Lingual Mucosal Graft Research Articles

Robotic-assisted laparoscopic modified ureteroplasty using lingual mucosa grafts or appendiceal flaps for the management of complex ureteral strictures: a retrospective cohort study

ObjectiveTo evaluate the feasibility, safety and efficacy of robot-assisted laparoscopic modified ureteroplasty using a lingual mucosa graft (LMG) or an appendiceal flap (AF) for complex ureteral strictures and summarize our experience.MethodsA total of 16 patients with complex ureteral strictures (range: 1.5–5 cm) who underwent robotic-assisted laparoscopic-modified ureteroplasty and were admitted to our hospital from May 2022-October 2023 were retrospectively analyzed. We used modified presuture methods in patients who needed the posteriorly augmented anastomotic technique to reduce anastomotic tension. Perioperative variables and outcomes were recorded for each patient.ResultsThe operation under robot-assisted laparoscopy was successfully performed in all sixteen patients (12 with LMG ureteroplasty and 4 with AF ureteroplasty) without conversion to open surgery. The mean length of the ureteral structure was 2.90 ± 0.90 cm (range: 1.5–5 cm), the mean operation duration was 209.69 ± 26.74 min (range: 170–255 min), the median estimated blood loss was 75 (62.5) ml (range: 50–200 ml), and the duration of postoperative hospitalization was 10.44 ± 2.10 d (range: 7–14 d). The follow-up time in this group was 6 ~ 21 months. The success rate of the surgery was 100%.ConclusionRobot-assisted laparoscopic modified ureteroplasty using AF or LMG is a safe and feasible operation for complex ureteral strictures and deserves to be popularized.

Role of lingual mucosa as a graft material in the surgical treatment of Peyronie's disease.

Peyronie's disease (PD) is a localized fibrosis of tunica albuginea, which causes the anatomical and functional changes to the penis. Corporoplasty with grafting is indicated in severe (>60°) and complex curvature. Buccal mucosa is the most favored autologous graft material nowadays. The ventrolateral aspect of lingual mucosa has similar histological features to the rest of the oral cavity. This study aimed to test the efficacy, safety, durability, and reproducibility of corporoplasty with lingual mucosal graft (LMG) in the surgical treatment of PD in terms of surgical outcome, sexual function, and donor site complications. This prospective study included 19 patients of PD with severe and complex curvature, who underwent corporoplasty with LMG. Surgical and functional outcomes were assessed at follow-up planned at 2 weeks, 3 months, 6 months, 1 year, and 2 years. The mean operative time was 126.31 ± 21.45 min. Additional Nesbit's plication to correct the residual deformity was required in 26% (5 / 19) of patients. Straightening of the penis (curvature <10°) was achieved in 89% (17 / 19) of patients. Increase in the penile length (>1 cm) postoperatively was achieved in 63% (12 / 19) of patients and a shortening of penis occurred in 5% (1 / 19) of patients. Newer onset erectile dysfunction developed in 11% (2 / 19) of patients, and patient and partner satisfaction rates were 89% (17 / 19) and 84% (16 / 19), respectively, in a mean follow-up of 20.66 ± 5.37 months. Donor site complications were minimal and no patient had any salivary changes or speech disturbances. LMG provided excellent short-term results in terms of deformity correction, improved sexual function, and minimal donor site morbidity. The method is simple and reproducible, and multicenter studies with larger number of cases with longer follow-up are required to confirm these favorable results.

Treating Multifocal Ureteral Strictures with Combined Techniques: 14 Cases of Initial Experience.

Purpose: To evaluate the safety and feasibility of lingual mucosal graft ureteroplasty (LMGU) combined with ureteral reimplantation (UR) for repairing managing multifocal ureteral strictures (MUS). Methods: Between December 2020 and December 2022, 14 patients underwent LMGU combined with UR. Their perioperative data were collected retrospectively and analyzed. For the proximal diseased ureter, the narrow segment was incised longitudinally to open the ventral wall of ureter, and a lingual mucosal graft was placed as an onlay graft. Meanwhile, UR was applied to treat distal ureteral strictures. Results: Of 14 patients, three (21.4%) had previously undergone a failed ureteral reconstruction. The mean (standard deviation [SD]) proximal stricture length was 4.0 cm (1.56), and distal ureteral stricture length was 4.3 cm (0.94). The mean (SD) operative time was 236 minutes (57), the estimated blood loss was 78 mL (41.5), and the length of postoperative stay was 6 days. One (7%) patient underwent double LMGU to treat proximal 2 segments of ureteral stricture. No open conversions and intraoperative complications occurred. With a mean follow-up of 15 months (range 6-29), the recurrence-free rate was 14/14 (100%). Conclusions: LMGU combined with UR is a feasible and effective technique for managing MUS and can be an alternative to ileal ureteral replacement or renal autotransplantation in some selected patients with MUS.

