Buccal Mucosal Graft Research Articles

Comparative study between use of Buccal Mucosal Graft and Martius flap as A Second Layer in Vaginal Repair of complex Vesicovaginal Fistula: A prospective randomized trial

Comparative study between use of Buccal Mucosal Graft and Martius flap as A Second Layer in Vaginal Repair of complex Vesicovaginal Fistula: A prospective randomized trial

Outcomes of Double-Face Buccal Mucosal Urethroplasty for Treating Anterior Urethral Stricture in Adult Males.

To assess the results of double-face buccal mucosal graft urethroplasty (BMG) for treating anterior urethral stricture in adult males. An observational study. Place and Duration of the Study: Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from 2021 to 2022. The inclusion criteria were adult males, aged 15 to 70 years, with a previous surgical procedure for hypospadias and the presence of long penile and bulbar strictures measuring over 2 cm, resulting from a straddle injury. Forty-three patients were selected who underwent urethroplasty in 2021 and completed a one-year follow-up in 2022. Uroflowmetry (UFM) and the International Index of Erectile Function (IIEF) assessment data were obtained from the patients' medical records. Success was defined as the patient attaining catheter freedom and achieving a maximum flow rate exceeding 15 ml/sec after one year. The mean UFM at one year was 20.89 ml/s. Four patients underwent endo-urological intervention (direct visual internal urethrotomy), and one patient needed a second double-face urethroplasty. After one year, the double-face BMG urethroplasty achieved an overall success rate of 88.4%. Double-face BMG urethroplasty is a reliable and effective surgical technique for the treatment of near obliterative or obliterative long anterior urethral strictures. Buccal mucosal graft urethroplasty, Direct visual internal urethrotomy, Anterior urethral stricture, Buccal mucosal graft, Urethral dilatation.

Outcomes of Double-Face Buccal Mucosal Urethroplasty for Treating Anterior Urethral Stricture in Adult Males.

To assess the results of double-face buccal mucosal graft urethroplasty (BMG) for treating anterior urethral stricture in adult males. An observational study. Place and Duration of the Study: Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from 2021 to 2022. The inclusion criteria were adult males, aged 15 to 70 years, with a previous surgical procedure for hypospadias and the presence of long penile and bulbar strictures measuring over 2 cm, resulting from a straddle injury. Forty-three patients were selected who underwent urethroplasty in 2021 and completed a one-year follow-up in 2022. Uroflowmetry (UFM) and the International Index of Erectile Function (IIEF) assessment data were obtained from the patients' medical records. Success was defined as the patient attaining catheter freedom and achieving a maximum flow rate exceeding 15 ml/sec after one year. The mean UFM at one year was 20.89 ml/s. Four patients underwent endo-urological intervention (direct visual internal urethrotomy), and one patient needed a second double-face urethroplasty. After one year, the double-face BMG urethroplasty achieved an overall success rate of 88.4%. Double-face BMG urethroplasty is a reliable and effective surgical technique for the treatment of near obliterative or obliterative long anterior urethral strictures. Buccal mucosal graft urethroplasty, Direct visual internal urethrotomy, Anterior urethral stricture, Buccal mucosal graft, Urethral dilatation.

Decision regret and long-term success rates after ventral buccal mucosa graft urethroplasty.

