT

Differentiated vulvar intraepithelial neoplasia (dVIN) is an obligate precancer, develops during chronic vulvodermatoses, such as lichen sclerosus and lichen simplex chronicus. The epidemiological, clinical, pathomorphological, diagnostic, and prognostic features of dVIN are discusses. A clinical case of interdisciplinary management of a patient with dVIN, complicated by malignancy and urethral stricture, is presented. Early oncological alertness was demonstrated, microinvasive vulvar cancer in woman with of lichen sclerosus was diagnosed. It is actually, because there is high amount primary patients with advanced vulvar cancer. The joint work of oncologists, urologists, and gynecologists made it possible to successfully perform reconstructive plastic surgery for urethral stricture using a buccal graft for the first time in the Trans-Baikal Territory. Thanks to this the urinary function was restored and the quality of life improved.

Editorial Comment: Complex Buccal Graft Urethroplasty Combined With HoLEP in the Setting of Concomitant Urethral Stricture Disease and Severe Benign Prostatic Hyperplasia: A Case Report

Editorial Comment: Complex Buccal Graft Urethroplasty Combined With HoLEP in the Setting of Concomitant Urethral Stricture Disease and Severe Benign Prostatic Hyperplasia: A Case Report

Current Trends in the Use of Buccal Grafts During Urethroplasty Among Society of Genitourinary Reconstructive Surgeons

Current Trends in the Use of Buccal Grafts During Urethroplasty Among Society of Genitourinary Reconstructive Surgeons

Complex Buccal Graft Urethroplasty Combined With HoLEP in the Setting of Concomitant Urethral Stricture Disease and Severe Benign Prostatic Hyperplasia: A Case Report

Background: Urethral strictures and benign prostatic hyperplasia (BPH) are 2 common causes of urinary obstruction and urinary emptying symptoms. While urethroplasty and endoscopic management of BPH have been extensively discussed in the literature when performed on their own, a case of simultaneous urethroplasty and endoscopic management of BPH has not been previously described in the literature. Case Description: We present the case of a 75-year-old man with significant BPH and concomitant bulbar obliterative urethral stricture. After discussion of treatment options with the patient, we elected to perform both holmium LASER enucleation of the prostate (HoLEP) of a 200cc prostate and buccal graft urethroplasty during the same surgery. The HoLEP was performed through a dorsal urethrotomy in anticipation of urethroplasty. Nontransecting anastomotic repair was then combined with the buccal graft urethroplasty. The patient did not have any acute postoperative complications and had no recurrence. He reported improvements in outcome questionnaire scores and uroflow parameters at the 12-month follow-up. Conclusions: This case presentation is the first to report on simultaneous complex urethroplasty and endoscopic management of BPH, specifically HoLEP. It shows that this approach can lead to positive urinary outcomes without added complications and with lasting outcomes, thereby allowing the use of a combined surgical approach.

Single Port Bilateral Ureteral Stricture Repair with Buccal Graft

Single Port Bilateral Ureteral Stricture Repair with Buccal Graft

THE EXPRESSION OF ALPHA-SMOOTH MUSCLE ACTIN IN CONTRACTED SOCKET

Abstract
 Introduction & Objectives : A contracted socket is considered a common complication in anophthalmic patients, with the resulting poor fitting of an ocular prosthesis. In severe cases where patients have had multiple previous reconstructive attempts, further socket contraction may result from fibrosis, leading to eventual surgical failure. Alpha-smooth muscle actin (alpha-SMA) is often used to identify pathologic fibroblasts. It may serve as a reliable marker for myofibroblast cells. The aim of the study was to find alpha-SMA protein expression in myofibroblasts derived from orbital socket contracture.
 Methods : In this study, we observed five patients with contracted sockets who underwent fornicoplasty and buccal graft surgery from October 2022 to February 2023. Tissue samples were taken from the conjunctival fornix area during the surgery and then examined for alpha-SMA expression.
 Results : In this study, there were 2 out of 5 (40%) positive alpha-SMA expressions with history of recurrent contraction, 2 (40%) negative expressions with no history of recurrent contraction, and 1 result that could not be assessed due to the limited number of samples containing fibroblasts in patient with history of recurrent contraction.
 Conclusion : Alpha-SMA levels can be detected in patients with contracted sockets. Patients with a history of recurrently contracted sockets have a tendency to express positive alpha-SMA. This may allow for the need for the administration of antimetabolites in patients with recurrent contracted sockets to avoid recurrence of this contracted socket.

