Oral Mucosa Graft Urethroplasty Research Articles

Early Postoperative Complications of One-Stage Substitution Urethroplasty with Oral Mucosa Graft: A Monocentric Retrospective Study

Introduction: We report early postoperative complications (PCs) (≤90 days) of one-stage oral mucosa graft (OMG) urethroplasty in treatment of acquired anterior urethral strictures. Material and Methods: In this study, we evaluated 530 males who underwent one-stage substitution urethroplasty (SU) between September 1996 and October 2020. Medical records were reviewed to identify and classify early PCs based on the Clavien-Dindo classification (CDC). We subdivided the PCs into three groups with different kinds of complications which allowed us a more detailed analysis concerning general surgical complications (GSCs), donor site morbidity (DSM) and complications specific for free graft urethroplasty (CSUs). The influence of patient demographics, stricture characteristics and operative procedure on the occurrence of PCs was analysed. Results: Early (90-day) PCs occurred in 90 (16.98%) patients, whereas only 19 patients (3.58%) experienced serious events (CDC grades III and IV). Early complications include 4.5% GSCs, 1.7% DSM and 10.8% CSUs. Only stricture length turned out to be an independent statistically significant risk factor for the occurrence of early PCs. There was a trend towards a higher rate of complications in patients with ASA III compared to ASA I. Conclusion: The incidence of severe early complications in patients undergoing one-stage SU with OMG is low.

Analysis of the urethral stricture score and patient-related factors as predictors of outcomes following oral mucosal graft urethroplasty

ObjectiveThe complexity of urethral strictures can predict outcomes following urethroplasty. The previously described urethral stricture score (U score) considered only stricture-related factors to grade the complexity of urethral strictures and to predict recurrence post urethroplasty, but not considered patient-related factors for the same. We aimed to study the correlation of both of these factors to the outcomes of oral mucosal graft urethroplasty. MethodsWe retrospectively reviewed data of 101 patients who underwent oral mucosal graft urethroplasty in our institute with a minimum follow-up of 6 months. Baseline patient characteristics and stricture-related parameters were noted. The U score was calculated for all patients which consisted of the length, location, number, and etiology of stricture. Univariate and multivariate Cox proportional hazard regression models were used to determine significant risk factors of recurrence. ResultsThe mean follow-up of patients was 15 months. Recurrence was seen in 28 patients and the mean time for detection of recurrence was 8 months of follow-up. The Charlson Comorbidity Index, history of previous intervention, length of strictures, location of strictures, number of strictures, history of smoking, and etiology were independent predictors of recurrence following urethroplasty. Based on these parameters, we formulated the modified U score (MU score). The scores ranged from 0 to 6 and a score of >2 was found to be predictive of recurrence. On comparing receiver operating characteristic curves for both scores by the DeLong test, the MU score had larger area under the curve than the U score. ConclusionThe MU scoring system is the first of its kind attempt taking into consideration both patient- and stricture-related factors to predict recurrence following oral mucosal graft urethroplasty.

Dorsal oral mucosa graft urethroplasty for female urethral stricture reconstruction: A narrative review.

Female urethral stricture is currently a challenging situation. In general, urethra dilatation can be selected for treatment, but the complications and high recurrence rate urge doctors to consider other treatments. Recently, dorsal oral mucosa graft urethroplasty is concerned by more and more surgeons, but there are not enough reports so far. A comprehensive search of dorsal oral mucosa graft urethroplasty was performed. According to the existing literature, there are applications of buccal mucosa and lingual mucosa, and compared with other kinds of grafts, the success rate is higher. However, there is a lack of multicenter, large sample and long follow-up studies. And there is still no enough comparative study between different types of oral mucosa. In summary, dorsal oral mucosa graft urethroplasty is an effective option for the management of female urethral stricture. More multicenter and large sample studies with long-term follow-up data are needed.

Smoking is an independent risk factor for stricture recurrence after the urethroplasty: a systematic review and meta-analysis.

