Mucosal Graft Harvest For Urethroplasty Research Articles

EDITORIAL COMMENT

In recent decades, oral mucosa grafts have increasingly replaced flaps and other grafts in the reconstructive urologists’ armamentarium for repair of urethral strictures by substitution urethroplasty. With the rise in oral mucosa graft use, there has also been a greater consideration of the potential limitations and morbidity of oral mucosa graft harvesting. 1 Wood DN Allen SE Andrich DE Greenwell TJ Mundy AR The morbidity of buccal mucosal graft harvest for urethroplasty and the effect of nonclosure of the graft harvest site on postoperative pain. J Urol. 2004; 172: 580-583 Crossref PubMed Scopus (151) Google Scholar As a result, further alternative graft sources have been investigated. Tunica vaginalis has been proposed as a potential alternate graft source for substitution urethroplasty, with several animal model studies and a small series of patients showing promising results in the short term. 2 Calado AA Macedo Jr, A Delcelo R de Figueiredo LF Ortiz V Srougi M The tunica vaginalis dorsal graft urethroplasty: experimental study in rabbits. J Urol. 2005; 174: 765-770 Crossref PubMed Scopus (25) Google Scholar , 3 Foinquinos RC Calado AA Janio R Griz A Macedo Jr, A Ortiz V The tunica vaginalis dorsal graft urethroplasty: initial experience. Int Braz J Urol. 2007; 33 (discussion 529-531): 523-539 Crossref PubMed Scopus (25) Google Scholar Tunica vaginalis may present some advantages over oral mucosa grafts, including its ease of harvest, lack of morbidity, and larger surface area.

Prediction of Early and Late Complications after Oral Mucosal Graft Harvesting: Multivariable Analysis from a Cohort of 553 Consecutive Patients

We investigated the early and late complications after oral mucosal graft harvesting, and reported the independent predictors of outcome via multivariable analysis. We performed a retrospective descriptive study of 553 patients from whom an oral mucosa graft was harvested for urethroplasty from single or bilateral cheeks. Patients who underwent oral mucosa harvesting from the lip, the tongue or from the cheek and lip at the same time were excluded from analysis. The oral graft was harvested in an ovoid shape with closure of the wound. Postoperative early and late complications were investigated using a self-administered, nonvalidated, semiquantitative questionnaire. There were 6 questions on early complications, and 13 questions investigated late complications and patient satisfaction. Descriptive statistics of categorical variables focused on frequencies and proportions. Univariable and multivariable analyses were used to predict early and late dissatisfaction of patients. Bleeding was reported in 3.4% of patients. Overall 53.2% of patients did not report any pain and 36.3% reported no swelling. Late complications analysis showed that 95.5% of patients declared that the surgical closure of the wound did not cause any difficulty in opening the mouth or problems with smiling (98.2%) and/or dry mouth (95.8%). Overall 98.2% of patients were satisfied with the procedure. Univariable and multivariable analyses revealed that bilateral graft harvesting was the only significant predictor of patient dissatisfaction (OR 2.85, p = 0.01 and OR 2.72, p = 0.02; respectively). Harvesting the oral mucosa ovoid graft from a single cheek with closure of the wound is a safe procedure with high rates of patient satisfaction.