To characterise the long-term success rate of ventral onlay buccal mucosa graft urethroplasty (vBMG) in the management of bulbar urethral stricture disease (USD), assess patient-reported postoperative satisfaction and decision regret, and delineate clinical factors impacting patient-reported metrics. Patients with prior vBMG for bulbar USD, performed at Cleveland Clinic between 2003 and 2022, were contacted and brief structured interviews were performed. Stricture recurrence and need for secondary procedures, baseline demographics, and patient-reported outcome surveys were collected. The surveys included the Decision Regret Scale (DRS), the Urethral Stricture Symptom Impact Measure (USSIM) and the 10-item Patient-Reported Outcomes Measurement Information System Short Form, version 1.2 (PROMIS-10). Descriptive, univariate and multivariable analyses were performed for clinical outcomes and survey responses. A total of 104 patients recorded responses. The median patient age was 49 years and the median follow-up was 7.4 years at time of survey. The median graft length was 5 cm and 38% of patients underwent partial thickness augmented anastomotic urethroplasty. At time of follow-up, 10 patients underwent a secondary procedure. Moderate to severe regret on the DRS was found in 12% of patients, and greater regret was associated with recurrence. The mean physical and mental health PROMIS-10 Global Health T-scores were 52 and 53. The mean total USSIM score was 56. A significant correlation was found between USSIM and DRS scores, with higher DRS score and recurrence negatively impacting USSIM score. USSIM scoring across all domains was significantly worse in the moderate to severe DRS group. This study showed that vBMG for bulbar USD confers both high success rates and patient-reported satisfaction at extended follow-up, based on emerging and validated patient-reported outcome measures.

Robotic buccal mucosal graft ureteroplasty using combination of posterior-inlay and anterior-onlay technique.

Buccal mucosal graft (BMG) ureteroplasty, particularly with the anterior-onlay technique, shows promise for treating complex ureteral strictures. However, long and circumferential strictures remain challenging. This study aimed to present the surgical technique of the posterior-inlay and anterior-onlay technique in robotic ureteroplasty with a BMG (RU-BMG). A 37-year-old male patient with a medical background of failed laparoscopic ureteroplasty and multiple endourological interventions was admitted to our hospital. Preoperative anterograde and retrograde pyelography revealed a 5-cm ureteral stricture. During the surgical procedure, the ureteral posterior wall was insufficient to facilitate a complete posterior augmented anastomosis, resulting in a posterior defect subsequent to the partial posterior augmented anastomosis. Ultimately, a BMG was utilized to address the posterior defect initially, followed by anterior-onlay ureteroplasty with a BMG. The Foley catheter was removed 2 weeks after surgery, while the nephrostomy tube was clamped on postoperative day 14. The double-J stent was removed 3 months after surgery. The preoperative serum creatine was 102.9 μmol/L. The surgery was performed successfully within 240 min, with estimated blood loss of 100 mL. The postoperative hospitalization was 4 days. Throughout the 12-month follow-up period, no symptoms or complications were observed, with a serum creatine of 82.0 μmol/L. Computed tomography urography indicated relieved hydronephrosis. In conclusion, RU-BMG using a combination of posterior-inlay and anterior-onlay technique is safe and feasible in the management of ureteral stricture. More cases and longer follow-up for this procedure are needed for better perfection of this procedure.

From failure to success: management of recurrent urethral strictures with buccal mucosa graft

From failure to success: management of recurrent urethral strictures with buccal mucosa graft

259 - Ventral inlay versus dorsal onlay buccal mucosal graft urethroplasty for female urethral stricture; Randomized control trial

259 - Ventral inlay versus dorsal onlay buccal mucosal graft urethroplasty for female urethral stricture; Randomized control trial

Reply to Editorial Comment on “Comparative Analysis of Dorsal Onlay Buccal Mucosal Graft and Vaginal Wall Graft Urethroplasty for Female Urethral Stricture at a Tertiary Care Centre”

Reply to Editorial Comment on “Comparative Analysis of Dorsal Onlay Buccal Mucosal Graft and Vaginal Wall Graft Urethroplasty for Female Urethral Stricture at a Tertiary Care Centre”

Editorial Comment on “Comparative Analysis of Dorsal Onlay Buccal Mucosal Graft and Vaginal Wall Graft Urethroplasty for Female Urethral Stricture at a Tertiary Care Centre”

Editorial Comment on “Comparative Analysis of Dorsal Onlay Buccal Mucosal Graft and Vaginal Wall Graft Urethroplasty for Female Urethral Stricture at a Tertiary Care Centre”

258 - Novel technique of Minced Buccal Mucosal Graft Endourethral Urethroplasty- A pilot Study

258 - Novel technique of Minced Buccal Mucosal Graft Endourethral Urethroplasty- A pilot Study

58 - Surgical Treatment of Complex Sexual Abuse Sequelae: a report of concurrent Buccal Mucosa Graft Urethroplasty, Autologous Sling, and Vulvoplasty.