The Whitaker test: a predictive tool for evaluating the surgical efficacy of upper urinary tract reconstruction in patients carrying a nephrostomy tube after surgery.

To explore the role of the Whitaker test in evaluating the postoperative outcome of upper urinary tract reconstruction surgery in patients carrying a nephrostomy tube after surgery. This was a prospective observational study performed in 42 patients with nephrostomy tube undergoing the Whitaker test after upper urinary tract reconstruction surgery between January 2020 and December 2021. Data on clinical information, the Whitaker test and surgical procedure were collected prospectively, and the long-term follow-up results were analysed retrospectively. The 46 ureters of 42 patients (right 16, left 22, bilateral 4) underwent six common upper urinary tract surgical reconstruction procedures and one combined procedure, including pyeloplasty, ureteroureterostomy, lingual mucosal onlay graft, appendiceal onlay flap, ureteral reimplantation, Boari flap, and ipsilateral lingual mucosal onlay graft combined ureteral reimplantation. All patients underwent the Whitaker test successfully without any discomfort after examination. The postoperative Whitaker test showed 43 kidneys without obstruction and 3 kidneys with obstruction. At a median follow-up of 18 months (range 13-31), the follow-up results showed that the overall success rate of the surgery was 100% (46/46). Concerning the concordance Whitaker test and follow-up results, the observed proportion of agreement was 93.5% (43/46). The Whitaker test can achieve similar consistency with the long-term follow-up results after upper urinary tract reconstruction surgery and can be used as a tool to evaluate the surgical efficacy of upper urinary tract reconstruction surgery, which can provide a prognostic efficacy evaluation for patients carrying a nephrostomy tube after surgery.

Minimally invasive ureteroplasty with lingual mucosal graft for complex ureteral stricture: analysis of surgical and patient-reported outcomes.

To evaluate objective treatment efficacy and safety, and subjective patient-reported outcomes in patients with complex ureteral strictures (US) undergoing minimally invasive lingual mucosal graft ureteroplasty (LMGU). We prospectively enrolled patients underwent robotic or laparoscopic LMGU between May 2020 and July 2022. Clinical success was defined as symptom-free and no radiographic evidence of re-obstruction. Patient-reported outcomes, including health-related quality of life (HRQoL), mental health status and oral health-related quality of life (OHRQoL), were longitudinally evaluated before surgery, 6 and 12 months postoperatively. Overall, 41 consecutive patients were included. All procedures were performed successfully with 32 patients in robotic approach and 9 in laparoscopic. Forty (97.56%) patients achieved clinical success during the median follow-up of 29 (range 15-41) months. Although patients with complex US experienced poor baseline HRQoL, there was a remarkable improvement following LMGU. Specifically, the 6-month and 12-month postoperative scores were significantly improved compared to the baseline (p < 0.05) in most domains. Twenty-eight (68.3%) and 31 (75.6%) patients had anxiety and depression symptoms before surgery, respectively. However, no significant decrease in the incidence of these symptoms was observed postoperatively. Moreover, there was no significant deterioration of OHRQoL at 6 months and 12 months postoperatively when compared to the baseline. LMGU is a safe and efficient procedure for complex ureteral reconstruction that significantly improves patient-reported HRQoL without compromising OHRQoL. Assessing patients' quality of life enables us to monitor postoperative recovery and progress, which should be considered as one of the criteria for surgical success.

Male refractory hypospadias with sexual reversal: a case report

BackgroundHypospadias is one of the most prevalent urogenital malformations in clinic. However, some hypospadias may have a more complex disorder of sex development. Usually, hypospadias in these patients is severe. Among them, the 46,XX male sex reversal syndrome is a rare disorder of sex development, and this may be the main reason for this type of hypospadias being difficult to repair.Case presentationWe present a Han nationality 19-year-old male with failure of repeated repair of hypospadias. No sperm was found on semen analysis. Lingual mucosal graft was carried out for this patient. It still did not succeed after using lingual mucosal graft repair. Karyotype analysis of this patient confirmed 46,XX karyotype.ConclusionHypospadias with 46,XX male sex reversal syndrome is hard to repair. Chromosome karyotype examination in patients with hypospadias is suggested. Genetic testing is recommended. In the future, further research is needed on the pathogenesis of disease and how to treat and prevent it.