To clarify the association between smoking and stricture recurrence after urethroplasty. Pubmed, Web of Science, Embase, and Cochrane databases were searched with keywords: "urethroplasty," "buccal mucosa graft urethroplasty," "oral mucosa graft urethroplasty," "excision and primary anastomosis urethroplasty," "urethral stricture recurrence" until July 1, 2022. Inclusion and exclusion criteria were based on PICOS principles. The quality of included studies was assessed by Newcastle-Ottawa Scale (N.O.S.) system. Hazard ratio (H.R.), odds ratio (OR), and relative risk (RR) with 95% confidence interval (CI) were extracted or re-calculated from included studies. Meta-analysis was performed with Stata 15.0 based on univariate and multivariate data separately. Sensitivity analysis was performed to test the stability of the meta-analysis. I2 was calculated to evaluate heterogeneity. Publication biases were assessed by Egger's and Begg's tests. Funnel plots of univariate analysis and multivariate analysis were also offered. Twenty one studies with 6791 patients were involved in this meta-analysis. The analysis results of the two stages were consistent. In the univariate meta-analysis stage, 18 studies with 5811 patients were pooled, and the result indicated that smoking might promote stricture recurrence (RR=1.32, P=0.001). Based on the adjusted estimate, 11 studies with 3176 patients were pooled in the multivariate meta-analysis stage, and the result indicated that smoking might promote stricture recurrence (RR=1.35, P=0.049). There was no significant heterogeneity in both the univariate and multivariate stages. Our study demonstrates that smoking may prompt stricture recurrence after the urethroplasty. Quitting smoking may be a good option for patients undergoing urethroplasty surgery.

A0865 - Dorsal onlay oral mucosa graft urethroplasty for female urethral stricture

A0865 - Dorsal onlay oral mucosa graft urethroplasty for female urethral stricture

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.

Dorsal Onlay Oral Mucosa Graft Urethroplasty for Female Urethral Stricture

ObjectiveTo describe and assess the outcomes of dorsal onlay oral mucosa graft urethroplasty for female urethral stricture. MethodsWe retrospectively reviewed the charts of all female patients who underwent dorsal onlay oral (buccal or lingual) mucosa urethroplasty for urethral stricture between 2011 and 2020 at two academic institutions. The primary endpoint was clinical success defined as any subjective improvement in LUTS self-assessed by the patients 1-3 months after catheter removal. Four surgeons performed the urethroplasties using a standardized technique: suprameatal incision, dissection and longitudinal opening of the dorsal aspect of the urethra, harvest of the oral mucosa graft, graft onlay sutured into the urethral opening. ResultsNineteen patients were included. The clinical success rate was 94.7% at 1-3 months and 90.9% at 1 year. After a median follow-up of 12 months (range 1-49) there was one recurrence (5.3%), clinical success was achieved in 17 patients (89.5%) and both the maximum urinary flow rate and post void residual were significantly improved (15.2 vs 7.4 ml/s preoperatively; P = .008 and 71.5 vs 161.1 ml preoperatively; P = .001 respectively). The de novo stress urinary incontinence rate was 15.7% at 1-3 months and 9.1% at 1 year. ConclusionDorsal onlay oral mucosa graft urethroplasty for female urethral stricture appears feasible across multiple surgeons and is associated with a low perioperative morbidity, satisfactory functional outcomes and a low recurrence rate. Other series with larger sample size and longer follow-up are needed to confirm these findings.

MP56-15 AN 18-YEAR ANALYSIS OF STAGED URETHROPLASTY: HOW OFTEN DO PATIENTS SUCCESSFULLY COMPLETE RECONSTRUCTION IN TWO STAGES?