Donor Site Evaluation After Lingual Mucosal Graft Harvest for Urethroplasty

This study was carried out in the Department of Urology, National Institute of Kidney Diseases and Urology, (NIKDU), during the period from Jan' 09 to Dec' 10 to assess the complications at donor site after lingual mucosal graft harvesting for urethroplasty. A total of 30 patients with mean age of 36.6 years (rang 21 to 56 years) and mean urethal stricture length of 36 mm (range 22 to 59 mm) who underwent urethroplasty for anterior urethral strictures using dorsal onlay of a lingual mucosal graft (LMG) were selected for the study. The site of the harvest graft was ventrolateral mucosal lining of the tongue. Donor site complications like pain, numbness, tightness, slurring of speech, salivatory changes and difficulty in protrusion of tongue were noted. The mean period of follow-up was 14 months (range 6-18 months). At the first postoperative day, 96% of the patients experienced pain at donor site and 26% had slurring of speech. Pain was mild to discomforting in 60% and distressing to excruciating in 37% of the patients. By third postoperative day, 22 (73%) patients were pain free, 06 (20%) suffered from mild pain and 02 (6%) suffered from discomforting pain only and none had slurring of speech. On the fifth postoperative day, only 02 (6%) patient suffered pain. By day 6 of surgery, all patients were pain free. Only 01 (3.3%) patients reported numbness which persisted during the whole period of follow up. The study showed that LMG is easy to harvest and associated with less postoperative pain, minor risk of donor site complications and without any functional or esthetic deficiency. So tongue may be the best alternative donor site for anterior urothroplasty. DOI: http://dx.doi.org/10.3329/bjmb.v5i2.13341 Bangladesh J Med Biochem 2012; 5(2): 48-52

Poster 43: Morbidity of Buccal Mucosal Graft Harvesting for Urethroplasty: A Long-Term Follow-Up Study

Previous studies have investigated early morbidity when using buccal mucosal grafts for reconstruction of urethral strictures. The aim of this study was to investigate long-term objective and subjective morbidity with regards to the oral donor site.

Oral complications after lingual mucosal graft harvesting for urethroplasty in 110 cases

OBJECTIVE • This study was to evaluate donor-site complications of lingual mucosal graft harvesting for substitution urethroplasty. PATIENTS AND METHODS • 110 patients with anterior urethral strictures or hypospadias underwent lingual mucosal grafts (LMGs) urethroplasty. Dual LMGs were harvested from both sites separately or a long mucosal graft was harvested from one side to other side of tongue in 29 patients (group one); a shorter mucosal graft was harvested from one side of tongue in 81 patients (group two). A standard proforma (Appendix) was used for all patients. RESULTS • The mean follow up time was 22 months (range 6~41). At six months follow-up, numbness of tongue was reported in 19 patients (17.27%), parageusias in six (5.45%) and slurring of speech in 9 (8.18%). • Ninety-six patients were followed up for more than 12 mo. Numbness in operative area of tongue was documented in seven patients (7.29%), parageusias in three (3.13%) and slurred speech in three (3.13%). • None of these complications occurred in the six pediatric cases (<14 year) with a history of failed hypospadias repair. CONCLUSIONS • LMGs urethroplasty, as most patients, were satisfied, but there were certain complications that have not been previously described in the literature. • Most oral complications subsided gradually within the first year.

Grafts are Unnecessary for Proximal Bulbar Reconstruction

We compared our experience with the reconstruction of proximal vs distal bulbar stricture to assess the role of excision and primary anastomosis vs graft procedures at each site. We reviewed all urethroplasties done by a single surgeon during a 2-year period. Data analyzed included patient history and demographics, operative details, stricture length and site, and clinical outcome. The proximal bulbar urethra was defined as the segment within 5 cm of the membranous urethra and the distal bulb was defined as the adjoining segment extending to the penoscrotal junction. Cases involving the pendulous or posterior urethra were excluded from study. Of 210 urethroplasties from 2007 to 2009, 112 were done for bulbar strictures, including 72 (64%) for proximal bulbar strictures. All 72 cases were treated with excision and primary anastomosis. Median stricture length was 2 cm (range 1 to 5), although 31 of 72 strictures (43%) were of intermediate length (2.5 to 5 cm). Recurrence developed in 1 case (1.4%). Distal bulbar strictures in 40 of the 112 cases (36%) were treated predominantly with substitution urethroplasty in 36 (90%), and with excision and primary anastomosis in 4 (10%). Median stricture length was 3.75 cm (range 1.5 to 20). We noted intermediate length stricture in 18 of 40 cases (45%) and recurrence in 11 (28%). Of intermediate length strictures recurrence was much rarer after excision and primary anastomosis than after graft procedures (1 of 33 or 3.0% vs 6 of 16 or 38%, p<0.05). Location is critical when selecting an appropriate technique for bulbar urethral reconstruction. Excision and primary anastomosis are superior to grafts in the proximal bulb. Grafts are often unnecessary for reconstructing proximal bulbar strictures 5 cm or less.