Robotic-assisted laparoscopic modified ventral onlay lingual mucosal graft in complex ureteral stricture construction: experience of eight cases

Objective: To examine the efficacy of robot-assisted laparoscopic modified ventral onlay lingual mucosal graft for complex ureteral stricture. Methods: The clinical data of 8 patients with ureteral stricture admitted to the Department of Urology, General Hospital of Southern Theater Command from May to October 2022 were retrospectively analyzed. There were 6 males and 2 females, aged (45.1±10.2) years (range: 34 to 64 years), body mass index (24.6±2.0) kg/m2 (range: 20.7 to 26.6 kg/m2). Five cases on the left side, 3 cases on the right side, the length of the ureteral structure was (3.1±0.7) cm (range: 2.2 to 4.5 cm). The value of preoperative serum creatinine was (113.8±22.3) μmol/L (range: 96 to 15 μmol/L). Before excising the structure segment, the titched anastomosed part of the dorsal wall of the ureter, and then the posteriorly augmented anastomotic, the remaining ventral side was augmented with a onlay lingual mucosa graft, then the omentum flap was used to wrap the reconstructed ureteral segment. The lingual mucosa graft with a length of 2.5 to 5.0 cm and a width of 1.0 to 1.5 cm was cut according to the actual structure. The surgery information of the patient, complications, and recent follow-up were recorded. Results: The operation under robot-assisted laparoscopy was performed successfully in the 8 patients without conversion to open surgery. The duration of the operation was (226.9±22.8) minutes (range: 210 to 255 minutes), estimated blood loss was (93.8±25.9) ml (range: 75 to 150 ml), the retention time of the postoperative drainage tube was (4.8±1.3) days (range: 3 to 7 days), and the duration of postoperative hospitalization was (11.1±3.6) days (range: 9 to 14 days). One week after the operation, the patient could pronounce correctly, enunciate clearly, and eat normally. Double J tubes were removed 4 to 8 weeks after the operation. The follow-up time in this group was 3 to 9 months, the follow-up patients underwent imaging and other examinations, which showed a significant improvement in hydronephrosis on the affected side, and the value of renal pelvic separation on the affected side was (1.4±0.8) cm (range: 0 to 2.3 cm). The serum creatinine value was (100.1±24.9) μmol/L (range: 76 to 155 μmol/L). Three months after the operation, the ureteroscopy showed that the ureter was smooth and the mucosa was normal. Conclusions: Robot-assisted laparoscopic ureteroplasty with a lingual mucosal graft is a safe and feasible operation for complex ureteral stricture without serious complications, which provides a surgical option for repairing ureteral stricture.

Robotic-assisted double lingual mucosal graft ureteroplasty for multifocal ureteral strictures: Case report and technical description.

Ureteroplasty with a single onlay graft for proximal ureter stricture has been widely used in the clinic. However, robotic ureteroplasty with a double lingual mucosal graft (RU-DLMG) has not been reported. The intraoperative measured ureteral stricture lengths of patient 1 were 1.8, 2.5, and 4.6cm, and those of patient 2 were 2.5 and 3.5cm. We performed a RU-DLMG in which the diseased ureter was incised longitudinally from the ventral side and repaired with a double lingual mucosal graft to widen the ureteral lumen. Because of the presence of a distal ureter stricture, RU-DLMG combined with ureteral reimplantation was performed in patient 1. Antegrade urography showed no obstruction of the reconstructed ureteral segment after removing the ureteral stent. The patients had no complaints about the donor site and flank pain during the 12-month follow-up. RU-DLMG appears to be a suitable option for multifocal ureteral strictures.

Comparative Study to Evaluate Surgical Outcome and Donor Site Morbidity of Buccal Versus Lingual Mucosa Graft in Anterior Urethroplasty