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III (MP56)1 Sep 2021MP56-15 AN 18-YEAR ANALYSIS OF STAGED URETHROPLASTY: HOW OFTEN DO PATIENTS SUCCESSFULLY COMPLETE RECONSTRUCTION IN TWO STAGES? Ziho Lee, Jolie Shen, Aaron Stewart, Desiree Sanchez, Alexander Skokan, and Judith Hagedorn Ziho LeeZiho Lee More articles by this author , Jolie ShenJolie Shen More articles by this author , Aaron StewartAaron Stewart More articles by this author , Desiree SanchezDesiree Sanchez More articles by this author , Alexander SkokanAlexander Skokan More articles by this author , and Judith HagedornJudith Hagedorn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002086.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although staged urethral reconstruction is ideally performed in two stages, this may not always be possible. We review our 18-year experience with staged oral mucosa graft (OMG) urethroplasty, and assess attrition and complication rates. METHODS: We retrospectively reviewed our urethroplasty database from 04/2001-10/2019 to identify all patients who underwent a first-stage OMG urethroplasty with the intention of completing a multi-stage reconstruction. Surgical success after first stage urethroplasty was assessed between 3-12 months postoperatively and defined as a neo-urethral OMG plate with ≥70% take and amenable to tubularization. Surgical success after second stage urethroplasty was defined as urethral patency (confirmed by evaluation with a 16Fr cystoscope) at time of last follow up. Patients developing urethrocutaneous fistulas and stricture recurrences after second stage urethroplasty were deemed unsuccessful. RESULTS: A total of 160 patients underwent first-stage OMG urethroplasty, and 128 (80.0%) patients were surgically successful. Of 128 patients who successfully underwent first-stage urethroplasty, 104 (81.3%) underwent second-stage urethroplasty and 24 (18.8%) did not undergo second-stage urethroplasty. With regards to patients who underwent successful first-stage urethroplasty but did not undergo second-stage urethroplasty, 13/24 (54.2%) patients were lost to follow up, 8/24 (33.3%) patients elected not to proceed with second-stage urethroplasty, and 3/24 (12.5%) patients had progression of urethral/penile cancer. At a median follow up of 19.5 (IQR 4.0-41.0) months after second-stage urethroplasty, 82/104 (78.9%) patients who underwent second-stage urethroplasty were surgically successful. After second-stage urethroplasty, fistula formation occurred in 12/104 (11.5%) and stricture recurrence occurred in 10/104 (9.6%). Overall, 82/160 (51.3%) patients initially intending to undergo a staged urethroplasty underwent urethral reconstruction in two stages. CONCLUSIONS: Roughly half of patients undergoing staged OMG urethroplasty will undergo successful urethral reconstruction in two stages. Patients considering staged urethroplasty should be counselled on the significant attrition rate, and the possibility of complications such as poor graft take, fistula formation, and stricture recurrence that may necessitate additional surgeries. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e974-e974 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ziho Lee More articles by this author Jolie Shen More articles by this author Aaron Stewart More articles by this author Desiree Sanchez More articles by this author Alexander Skokan More articles by this author Judith Hagedorn More articles by this author Expand All Advertisement Loading ...

MP56-14 AN 18-YEAR ANALYSIS ASSESSING PREDICTORS OF UNSUCCESSFUL GRAFT TAKE AFTER FIRST-STAGE ORAL MUCOSA GRAFT URETHROPLASTY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III (MP56)1 Sep 2021MP56-14 AN 18-YEAR ANALYSIS ASSESSING PREDICTORS OF UNSUCCESSFUL GRAFT TAKE AFTER FIRST-STAGE ORAL MUCOSA GRAFT URETHROPLASTY Ziho Lee, Aaron Stewart, Jolie Shen, Desiree Sanchez, Alexander Skokan, and Judith Hagedorn Ziho LeeZiho Lee More articles by this author , Aaron StewartAaron Stewart More articles by this author , Jolie ShenJolie Shen More articles by this author , Desiree SanchezDesiree Sanchez More articles by this author , Alexander SkokanAlexander Skokan More articles by this author , and Judith HagedornJudith Hagedorn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002086.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Graft take after first-stage oral mucosa graft urethroplasty is an important outcome measure given its implications for technical feasibility and efficacy of multi-stage urethral reconstruction. We review our 18-year experience with first-stage oral mucosa graft urethroplasty, and identify clinical predictors of unsuccessful graft take. METHODS: We retrospectively reviewed all patients who underwent a first-stage oral mucosa graft urethroplasty as part of a planned multi-stage urethral reconstruction from 04/2001-10/2019. In all cases, the oral mucosa graft was fenestrated prior to securing it to the neo-urethral plate with absorbable sutures. The primary outcome measure was unsuccessful graft take, which was assessed between 3 and 12 months postoperatively and defined as an oral mucosa graft plate suboptimal for neo-urethral tubularization. More specifically, patients with unsuccessful graft take included those recommended to undergo repeat first-stage urethroplasty and/or those with <70% graft take. Multivariable logistic regression was utilized to identify clinical predictors of unsuccessful graft take. RESULTS: Of 160 patients who underwent first-stage oral mucosa graft urethroplasty, 32 (20.0%) had unsuccessful graft take. Indications for multi-stage urethroplasty included hypospadias in 55/160 (34.4%) patients, lichen sclerosis in 46/160 (28.8%) patients, trauma in 12/160 (7.5%) patients, and other in 47/160 (29.4%) patients. Within our cohort, 60/160 (37.5%) patients previously underwent at least one failed urethral reconstruction prior to first-stage urethroplasty. Higher body mass index (p=0.020) and positive history of previously failed urethral reconstruction (p=0.011) were independent predictors of unsuccessful graft take. Age at time of surgery (p=0.090), stricture etiology (p=0.691), total area grafted at time of first-stage urethroplasty (p=0.164), history of diabetes (p=0.217), history of cardiovascular disease (p=0.526), and current smoking status (p=0.508) did not predict unsuccessful graft take. CONCLUSIONS: Elevated body mass index and positive history of previously failed urethral reconstruction are associated with unsuccessful graft take after first-stage oral mucosa graft urethroplasty. Patients at risk for unsuccessful graft take after first-stage oral mucosa graft urethroplasty should be appropriately counselled when considering multi-stage urethral reconstruction for complex anterior urethral stricture disease. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e974-e974 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ziho Lee More articles by this author Aaron Stewart More articles by this author Jolie Shen More articles by this author Desiree Sanchez More articles by this author Alexander Skokan More articles by this author Judith Hagedorn More articles by this author Expand All Advertisement Loading ...