58 - Surgical Treatment of Complex Sexual Abuse Sequelae: a report of concurrent Buccal Mucosa Graft Urethroplasty, Autologous Sling, and Vulvoplasty.

Patient-reported outcomes after one-stage neourethral reconstruction in transmen with phalloplasty-associated strictures and fistulas

IntroductionUrethral strictures and fistulas arising after gender-affirming surgery in transmen require meticulous management strategies. This study evaluates the safety and efficacy of urethral reconstruction and patient satisfaction post-surgery.MethodsA retrospective analysis examined peri- and postoperative data from transmen undergoing urethral reconstruction for urethral fistula and/or strictures at the distal urethral anastomosis between December 2017 and April 2023. Follow-up involved clinical examinations, uroflowmetry, and voiding cystourethrography. Patient satisfaction and quality of life were assessed using USS PROM and ICIQ-S questionnaires.ResultsAmong 25 patients, 88% (n = 23) had urethral fistulas, and 48% (n = 12) had urethral strictures. 41% of fistula patients also had strictures, while 75% of stricture patients had concurrent fistulas. Previous surgeries for fistula or stricture repair were noted in 26% of cases. Techniques for stricture included modified flap (50%), buccal oral mucosal grafting (33%), and primary anastomosis (17%). Post-operative urethrogram revealed urethral strictures in 15% (n = 3) and urinary extravasation in an equal number. Postoperative uroflow parameters showed improvement (Qmax 18 ml/s, Qave 7.9 ml, time 37 s, volume 332 ml). Perioperative complications were low (n = 6, 24%), all grade one (Clavien-Dindo). Follow-up revealed that 33% required another surgical intervention. The mean six-item LUTS score was 6.7 (SD 3.9). Mean ICIQ-S overall satisfaction score was 8.6 (SD 1.6) and outcome score was 20 (SD 2.8).DiscussionOur study found a significant recurrence rate of urethral strictures and fistulas post-surgery. Despite this, patient satisfaction remains high and complications are generally low-grade, highlighting the importance of expert surgical intervention.

A novel lower eyelid reconstruction using a skin-tarsoligamentous sling to prevent postoperative drooping deformity: Quantitative analyses using drooping index and angular difference in canthal tilt

Lower eyelid reconstruction using skin flaps sometimes results in undesirable deformities due to postoperative flap drooping. We aimed to examine the effectiveness of a novel procedure for reconstructing the skin-tarsoligamentous sling of the lower eyelid. We included 37 patients who underwent anterior lamellar reconstruction with a cheek rotation flap for full-thickness lower eyelid defect. They were divided into two groups: Group A included 19 patients who underwent tarsoligamentous sling reconstruction with a fascia lata strip and buccal mucosa grafting, while Group B comprised 18 patients who underwent skin-tarsoligamentous sling reconstruction using an additional combination of a periosteal flap and de-epithelialized triangle flap at the lateral canthal region, representing our novel approach. To evaluate the severity of postoperative deformities, we used the drooping index, the ratio of drooping compared to the healthy side, along with the angular difference in canthal tilt, obtained between the reconstructed and healthy sides, using photographs taken ≥6 months post-reconstruction. Group B demonstrated superior outcomes, with mean drooping indices of 1.13 compared to 1.33 in Group A (P = 0.031) and mean angular differences in canthal tilt of -0.73° compared to -2.45° in Group A (P = 0.021). Patient satisfaction was significantly higher in Group B than in Group A (P = 0.042). Furthermore, patients with a drooping index of < 1.2 and an angular difference in canthal tilt ≥-1.0° exhibited higher satisfaction scores. Our novel approach to lower eyelid reconstruction using a skin-tarsoligamentous sling yielded improved aesthetic outcomes, fewer complications, and higher patient satisfaction.