Background: Stricture urethra is a frequent urological problem and substitution urethroplasty is the standard treatment for longer (&gt;2 cm) urerthral strictures, multiple urethral strictures and recurrent strictures. Currently, buccal mucosa graft (BMG) is the preferred donor site for substitution urethroplasty which is associated with donor site morbidities. The mucosa covering the lateral and undersurface of the tongue is identical to the rest of the lining of oral cavity and seems to be associated with less risk of donor site complications. The aim of the study was to compare the surgical outcome and donor site morbidity of buccal versus lingual mucosa graft in anterior urethroplasty. Methods: A prospective experimental study was done in the department of Urology Dhaka Medical College Hospital during the period of April 2017 to September 2018. Total 54 Patients were included by purposive sampling for the study as per inclusion and exclusion Criteria. Patients were than allocated into two groups. Group A consisted of 27 patients where Lingual mucosa graft (LMG) urethroplasty done and group B also consisted of 27 patients where Buccal mucosa graft (BMG) urethroplasty done. Results: In the present study, the baseline characteristics of the patients in group A and Group B were almost similar having no statistically significant difference. The overall surgical outcome between two groups was in group A 92% and in group B 88%. The inter-group difference was not statistically significant. Donor site complications more frequently occurred in Group B. Pain in oral cavity at 3rd week in Group A was in 1(4%) patient and in group B was in 9(36%) patients, at 6th month follow up, eating and drinking problem (Group A 4% versus group B 32%), peri-numbness (Group A 4% versus Group B 28%), oral tightness (Group A 0% versus Group B 32%), salivary disturbance (Group A 0% versus Group B 28%) were significant statistically (p&lt;0.05). Conclusion: We conclude that that lingual mucosa ....

Robotic versus laparoscopic ureteroplasty with a lingual mucosa graft for complex ureteral stricture.

Ureteroplasty with a lingual mucosa graft (LMG) for complex ureteral stricture was reported promising. We aimed to compare outcomes of robotic versus laparoscopic ureteroplasty using a LMG (RU-LMG vs. LU-LMG, respectively). From October 2018 to January 2021, 32 ureteroplasties using LMGs were performed by one experienced surgeon, including 16 robotic and laparoscopic procedures each. Patient demographics and peri-operative, post-operative, and follow-up data were prospectively collected and compared. The robotic group had a higher rate of previous reconstruction than the laparoscopic group (62.50% vs. 18.75%; p = 0.012). The stricture length was significantly longer in the robotic group (4.8 ± 1.2cm) than the laparoscopic group (3.7 ± 1.2cm; p = 0.013). All procedures were completed successfully without open conversion. The operative time was shorter in the robotic group (192 ± 54min) than the laparoscopic group (254 ± 46min; p = 0.001). The robotic group had a shorter length of post-operative stay (6.1 ± 2.4 d vs. 8.9 ± 4.3 d; p = 0.033) but a higher hospital cost (76,801 ± 17,974 vs. 42,214 ± 15,757 RMB; p < 0.001) than the laparoscopic group. The mean follow-up time was 21 ± 7months for the robotic group and 29 ± 9months for the laparoscopic group respectively (p = 0.014). No difference was detected in the success rate (93.75% and 100%, respectively; p = 0.309) and complication rate (18.75% and 31.25%, respectively; p = 0.414) between the robotic and laparoscopic groups. Both RU-LMG and LU-LMG are feasible, effective, and safe for repair of complex ureteral strictures. RU-LMG had a shorter operative time and a shorter length of post-operative stay but a higher hospital cost.

Comparison between Lingual Mucosal Graft Urethroplasty and Buccal Mucosal Graft Urethroplasty in The Management of Anterior Urethral Stricture.

Background: Urethral stricture is a chronic and common urological problem in Bangladesh and its management poses a big challenge to urologists. Surgical treatment of urethral stricture diseases is a continuously evolving process, and the superiority of one technique over another has yet to be clearly demonstrated. Urethrotomy is the most commonly used technique but long term results are not satisfactory. Long penile urethral strictures are best treated by substitution urethroplasty. The ideal graft material for substitution urethroplasty is constantly evolving. Buccal mucosa produces excellent result but is associated with many long term donor site complications. Lingual mucosa is an alternative donor site for graft urethroplasty and achieved good functional and aesthetic results. Materials &amp; Methods: A hospital based prospective study was conducted in the department of urology, Dhaka Medical College Hospital from July 2016 to March 2017. Total 40 patients were included in this study. They were divided in two groups, group 1 was treated by lingual mucosal graft and group 2 was treated by buccal mucosal graft. All patients were followed up for six months noting pre and post-operative maximum urine flow rate (Qmax), voiding time and complications at both urethroplasty and donor site. Results: There were no significant differences in overall operative success rate between two groups of patients. But complications at donor site were higher in group 2 patients. Conclusion: Lingual mucosal graft urethroplasty may be preferred to buccal mucosa in anterior urethral stricture as it is easy to harvest and is associated with less short and long term donor site complications without significant difference in operative success rate. KYAMC Journal Vol. 13, No. 02, July 2022: 108-114

Lingual Mucosal Graft Ureteroplasty for Long Proximal Ureteral Stricture: 6 Years of Experience with 41 Cases