What is the role of single-stage oral mucosa graft urethroplasty in the surgical management of lichen sclerosus-related stricture disease in men? A systematic review.

The benefits and harms of the available types of surgical management for lichen sclerosus-related (LS) strictures remain unclear and, thus, clear and robust clinical practice recommendations cannot be given. To assess the role of single-stage OMGU in the management of LS strictures and explore how its benefits and harms compare with the alternative management options. Medline, Embase and Cochrane controlled trial databases (CENTRAL, CDSR) were systematically searched. Randomized (RCTs) and nonrandomized studies (NRCSs) comparing single-stage OMGU with other surgical management options for LS strictures and single-arm studies on single-stage OMGU were included. Risk of bias (RoB) was assessed. Of the 1912 abstracts identified, 15 studies (1 NRCS and 14 single-arm studies) were included, recruiting in total 649 patients. All studies were at high RoB. In the only NRCS available, stricture-free rate (SFR) for single-stage and staged OMGU was 88% vs 60%, respectively (p = 0.05), at a mean follow-up of 66.5months. SFR range for single-stage OMGU in single-arm studies was 65-100% (mean/median follow-up, 12-59months). Single-stage OMGU had low complication rates and beneficial impact on LUTS and QoL. The present SR highlights the methodological limitations of the available literature. In the absence of adverse local tissue conditions, and taking into consideration benefit-harm balance and surgeon's skills and expertise, single-stage OMGU can be justified in patients with LS strictures.

A novel transurethral approach to inlay oral mucosal graft urethroplasty technique for meatal and fossa navicularis stricture resulting from distal hypospadias repair

Meatal and fossa navicularis stricture after hypospadias repair is a challenging condition. A range of management techniques have been applied to treat meatal and fossa navicularis stenosis but, as yet, there is no consensus as to the best method. Open urethroplasty with oral mucosal graft (OMG) has been widely accepted to be the gold standard in repairing the stricture. Generally, the stricture site is approached through a ventral midline, subcoronal, and circumcising incision. A novel effective technique for short segment stricture, transurethral approach to inlay oral mucosal graft urethroplasty would help in avoiding ventral glans, distal penis or ventral urethral incision and can preserve glans of the penis. A 5-year-old boy with mid-shaft hypospadias underwent repair when he was 3 years old. Two months after surgery, he had developed urethral meatal and fossa navicularis stenoses. He is to undergo a novel transurethral approach of inlay OMG urethroplasty. The procedure consisted of transurethral excising the fibrotic tissue at the dorsal site of the stricture urethra. The bougies dilator was used for calibrating the size of the urethra up to 12 Fr. An OMG with a size of 5×6mm was then harvested from the lower lip and applied to cover the defect. A urethral catheter was inserted for 1 week. The outcome was shown to be successful and the patient can void with a good flow after removing the catheter. The graft was well vascularized and the glans was cosmetically acceptable. There was no recurrent stricture after 12 months follow up. This novel technique is simple, effective and may be beneficial as it obviates the need for complex reconstruction. However, this technique would only be feasible in selected patients with suitable conditions of meatal opening and those with a short segment of stricture.