Urethroplasty- a single centre single surgeon experience.

Male urethral stricture affects 100 in 100,000 men. These are investigated using uroflowmetry, retrograde urethrography and cystourethroscopy. Management is usually endoscopic with urethral dilation or direct visual internal urethrotomy, although they have high failure rates. It is now recommended that urethroplasty is performed earlier. In this study we have reviewed a single surgeons experience with urethroplasty and patient outcomes. We retrospectively reviewed a prospectively maintained database of all urethroplasty operations performed in our hospital over a 5 -year period. Forty-five patients were identified, with a mean age of 46. The most common presenting symptom was poor flow (100%). Uroflowmetry was performed in 31 of 45 patients(69%). More patients had a urethrogram (58%) than flexible cystoscopy (38%). Most strictures were idiopathic (67%). Mean stricture length was 2.6cm. 71% did not require any further intervention. Five patients required repeat surgery. Four required DVIU and one required a repeat urethroplasty. The most popular techniques for urethroplasty in the UK are augmentation urethroplasty using a buccal mucosal graft and anastomotic urethroplasty, both of which we describe. There are variations in what is deemed as successful surgery. The most widely used definition is 'the lack of need for any further operative intervention'. We have recently adopted Patient Reported Outcome Measures using a validated questionnaire to measure the patients perception of a successful outcome. Complex strictures have a higher incidence of complications. 42% of our cohort were complex and we describe results comparable to the published literature.

Non-invasive assessment of the dynamics of change in the vascular bed in the buccal autograph during treatment of extended urethral strictures

The male urethral stricture disease treatment despite all successful achievements and treatment options still remains one of the most actual and complex problems of modern urology. The presence of prolonged urethral strictures complicated with such factors as expressed scared deformation, infection, fistulae, previous unsuccessful urethral interventions, total urethral obliteration require the use of two- or multistage operations. In the light of recent times, the improvement methods dedicated to buccal mucosa graft adaptation assessment and autotransplant microvascularity evaluation are very relevant nowadays. In this study we made an attempt to estimate the dermatoscopy role in objective assessment of buccal mucosa graft microvascular network after two staged substitutive urethroplasty.The analysis of graft microphotos made in different time periods after urethroplasty allows us to define the main thing. In our point of view, the absence of evaluation changes after 90–120 postoperative days allows us to estimate a correct time for the second stage of urethroplasty-tubularization. stages of microvasculature evolution.Considering the statement that microvasculature evolution is the evolution of its graft, we think that the correct research direction is to study microangiogenesis stimulation methods.

Current Potential Outcomes of Buccal Mucosal Graft Anterior Urethroplasty for Male Urethral Stricture: A Single-Centre Study in Nepal.

Objective This study evaluates the efficacy and potential complications of Buccal Mucosal Graft (BMG) urethroplasty for anterior urethral stricture over a 48-month follow-up. Method A retrospective review was conducted on 130 patients who underwent various types of BMG urethroplasty between 2012 and 2019. Data on patient demographics, stricture etiology, and anatomic sitewere collected. Adverse outcomes such as complications likeerectile dysfunction (ED)persisting for over 12 months, and post-micturition dribbling (PMD) were analyzed to determine success rates, recurrent stricture risk factors, complications, and the definition of failure as stricture recurrence during the 48-month follow-up period. Results Of the 130 patients, there was a recurrence in 15.4 % (20 males), yielding a success rate of 84.6% (n=110). ED was reported in 11% (n=14) and PMD in 14% (n=18). All instances of ED were non-organic, and patients were administered oral phosphodiesterase type 5 (PDE5) inhibitors. These complications were observed in 20 patients (15.4%); with urinary fistula (3.0%), graft contracture (2.3%), graft failure (3.8%), urinary tract infection (UTI) (3.0%), and wound infection (2.3%) being the most prevalent after penile urethroplasty. Univariate analysis indicated age (31-50 years, >50 = P<0.05) at surgery, etiology (Balanitis Xerotica Obliterans (BXO)= P<0.05), stricture length (4.1-8 cm, >8 cm = P<0.05), and location as significant predictors of stricture recurrence. However, multivariate analysis highlighted penile location (P<0.05) as the sole independent predictor for restricture during the follow-up period. Conclusion BMG urethroplasty demonstrates a substantial 84.6% success rate in treating anterior urethral stricture over a 48-month follow-up period. This outcome underscores the advancements in healthcare quality in resource-limited settings in countries like Nepal.