BackgroundManagement of a long proximal ureteral stricture is challenging. Lingual mucosal graft ureteroplasty (LMGU) is a novel minimally invasive technique for ureteral reconstruction that avoids the morbidity of bowel interposition or autotransplantation. ObjectiveTo evaluate the long-term effectiveness of LMGU for managing long, complex proximal ureteral strictures in a multi-institutional cohort of patients. Design, setting, and participantsThis retrospective study involved data for 41 patients treated with LMGU at three centers between June 2015 and January 2021. Surgical procedureLMGU was performed using either an onlay ureteroplasty in which the diseased ureter was incised ventrally and repaired with a lingual mucosal graft (LMG) to widen the ureteral lumen, or an augmented anastomotic technique in which the obliterated segment of the ureter was excised and reanastomosed primarily on dorsal side, and an LMG was placed on the ventral side. MeasurementsPre-, intra-, and postoperative variables and outcomes were assessed. A descriptive statistical analysis was performed. Results and limitationsOf 41patients, 40 were operated with laparoscopic procedures and one with a robot. Twenty-four (59%) patients underwent an onlay ureteroplasty, and 17 (41%) underwent an augmented anastomotic ureteroplasty. The reconstructed ureter was wrapped with omentum in 90% of cases. The median (range) stricture length was 4.8 cm (2.0–8.0), operative time was 166 min (98–306), and estimated blood loss was 65 ml (15–220). No open conversions and intraoperative complications occurred. At a median follow-up of 35 mo (range 13–80), the overall success rate was 97.6% (40/41). ConclusionsLMGU is a safe, feasible, and effective long-term technique for managing long, complex proximal ureteral strictures. Patient summaryWe reported a novel technique for long proximal complex ureteral strictures using an onlay lingual mucosal graft (LMG). Our 6-yr outcomes demonstrate that onlay LMG ureteroplasty is a safe, feasible, and effective long-term procedure for ureteral reconstruction.

V06-09 DORSAL ONLAY LINGUAL MUCOSA GRAFT URETHROPLASTY FOR FEMALE URETHRAL STRICTURE

You have accessJournal of UrologyCME1 May 2022V06-09 DORSAL ONLAY LINGUAL MUCOSA GRAFT URETHROPLASTY FOR FEMALE URETHRAL STRICTURE Claire Richard, Benoit Peyronnet, Alice Drain, Juliette Hascoet, Nirit Rosenblum, Rachael Sussman, Lucas Freton, Lee C. Zhao, Victor W. Nitti, and Benjamin Brucker Claire RichardClaire Richard More articles by this author , Benoit PeyronnetBenoit Peyronnet More articles by this author , Alice DrainAlice Drain More articles by this author , Juliette HascoetJuliette Hascoet More articles by this author , Nirit RosenblumNirit Rosenblum More articles by this author , Rachael SussmanRachael Sussman More articles by this author , Lucas FretonLucas Freton More articles by this author , Lee C. ZhaoLee C. Zhao More articles by this author , Victor W. NittiVictor W. Nitti More articles by this author , and Benjamin BruckerBenjamin Brucker More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002586.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The most widely accepted definition of female urethral stricture (FUS) is a symptomatic, anatomical narrowing of the urethra based on a failure of catheterization, urethral calibration, visual inspection, endoscopy or radiography. Thus it is a rare condition, its diagnostic and treatment are challenging for the reconstructive urologist. METHODS: We present the case of a 47 year-old female, with a urethral stricture due to vulvar lichen sclerosus inducing incomplete bladder emptying and recurrent urinary tract infections. We decided to use lingual mucosa because the buccal mucosa was also affected by the lichen. The aim of this video was to describe the procedure of dorsal onlay lingual mucosa graft urethroplasty. RESULTS: The operating time was 70 minutes. The procedure began with the injection of adrenaline and xylocaine serum. An inverted U incision was performed anterior to the urethra. Dissection was carried out in the plane developed between the underlying urethra and overlying clitoral cavernous tissue. A dorsal urethrotomy was performed at a 12 o’ clock position until healthy proximal urethra was reached. The lingual mucosa graft was harvested after having identified the Wharton’s duct orifices. The graft edges were incised using a scalpel and the graft was removed using sharp scissors. The graft was maturated by removing the fat and muscular tissue of its non-mucosal side. The graft was sutured to the margins of the urethral plate. The distal part of the graft was quilted to the above periurethral flap in order to recreate the ventral aspect of the urethral meatus. A 18FR silicone catheter was placed carefully at the end of the procedure. No peri operative complication occurred. The patient was discharged two days after surgery and did not have recurrence of stricture after 6 months. CONCLUSIONS: Dorsal onlay lingual mucosa graft urethroplasty is a feasible option for female urethral stricture with satisfactory postoperative outcomes. Source of Funding: No © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e567 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Claire Richard More articles by this author Benoit Peyronnet More articles by this author Alice Drain More articles by this author Juliette Hascoet More articles by this author Nirit Rosenblum More articles by this author Rachael Sussman More articles by this author Lucas Freton More articles by this author Lee C. Zhao More articles by this author Victor W. Nitti More articles by this author Benjamin Brucker More articles by this author Expand All Advertisement PDF DownloadLoading ...