Staged Reconstruction of Long Segment Urethral Strictures in Men With Previous Pediatric Hypospadias Repair

Reconstruction of long segment urethral stricture disease in adults with a history of pediatric hypospadias repair remains complex secondary to poor urethral blood supply, extensive penile scarring and the need for significant amounts of graft or flap tissue. We describe our experience with staged urethroplasty in this cohort of men. A total of 15 males underwent staged urethroplasty for urethral stricture disease following previous hypospadias repair in childhood. All men underwent 2-stage repair with a minimum of 6 months separating each operation. Bulbar urethral stricture disease due to previous dilation was seen in 2 of the 15 men (14%). Graft sources included buccal mucosa in 12 cases, full-thickness hairless abdominal wall skin in 2, penile skin in 1 and posterior auricular tissue in 1. Median patient followup was 22 months (range 5 to 62) after stage 2 closure. Median patient age at presentation was 31 years (range 19 to 57). Mean stricture length was 8 cm (range 5 to 14) and mean graft area was 22 cm(2) (range 10 to 38). There was no clinical evidence of stricture recurrence, fistula or wound dehiscence at last followup in 13 of the 15 men (86%). Two men with a congenital hypoplastic glans were left with distal hypospadias. Minor voiding symptoms were described in 3 of the 15 men (21%) with resolution in all by 6 months postoperatively. We describe outcomes after staged reconstruction for extensive urethral stricture disease in men after previous pediatric hypospadias repair in childhood. At intermediate followup staged urethroplasty provided acceptable outcomes.

Oral complications after lingual mucosal graft harvest for urethroplasty

ANZ Journal of SurgeryVolume 78, Issue 10 p. 933-934 Oral complications after lingual mucosal graft harvest for urethroplasty Alchiede Simonato MD, Alchiede Simonato MD * Luciano Giuliani Institute of Urology, University of Genoa, Genoa, and † Department of Urologic Surgery, Luigi Sacco University Medical Center, Milan, ItalySearch for more papers by this authorAndrea Gregori MD, Andrea Gregori MD * Luciano Giuliani Institute of Urology, University of Genoa, Genoa, and † Department of Urologic Surgery, Luigi Sacco University Medical Center, Milan, ItalySearch for more papers by this author Alchiede Simonato MD, Alchiede Simonato MD * Luciano Giuliani Institute of Urology, University of Genoa, Genoa, and † Department of Urologic Surgery, Luigi Sacco University Medical Center, Milan, ItalySearch for more papers by this authorAndrea Gregori MD, Andrea Gregori MD * Luciano Giuliani Institute of Urology, University of Genoa, Genoa, and † Department of Urologic Surgery, Luigi Sacco University Medical Center, Milan, ItalySearch for more papers by this author First published: 08 October 2008 https://doi.org/10.1111/j.1445-2197.2008.04703.xCitations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume78, Issue10October 2008Pages 933-934 RelatedInformation

Long-Term Efficacy of Distal Penile Circular Fasciocutaneous Flaps for Single Stage Reconstruction of Complex Anterior Urethral Stricture Disease

We determined the overall efficacy and predictors of success of the distal penile circular fasciocutaneous flap in the management of complex anterior urethral stricture disease not due to lichen sclerosus. We performed a retrospective review of all patients undergoing reconstruction of complex anterior urethral strictures without lichen sclerosus repaired from 1985 to 2006. Primary and overall stricture-free survival curves were estimated using the Kaplan-Meier method. Cox proportional hazards regression analysis was used to identify univariate and multivariate predictors of flap success. A total of 124 patients met the inclusion and exclusion criteria. Median patient age was 48 years (range 16 to 83). Median followup was 7.3 years (range 1 month to 19.5 years). Median stricture length was 8.2 cm (range 0.5 to 24). At 1, 3, 5 and 10 years the overall estimated stricture-free survival rates were 95%, 89%, 84% and 79%, respectively. On multivariate analysis smoking (HR 4.0, 95% CI 1.2-12.9, p = 0.02), history of hypospadias repair (HR 4.4, 95% CI 1.3-14.6, p = 0.01) and stricture length 7 to 10 cm (HR 7.0, 95% CI 1.4-34.7, p = 0.02) were predictive of failure. Fasciocutaneous flap urethroplasty has good and durable success rates in the treatment of complex anterior urethral strictures. Predictors of failure included smoking, history of hypospadias repair and longer stricture length.