PE009 Robot-assisted buccal mucosa graft ureteroplasty for the treatment of benign acquired lumbar ureteral strictures: Initial experience in a tertiary academic referral center

PE009 Robot-assisted buccal mucosa graft ureteroplasty for the treatment of benign acquired lumbar ureteral strictures: Initial experience in a tertiary academic referral center

Evaluation of bi-layer silk fibroin grafts for onlay urethroplasty in a rabbit model of urethral stricture disease.

Background: Autologous tissues such as buccal mucosa (BM) are widely used for reconstruction of urethral strictures; however, limitations such as donor site morbidity and scarce tissue supply require the development of alternative biomaterials for urethral repair. The goals of this study were to determine the safety and efficacy of bi-layer silk fibroin (BLSF) matrices for urethral stricture repair and compare histological and functional outcomes to the standard approach, BM urethroplasty under good laboratory practices.Material and methods: A total of 13 rabbits exhibiting urethral stricture formation following electrocoagulation injury were treated with onlay urethroplasty with either acellular BLSF (N=7) or autologous BM (N=6) grafts for 3months. Uninjured control rabbits were maintained in parallel (N=4).Results and conclusion: Animals receiving BLSF implants were demonstrated to be functionally equivalent to BM grafts in their ability to restored strictured calibers, support micturition and promote tissue regeneration with minimal inflammation.

The urinary and sexual outcomes of buccal mucosal graft urethroplasty versus end-to-end anastomosis: a systematic review with meta-analysis.

The urinary and sexual outcomes after urethroplasty may be a concern for patients, but there are still some controversies regarding the consequences of buccal mucosal graft urethroplasty (BMG) in terms of erectile dysfunction (ED). This meta-analysis aimed to compare urinary and sexual outcomes of BMG and end-to-end urethroplasty (EE). The PubMed, Web of Science, Cochrane, and Embase databases were searched until February 31, 2023. Data extraction and quality assessment were performed by 2 designated researchers. Dichotomous data were analyzed as odds ratios with 95% confidence intervals (CIs). Heterogeneity across studies was assessed by the I2 quantification, and publication bias using Begg's and Egger's tests. Meta-analysis was performed using RevMan software. Outcomes included stricture recurrence, ED, penile complications, and voiding symptoms. Eighteen studies, including 1648 participants, were included in our meta-analysis. The meta-analysis revealed that there was no significant difference in stricture recurrence (OR = 0.74; 95% CI, 0.48-1.13; P = .17) and voiding symptoms (OR = 1.12; 95% CI, 0.32-3.88; P = .86) between the BMG group and the EE group. BMG was associated with lower risk of penile complications (OR = 0.40; 95% CI, 0.24-0.69; P = .001) and ED (OR = 0.53, 95% CI, 0.32-0.90, P = .02). The study may help clinicians choose procedures that achieve better recovery of the urological and sexual function in the treatment of urethral stricture. This meta-analysis is the first to evaluate the urinary and sexual outcomes of BMG vs EE. A limitation is that most of the included studies were retrospective cohort studies. BMG is as effective as EE in the treatment of bulbar urethral stricture, but BMG has fewer complications and ED than EE.

Robotic Buccal Mucosa Grafting for Distal Ureter Stricture Related to Deep Endometriosis

Robotic Buccal Mucosa Grafting for Distal Ureter Stricture Related to Deep Endometriosis