Histological Comparison of Buccal and Lingual Mucosa Grafts for Urethroplasty: Do They Share Tissue Structures and Vascular Supply?

Comparable outcomes were published using a buccal mucosa graft (BMG) from the cheek and a lingual mucosa graft (LMG) from the sublingual area, for urethral augmentation or substitution. To date, no histological comparison between both grafts has been conducted. We histologically assessed BMG and LMG harvested during urethral surgeries, aiming to compare graft properties and vascular support. We conducted a prospective single cohort study, including oral mucosa urethroplasty patients. During surgery, graft dimensions and donor sites were collected, and a 0.5 × 0.5 cm sample was obtained from the prepared graft. Formalin-fixed paraffin-embedded samples were sliced at 4 micrometres (µm) and hematoxylin-eosin stained. Using a telepathology tool, all slides were digitalized and measured from 10× to 40× magnification. In each graft, global and individual layers thicknesses were assessed, including vascular density and area. Descriptive and comparative (parametrical and non-parametrical) statistical analysis occurred. We collected 57 grafts during 33 urethroplasties, with 30 BMG and 22 LMG, finally, included. The mean age was 56.6 (SD 15.2) years, and the mean graft length was 5.8 (SD 1.7) cm and the width was 1.7 (SD 0.4) cm. The median graft thickness was 1598.9 (IQR 1200–2100) µm, the mean epithelium layer was 510.2 (SD 223.7) µm, the median submucosa was 654 (IQR 378–943) µm. the median muscular was 477.6 (IQR 286–772) µm, the median vascular area was 5% (IQR 5–10), and the median adipose tissue area was 5% (IQR 0–20). LMG were significantly longer and narrower than BMG. Total graft thickness was similar between LMG and BMG, but the epithelium and submucosa layers were significantly thinner in LMG. The muscular layer was significantly thicker in LMG. Vascular density and vascular areas were not significantly different between both types of grafts. LMG showed significantly less adipose tissue compared with BMG. Our findings show LMG and BMG for urethroplasty surgeries share the same thickness and blood supply, despite having significantly different graft sizes as well as mucosal and submucosal layers thickness.

Robotic-assisted Lingual Mucosal Graft Ureteroplasty for the Repair of Complex Ureteral Strictures: Technique Description and the Medium-term Outcome

BackgroundRobot-assisted autologous graft ureteroplasty provides another treatment option for complex ureteral strictures, circumventing ileal ureter or renal autotransplantation. ObjectiveTo report the medium-term outcome of robotic ureteroplasty with a lingual mucosal graft (RU-LMG) for managing complex ureteral strictures. Design, setting, and participantsBetween June 2019 and September 2020, 12 patients underwent RU-LMG. The perioperative variables were prospectively collected, and the outcomes were assessed. Surgical procedureAfter ureteral stricture dissection, the narrow segment was cut longitudinally, and a lingual mucosal graft (LMG) of the required length was harvested, followed by double-J stent placement and LMG ventral onlay anastomosis. If the diseased ureter required transection, posteriorly augmented ureteral anastomosis could be performed before LMG harvest. Finally, the anastomotic area was wrapped by the omental flap. MeasurementsA descriptive statistical analysis was performed. The criteria for complete success included the absence of both clinical symptoms and obstruction on radiography. Results and limitationsSeven patients (58%) had a history of failed ureteral reconstruction. The mean (range) stricture length was 4.7 (3–6.5) cm, LMG length was 4.4 (3–7) cm, LMG width was 1.5 (1–2) cm, operative duration was 197.1 (130–346) min, estimated blood loss was 49.2 (10–200) ml, and the duration of postoperative hospitalization was 6 (4–14) d. No open conversions and intraoperative complications occurred. The median follow-up time was 15 mo (range: 13–27 mo). The overall success rate was 92% (11/12). ConclusionsThese medium-term follow-up results demonstrate that RU-LMG is a safe and feasible technique for repairing ureteral strictures. Patient summaryOur study proves that robotic ureteroplasty with a lingual mucosal graft is a safe and feasible technique for ureteral reconstruction that can serve as another choice for managing long, complex ureteral strictures.