THE EXPRESSION OF ALPHA-SMOOTH MUSCLE ACTIN IN CONTRACTED SOCKET

Purpose: A contracted socket is considered a common complication in anophthalmic patients, with the resulting poor fitting of an ocular prosthesis. In severe cases where patients have had multiple previous reconstructive attempts, further socket contraction may result from fibrosis, leading to eventual surgical failure. Alpha-smooth muscle actin (?-SMA) is often used to identify pathologic fibroblasts. It may serve as a reliable marker for myofibroblast cells. The aim of the study was to find ?-SMA protein expression in myofibroblasts derived from orbital socket contracture. Methods: In this study, we observed five patients with contracted sockets who underwent fornicoplasty and buccal graft surgery from October 2022 to February 2023. Tissue samples were taken from the conjunctival fornix area during the surgery and then examined for ?-SMA expression. Result: In this study, there were 2 out of 5 (40%) positive ?-SMA expressions with history of recurrent contraction, 2 (40%) negative expressions with no history of recurrent contraction, and 1 result that could not be assessed due to the limited number of samples containing fibroblasts. Conclusion: ?-SMA levels can be detected in patients with contracted sockets. Patients with a history of recurrently contracted sockets have a tendency to express positive ?-SMA. This may allow for the need for the administration of antimetabolites in patients with recurrent contracted sockets to avoid recurrence of this contracted socket.

Bilateral Robot-Assisted Reconstruction of the Ureter with Buccal Graft and Omental Wrapping

Bilateral Robot-Assisted Reconstruction of the Ureter with Buccal Graft and Omental Wrapping

Hard tissue stability outside the buccal bone arch contour after guided bone regeneration in the anterior maxilla: A retrospective cohort radiographic study.

To radiographically evaluate the stability of the bone substitute augmented outside the buccal bony arch contour in the maxillary esthetic zone. Patients who missed a single anterior tooth and received simultaneous GBR in implant surgery were included. The contralateral homonymous area of the implant site was horizontally mirrored as the individual bone arch contour. According to the relative position of the postoperative buccal grafts and bone arch contour at the implant shoulder, 62 patients were allocated into the outside-contour (OC) and inside-contour (IC) groups. Cone-beam computed tomography was performed before surgery, after implant insertion, before re-entry surgery, and at follow-up. The profilometric changes of the buccal bone plate were analyzed via the bone distance to the mirrored bony contour. At the implant shoulder, the bone distance in the OC group was higher than that in the IC group, with statistically significant differences at re-entry surgery and follow-up. However, the bone grafts outside the bone arch contour were reduced into the contour after remodeling and showed more bone resorption than the IC group. At other vertical levels below the implant shoulder, bony grafting of overcontour 1-2 mm range was favorable to regenerate stable bone plates reaching the individual contour at follow-up. The overaugmented bone outside the buccal bone arch contour tended to remodel into the original contour, which indicates that the anterior bone arch contour is worthy of careful observation for deciding buccolingual implant position and bone augmentation width.

Application of augmented anastomotic urethroplasty with buccal graft in treatment of decompensated posttraumatic urethral stricture of bulbar urethra (case report)

Application of augmented anastomotic urethroplasty with buccal graft in treatment of decompensated posttraumatic urethral stricture of bulbar urethra (case report)

Ослοжнения первичнοй и пοвтοрнοй буккальнοй уретрοпластики у мужчин.

Introduction. Recently, there has been a tendency to perform reconstructive-plastic interventions for the treatment of both primary and recurrent urethral strictures. Buccal urethroplasty is currently recognized as the «gold standard» for the urethral strictures treatment. However, despite a large number of works on operative correction of urethral strictures using the cheek mucosa, the issues of prevention and correction of intra- and postoperative complications of buccal urethroplasty have not been finally resolved. The purpose. Using the world literature, to stydy complications, methods of their prevention and correction for improving the efficiency of primary and repeated recοnstructive-plastic οperations on the urethra using free autograft of mucous membranes οth cheeks. Materials and methods. The literature review was made using bibliographic databases: Pubmed, Web of Sience, Science Direct, Scopus, Cyberleninka, eLibrary.ru and others for the period from 1990–2022. The following keywords were used: urethral stricture, buccal graft, complications of buccal urethroplasty, buccal urethroplasty, diagnosis of complications of buccal urethroplasty, treatment of complications of buccal urethroplasty, anastomotic urethroplasty, urethroplasty replacement. In total, 150 original publications were identified and analyzed, and 104 articles of them were selected for a literary review. Results. The analysis of complications of primary and repeated buccal urethroplasty was carried out, possible options for diagnosis and correction of complications of reconstructive plastic surgery on the urethra of men using the cheek mucosa were studied and the quality of life of patients after surgical treatment was analyzed. Conclusion. The analysis of the scientific literature on the results of the surgical treatment of primary and recurrent urethral strictures using buccal mucosa graft shows that at present there is no single clinical position that would clearly classify the emerging complications of this method of uretroplastics and contributed to the development of measures for their prevention.