The Tongue as an Alternative Donor Site for Graft Urethroplasty: A Pilot Study

Urethroplasty with a buccal mucosal graft provides excellent clinical results but it may also cause oral complications in some cases. The mucosa covering the lateral and under surface of the tongue is identical in structure with that lining the rest of the oral cavity. We evaluated LMGs for urethroplasty. From January 2001 to September 2004, 8 men 34 to 65 years old (mean age 46.1) with urethral strictures 1.5 to 4.5 cm long were selected for 1-stage dorsal onlay urethroplasty. The site of the harvest graft was the lateral mucosal lining of the tongue. Postoperatively all patients were followed with urethrography, uroflowmetry, cystourethrography and flexible urethroscopy after 3 and 12 months. Successful reconstruction criteria were peak flow rate greater than 15 ml per second and no need for postoperative urethral dilation. Median followup was 18 months (mean 22.1, range 3 to 47). Seven cases were successful. One patient had a partial urethral stricture. In successful cases cystourethrography revealed no significant graft contractures or sacculations and at flexible urethroscopy LMG was almost indistinguishable from native urethra. There were no pain, esthetic or functional complications at the donor site. Harvesting the LMG is feasible and easy to perform. Compared with the buccal mucosal graft the LMG seems to be associated with less postoperative pain and a minor risk of donor site complications. These preliminary functional and esthetic data are satisfactory.

Oral Complications After Buccal Mucosal Graft Harvest for Urethroplasty

No AccessJournal of UrologyUrological Survey: Trauma, and Genital and Urethral Reconstruction1 Jul 2005Oral Complications After Buccal Mucosal Graft Harvest for Urethroplasty Allen F. MoreyM.D. Allen F. MoreyAllen F. Morey More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000164320.98968.a1AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Oral Complications After Buccal Mucosal Graft Harvest for Urethroplasty." The Journal of Urology, 174(1), pp. 182–183 © 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 174Issue 1July 2005Page: 182-183 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.MetricsAuthor Information Allen F. Morey More articles by this author Expand All Advertisement PDF downloadLoading ...

Oral Complications After Buccal Mucosal Graft Harvest for Urethroplasty

Editorial Comment: Although the MAGPI technique, first developed in 1976 and described in 1981, has had widespread use in the past, with the advent of the tubularized incised urethral plate repair urologists seem to use it less and less. In some ways the MAGPI is a bit more complicated in concept and in execution. As a result, without a modification such as described in this report it is often difficult to achieve the excellent cosmetic result that is now routine for minor hypospadias repairs. This modification, removal of a flap of tissue from the midline of the glans, facilitates the placement of the urethra deeply into the glans to minimize the potential for retraction of the meatus and meatal stenosis. Douglas A. Canning, M.D.