Treatment of Meatal Strictures by Dorsal Inlay Oral Mucosa Graft Urethroplasty: A Single-Center Experience.

Background: To report on the use of oral mucosa graft urethroplasty for meatal strictures using the dorsal inlay technique. Methods: Patients who underwent a single-stage dorsal inlay oral mucosal graft urethroplasty between January 2000 and May 2021 were included in this study. A follow-up of a minimum of 12 months was necessary for inclusion. Exclusion criteria were stricture extension into the penile urethra, concomitant stricture at another location, flap urethroplasty for a meatal stricture, dorsal inlay urethroplasty with another type of graft, ventral onlay graft urethroplasty or staged urethroplasty. Recurrence was defined by the inability to pass a 14F metal sound through the reconstructed meatus irrespective of patients’ complaints. Results: Our study cohort included 40 patients. Buccal mucosal graft (BMG) urethroplasty was used in 25 patients and 15 patients were treated with the aid of lingual mucosal graft (LMG). The median follow-up was 85 (IQR: 69–110) months. Seven (17.5%) patients suffered a stricture recurrence of which four (10%) needed re-intervention. The median 5-y recurrent free survival (RFS) for the entire cohort was 85 (±6)%. The median 5-y RFS was 96 (±4)% versus 65 (±13)% for respectively BMG and LMG (p = 0.03). Post-operative complications were identified in 11 (27.5%) patients with only one (2.5%) patient who had a grade 3a complication. Conclusions: Dorsal inlay oral mucosa graft urethroplasty is a safe and feasible technique for selected patients with meatal stenosis.

MP56-20 LONG-TERM OUTCOMES AND COMPLICATIONS OF MODIFIED LINGUAL MUCOSA GRAFT RECONSTRUCTIVE TECHNIQUE FOR ANTERIOR URETHRAL STRICTURE

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III (MP56)1 Sep 2021MP56-20 LONG-TERM OUTCOMES AND COMPLICATIONS OF MODIFIED LINGUAL MUCOSA GRAFT RECONSTRUCTIVE TECHNIQUE FOR ANTERIOR URETHRAL STRICTURE Chao Feng, Yue-min Xu, Ying-long Sa, Jiong Zhang, Hong xie, Chong-rui Jin, Jie-min Si, Lu-jie Song, Kai-le Zhang, and Qiang Fu Chao FengChao Feng More articles by this author , Yue-min XuYue-min Xu More articles by this author , Ying-long SaYing-long Sa More articles by this author , Jiong ZhangJiong Zhang More articles by this author , Hong xieHong xie More articles by this author , Chong-rui JinChong-rui Jin More articles by this author , Jie-min SiJie-min Si More articles by this author , Lu-jie SongLu-jie Song More articles by this author , Kai-le ZhangKai-le Zhang More articles by this author , and Qiang FuQiang Fu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002086.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The feasibility and reliability of lingual mucosa graft (LMG) for urethroplasty has been confirmed. In this study, we tried to evaluate the long term results of LMG urethroplasty and to analyze the impact factors for the surgical outcome of LMG reconstruction. METHODS: This retrospective study conclude 105 male patients with anterial urethral strictures. The etiology of strictures included lichen sclerosis, trauma, inflammatory, iatrogenic and idiopathic. Modified lingual mucosa graft harvesting technique was used in all cases. One side dissection dorsal onlay technique (Kulkarni technique) was used for reconstruction. The cases were followed up 6 months, 2 years and 5 years after discharge. RESULTS: The mean follow-up duration was 33.77±19.43 months. The average length of stricture was 7.45±4.22 cm. The average length and width of lingual mucosa graft were 7.13±3.95 cm and 1.50±0.45 cm, respectively. By the 6 months after operation, 77.17% cases were recorded a good result. At the end of 2 years, 80.95% cases still maintained an idea outcome. Within 5 years follow-up, only 7 cases complained about the oral complications since 6 months after the operation. The width and length of graft was not related with surgical outcome and complication. However, age showed the relationship with short term surgical outcome. CONCLUSIONS: The modified lingual mucosa graft reconstructive technique has been proved to be used for various anterior urethral stricture feasibly. For the long-term results, it showed the good outcome and few complications. The age might be the independent impact factors for the short term surgical ooutcome. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e976-e977 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chao Feng More articles by this author Yue-min Xu More articles by this author Ying-long Sa More articles by this author Jiong Zhang More articles by this author Hong xie More articles by this author Chong-rui Jin More articles by this author Jie-min Si More articles by this author Lu-jie Song More articles by this author Kai-le Zhang More articles by this author Qiang Fu More articles by this author Expand All Advertisement Loading ...