Complications after Prostate Cancer Treatment: Pathophysiology and Repair of Post-Radiation Urethral Stricture Disease.

Radiation therapy (RT) in the management of pelvic cancers remains a clinical challenge to urologists given the sequelae of urethral stricture disease secondary to fibrosis and vascular insults. The objective of this review is to understand the physiology of radiation-induced stricture disease and to educate urologists in clinical practice regarding future prospective options clinicians have to deal with this condition. The management of post-radiation urethral stricture consists of conservative, endoscopic, and primary reconstructive options. Endoscopic approaches remain an option, but with limited long-term success. Despite concerns with graft take, reconstructive options such as urethroplasties in this population with buccal grafts have shown long-term success rates ranging from 70 to 100%. Robotic reconstruction is augmenting previous options with faster recovery times. Radiation-induced stricture disease is challenging with multiple interventions available, but with successful outcomes demonstrated in various cohorts including urethroplasties with buccal grafts and robotic reconstruction.

The Evolution and Outcomes of the "Maddern Procedure" for the Treatment of Subglottic Stenosis.

A novel technique to treat subglottic stenosis, the "Maddern Procedure", has been gaining acceptance in academic centers. This study describes the technique in detail, as well as its evolution over the first 28 patients performed at an academic center. A prospective case-series, with descriptive technique modifications cataloged throughout the 6 years needed to accumulate the patient cohort with a minimum of 2 years of follow-up (11/2015-11/2021). Main outcomes examined included changes to surgical indications, complications, and post-operative outcomes as measured by validated measures of voice and breathing. Complete resection of subglottic scaring was performed, at first transcervically (2 pts), then transorally (26 pts). Successful performance of the procedure occurred in all patients without complications, with either successful decannulation of previously existing tracheotomies, or removal of perioperative tracheotomies. Buccal grafts (8/26) replaced skin graft as the graft of choice. Although high subglottic disease was first thought to be a contraindication, superior results became evident in cases of high stenosis rather than disease that included the upper trachea, with 4/26 patients requiring subsequent tracheal resection or tracheal dilation. Of the 22 remaining patients, 19/22 had successful arresting of restenosis, with 2/22 undergoing subsequent cricotracheal resection, and 1/22 pts requiring subglottic dilation. Overall, 19/26 Maddern pts (73%) had objectively favorable outcomes, with 24/26 (92%) reporting that they would have undergone the procedure again. Full-thickness mucosal resection and relining of the subglottis is a developing technique that is a safe, yet technically challenging procedure which addresses the recurrent nature of the disease. Level 4 (Case-series) Laryngoscope, 133:3100-3108, 2023.