Oral complications after buccal mucosal graft harvest for urethroplasty

RESULTS Thirty-five patients were identified but only 30 (mean age 48.3 years, range 24 – 86) could be contacted; they had had 31 operations. Soon after surgery (the first 48 h), 22 (73%) of the patients had little or no oral pain; 70% and 90% of the patients were able to eat and drink, respectively; 59% complained of numbness and 75% complained of tightness of the mouth. At discharge 6 days after surgery 90% of patients had little or no oral pain and all were able to eat and drink, but 10% had moderate-to-severe oral pain, 39% had oral numbness, and 52% had tightness of the mouth. At the time of interview, 16% of patients had oral numbness (mean duration 13.6 months) and 32% had tightness of the mouth (mean duration 20.9 months). In answer to the question of whether they would have their cheek mucosa harvested again if required, 74% responded ‘yes’, 3% ‘no’, and 23% had mixed feelings. CONCLUSIONS BMG harvesting is a good operation, as most patients were satisfied, but it is not without long-term complications and patients should be adequately informed. Editorial Comment: Buccal mucosal grafting has been established as an important tool in the hypospadiology armamentarium, particularly when used in a staged repair where the initial stage includes covering the urethral plate with buccal mucosa followed months later with a closure of the neourethra. As urologists, we tend to focus less on the potential complications associated with harvesting the buccal mucosal graft than we do on the complications following the urethroplasty. This sample, taken primarily from the adult population, reminds us that there is morbidity associated with the harvest and healing of the buccal mucosal graft. In this series there was persistent numbness as far out as 1 year for 16% of the patients, and 32% had persistent “tightness” of the mouth. In all cases the surgeons closed the graft site following the harvest. Not all surgeons close the oral mucosa to avoid an oral wound contracture. However, this article reminds us of the importance of reviewing these potential complications with the patient or his or her family when considering this approach for a major urethral reconstruction. Douglas A. Canning, M.D.

Oral complications after buccal mucosal graft harvest for urethroplasty.

To report long-term oral complications after buccal mucosal graft (BMG) harvesting for urethroplasty. In a retrospective study of all patients who had BMG harvesting for urethroplasty from April 1996 to September 2002, telephone interviews were conducted using a standard proforma. Thirty-five patients were identified but only 30 (mean age 48.3 years, range 24-86) could be contacted; they had had 31 operations. Soon after surgery (the first 48 h), 22 (73%) of the patients had little or no oral pain; 70% and 90% of the patients were able to eat and drink, respectively; 59% complained of numbness and 75% complained of tightness of the mouth. At discharge 6 days after surgery 90% of patients had little or no oral pain and all were able to eat and drink, but 10% had moderate-to-severe oral pain, 39% had oral numbness, and 52% had tightness of the mouth. At the time of interview, 16% of patients had oral numbness (mean duration 13.6 months) and 32% had tightness of the mouth (mean duration 20.9 months). In answer to the question of whether they would have their cheek mucosa harvested again if required, 74% responded 'yes', 3% 'no', and 23% had mixed feelings. BMG harvesting is a good operation, as most patients were satisfied, but it is not without long-term complications and patients should be adequately informed.

240: The Morbidity of Buccal Mucosal Graft Harvest for Urethroplasty and the Effect of Non-Suture of the Graft Harvest Site on Post-Operative Pain

You have accessJournal of UrologyPodium, Saturday, May 8, 2004, 3:30 - 5:30 pm1 Apr 2004240: The Morbidity of Buccal Mucosal Graft Harvest for Urethroplasty and the Effect of Non-Suture of the Graft Harvest Site on Post-Operative Pain Tamsin J. Greenwell, Daniela E. Andrich, and Anthony R. Mundy Tamsin J. GreenwellTamsin J. Greenwell More articles by this author , Daniela E. AndrichDaniela E. Andrich More articles by this author , and Anthony R. MundyAnthony R. Mundy More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)37502-5AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "240: The Morbidity of Buccal Mucosal Graft Harvest for Urethroplasty and the Effect of Non-Suture of the Graft Harvest Site on Post-Operative Pain." The Journal of Urology, 171(4S), p. 63 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 171Issue 4SApril 2004Page: 63 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Tamsin J. Greenwell More articles by this author Daniela E. Andrich More articles by this author Anthony R. Mundy More articles by this author Expand All Advertisement PDF downloadLoading ...

Intraoral morbidity following free buccal mucosal graft harvesting for urethroplasty

Buccal mucosa is the preferred donor tissue for urethroplasty in many cases. This study documents donor site morbidity associated with this technique in 12 patients. Nine patients had a transiently decreased parotid salivary flow for 1 week, and one patient reported transient nerve involvement (long buccal nerve). Intraincisal opening returned to presurgical values within 6 weeks and in some cases exceeded presurgical values. This appears to be a low morbidity technique with high patient acceptance.