Lingual mucosa graft ureteroplasty for ureteral stricture: a narrative review of the current literature

Long proximal or middle ureteral strictures remain challenging conditions. Although ileal replacement of the ureter or renal autotransplantation are possible solutions for these problems, both present complexities and considerable morbidity. In recent years, many urologists have tended to use oral mucosal grafts to repair complex proximal or middle ureteral strictures and thereby avoid ileal replacement and renal autotransplantation. A comprehensive search of oral mucosa graft ureteroplasty and lingual mucosa graft (LMG) ureteroplasty was performed. All literatures must be in English language. Most reports related to oral mucosa graft ureteroplasty focus on buccal mucosa grafts (BMGs). The available data about LMG ureteroplasty are limited. Both LMG and BMG are oral mucosa grafts that have similar histological structures. The success rates of urethroplasty with LMG and BMG are similar. Although there is still no comparative study between LMG and BMG for ureteroplasty, the limited reports show that LMG ureteroplasty is safe and effective for the management of ureteral strictures. This method provides one more option for the management of long proximal and/or middle ureteral strictures. However, the current studies on LMG ureteroplasty have a small sample size and are retrospective. More prospective, multicenter and large sample studies with long-term follow-up results that can further prove the efficacy of LMG ureteroplasty are still needed.

Multi-Factorial Analysis of Recurrence and Complications of Lingual Mucosa Graft Urethroplasty for Anterior Urethral Stricture: Experience from a Chinese Referral Center

ObjectiveTo evaluate the risk factors that pertain to stricture recurrence and oral complications. MethodsPatients with long segmented anterior urethral stricture who visited our hospital from 2009 to 2016 were treated with lingual mucosa graft (LMG) urethroplasty. The incidence of complications in all of 128 patients were evaluated. The data were analyzed using the chi-squared test and Fisher's exact test. A multi-factorial regression analysis was performed to identify the risk factors responsible for the recurrence and complications. ResultsFor patients having LMG urethroplasty, there were no significant difference in recurrence of urethral stricture according to the studied variables. Binary logistic regression analysis reveals that previous surgery involving the urethra was a significant predictor of urethral stricture recurrence (odds ratio [OR]=5.07; 95% confidence interval [95% CI], 1.06–24.40; P = .043). The length of the substitute was significantly related to oral morbidity (P = .020), even after controlling for the studied variables. Patients with a harvested oral mucosa longer than 7 cm had a higher risk of oral morbidity than those with a harvested oral mucosa shorter than 7 cm (OR=4.35; 95% CI, 1.35–14.06; P = .014). ConclusionOur study shows that LMG urethroplasty is effective for patients with long segmented anterior urethral stricture. Previous urethral surgery was identified as a risk factor to cause recurrence and injury to the tip of the tongue for the oral complications.

The application of the "omental wrapping" technique with autologous onlay flap/graft ureteroplasty for the management of long ureteral strictures.

BackgroundTo present our experience with the “omental wrapping” technique in laparoscopic and robotic ureteroplasty using onlay flaps or grafts for the management of long proximal or middle ureteral strictures.MethodsThis is a retrospective review of 25 patients with long proximal or middle ureteral strictures who underwent laparoscopic and robotic onlay flaps or grafts ureteroplasty using an omental flap to reinforce an anastomosis site between August 2018 and November 2019. Perioperative and follow-up data were collected.ResultsSixteen laparoscopic procedures and nine robotic procedures were performed successfully. Sixteen patients underwent ureteroplasty with lingual mucosal graft (LMG), and nine patients with appendiceal onlay flap (AOF). The median stricture length was 4 cm (range, 2–6 cm). The mean operative time (OT) was 220.5±50.6 min, the estimated blood loss (EBL) was 66.0±38.9 mL, and the length of hospital stay (LHS) was 8.0±3.6 days. In the LMG group, four patients had tongue numbing and one had an oral ulcer, which relieved itself gradually without intervention. Two patients in the LMG group and four patients in the AOF group experienced urinary tract infection, and all responded well to antibiotic treatment. There were no complications attributed to “omental wrapping”. The mean follow-up was 16.3±4.8 months. According to the standards regarding improvement in clinical symptoms, relief of obstruction radiologically and a stable estimate glomerular filtration rate, our surgical success rate was 100%.ConclusionsThe “omental wrapping” technique in laparoscopic and robotic onlay flaps or grafts ureteroplasty for long proximal or middle ureteral strictures is an efficient, safe, reproducible and simple technique.