Laparoscopic buccal plasty of the pyeloureteral segment and proximal ureter

BACKGROUND: With recurrent extended strictures of the pyeloureteral segment and the proximal ureter, when standard operations are ineffective or technically impossible, the narrowed area can be replaced with a flap from the cheek mucosa. AIM: The aim of the study is the results of laparoscopic plastic surgery of the pyeloureteral segment and proximal ureter with buccal graft. MATERIALS AND METHODS: Minimally invasive plastic surgery of the extended stricture of the pyeloureteral segment, upper and middle third of the ureter with a flap from the cheek mucosa was performed in 27 patients. There were 16 men, 11 women, and the average age was 51 years. The cause of narrowing in 16 patients was previously performed pyeloplasty, in 10 contact ureterolithotripsy in the proximal ureter, in 1 his injury during laparoscopic excision of a parapelvical kidney cyst. Laparoscopic access was used in 24 patients, and robot-assisted access was used in 3 patients. In 17 of them, the narrowed area was replaced by the onlay technique, in 10 patients, anastomosis augmentation was performed with a buccal graft. RESULTS: There were no intraoperative complications. The duration of operations ranged from 115 to 340 minutes. There were no cases of urine leaking through the drainage. Fever up to 38.0 C was observed in 5 (18.5%) patients, 3 (11.1%) of them underwent antibacterial therapy (grade II according to Clavien), and 2 (7.4%) without nephrostomy drainage, puncture nephrostomy (grade IIIa according to Clavien) was performed. There were no complications according to Clavien IIIb degree. On excretory urograms and computed tomography, the area of the ureter replaced by a buccal flap is wide and well passable. In patients with pyeloureteral segment strictures, a decrease in the size of expanded cups and pelvis was observed in dynamics. Clinically, all operations were successful, as it was possible to relieve patients from nephrostomy drainage and symptoms of upper urinary tract obstruction. CONCLUSIONS: Buccal ureteroplasty may be the method of choice in patients with extensive narrowing of the pyeloureteral segment and proximal ureter. It is a relatively simple operation and does not require extensive mobilization of the ureter and provides good functional results.

Pathomorphism of buccal grafts used in surgery of extensive bulbar urethral strictures: immunohistochemical analysis

Introduction. The adverse effects of urine on unadapted tissues are known. This is also entirely relevant for buccal grafts used in augmentation urethroplasty, where these effects have not been thoroughly studied so far.Objective. To assess the ongoing pathomorphosis in buccal grafts used for urethral augmentation of extensive strictures in the bulbous region and to evaluate how much urine influences their histological transformation following surgery.Materials & methods. The study included 15 patients with extensive strictures of the bulbous urethra, who underwent a two-stage augmentation urethroplasty with buccal grafts. The grafts pathomorphosis was studied 6 months after the first surgery stage where urethrotomy had been performed with graft augmentation of the dorsal semicircle and the formation of distal and proximal neomeatuses. Natural urination through the latter was restored on days 14 – 20 following the surgery. During the second stage, six months later, urethral tubularisation was performed with two preliminary biopsies of the proximal and distal segments of the grafts implanted in the areas of the neomeatuses formed earlier. The distal area of the graft had no contact with urine, while this contact has occurred in the proximal segment since restoration of natural urination. In biopsy specimens, pathomorphosis of the grafts was studied using immunohistochemical markers: vimentin, clone SRL33; CD34, clone QBEnd/10; MSA HHF-35; СD3, clone LN10; Bcl-2, clone bcl-2\100\D5; CK-HMW 34BE-12.Results. It was found that inflammation was minimal in areas of grafts implanted that had no contact with urine, while in areas where such contact occurred it was verified to be pronounced even 6 months after the operation. On the submucosal level, this was manifested by an uneven arrangement of collagen fibers, a dysplastically developed vascular network, uneven proliferation of the endothelium with swelling and loss of cellular connectivity, in contrast to areas where there was no contact with urine. In such areas, the graft submucosa had a dense collagen framework with organized microvasculature and uniform epithelial surface.Conclusion. The impact of urine on buccal grafts used in augmentation urethroplasty is characterised by the disorganisation of its collagen framework, with a pronounced inflammatory component and the “reactivity” of the epithelial lining to the “toxic agent” that persists even 6 months after surgery. This may underlie the risk of a stenosis relapse in the proximal anastomosis area.

V08-09 TRANSURETHRAL DORSAL BUCCAL GRAFT URETHROPLASTY FOR PROXIMAL FEMALE URETHRAL STRICTURES

V08-09 TRANSURETHRAL DORSAL BUCCAL GRAFT URETHROPLASTY FOR PROXIMAL FEMALE URETHRAL STRICTURES

MP78-09 SALVAGE DIRECT VISION INTERNAL URETHROTOMY FOR AFTER FAILED SUBSTITUTION URETHROPLASTY: EXTENDED LONG-TERM FOLLOW-UP FROM A RECONSTRUCTIVE REFERRAL CENTER

MP78-09 SALVAGE DIRECT VISION INTERNAL URETHROTOMY FOR AFTER FAILED SUBSTITUTION URETHROPLASTY: EXTENDED LONG-TERM FOLLOW-UP FROM A RECONSTRUCTIVE REFERRAL CENTER