One-Stage Buccal Mucosal Graft Urethroplasty for Lichen Sclerosus-Related Urethral Stricture Disease: A Systematic Review and Pooled Proportional Meta-Analysis.

Performing 1-stage urethroplasty in patients with urethral strictures caused by lichen sclerosus (LS) is hotly debated among reconstructive urologists due to conflicting reports of success. Therefore, the objective of this study was to determine the pooled incidence of stricture recurrence following 1-stage buccal mucosal graft (BMG) urethroplasty in patients with LS, to determine the impact of surgical technique on recurrence and to compare recurrence risk between patients with and without LS after 1-stage repairs. A systematic review was conducted in accordance with PRISMA criteria. The primary outcome was pooled incidence of recurrence, which was calculated using a Der-Simonian-Laird binary random effects model with a Freeman-Tukey arcsine transformation. A total of 21 studies were included, of which 15 provided data for comparative analyses. Pooled data from 625 LS patients revealed a stricture recurrence rate of 10% (95% CI 6-14). Among studies with longer followup (≥24 months), this increased to 18%. Among patients with penile urethral involvement, studies utilizing a penile skin incision had significantly higher pooled recurrence rates than those utilizing penile invagination (p=0.004). Across all studies, there was no evidence to suggest a difference in pooled recurrence rate between patients with and without LS (p=0.36). However, across only long-term studies, recurrence risk was significantly higher for patients with LS (OR 1.83, p=0.05). One-stage BMG urethroplasty is likely a viable surgical option for patients with LS-related strictures; however, high-quality data are limited. Future multi-institutional, long-term prospective studies are needed to assess durability of 1-stage repair.

Practice of the use of oral mucosa graft urethroplasty among Nigerian urologists

Background: Urethral stricture is an ancient disease that has plagued men. Management of this disease has been evolving due to advances in technology and better understanding of the pathogenesis. Use of oral mucosal grafts for substitution urethroplasty has been gaining world-wide acceptance and application by urologists. This article examines the of application of this urethral substitute among Nigerian urologists.Methods: This was a questionnaire-based study administered to urologists during the annual general meeting and scientific conference.Results: Forty two respondents completed the questionnaire and comprised of 41 (97.6%) males and 1 (2.4%) female. There were 24 (57.1%) consultants, senior registrars and others 4 (9.6%). Thirty three (78.6%) of the respondents had practised for less than 10 years. Region of practice in Nigeria were 13 (31%) in South-west, 5 (11.9%) in South-East, 3 (7.1%) in South -South, 9 (21.4%) in North-West, 10 (23.8%) in North-central and 2 (4.8%) in North-East. Annual volume of urethroplasty was less than 10 in 19 (45.2%) and only 3 (7.1%) performed more than 30 urethroplasties. Place of practice was mainly in the University Teaching Hospital 33 (78.6%). Oral mucosa grafts (OMGs) used either alone or in combination with penile flaps was used by 30 (71.4%) respondents while 11 (26.2%) used only penile skin flaps. Up to 10 (23.8%) of the respondents indicated desire to undergo training on the use of OMG for urethral reconstruction.Conclusions: Use of OMG is accepted by Nigerian urologists, however application is limited by low annual urethroplasty volume and lack of training.

FR01-13 THE EVOLUTION OF COLONIC MUCOSA USE IN URETHRAL RECONSTRUCTION

You have accessJournal of UrologyHistory of Urology Forum I (FR01)1 Apr 2020FR01-13 THE EVOLUTION OF COLONIC MUCOSA USE IN URETHRAL RECONSTRUCTION Elizabeth Pagura*, Jaime Cavallo, Alexander Rozanski, Leonard Zinman, and Alex Vanni Elizabeth Pagura*Elizabeth Pagura* More articles by this author , Jaime CavalloJaime Cavallo More articles by this author , Alexander RozanskiAlexander Rozanski More articles by this author , Leonard ZinmanLeonard Zinman More articles by this author , and Alex VanniAlex Vanni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000850.013AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Oral mucosa graft urethroplasty was first described by the Ukrainian surgeon Kirill Sapezhko in 1894. His protégé, I.A. Thyrmos, pioneered substitution urethroplasty with rectal mucosa and published its first use in 1902. We describe the poorly known evolution of colonic mucosa use in urethral reconstruction to its modern-day resurgence. METHODS: PubMed, the Journal of Urology archives, and the Hirsch Medical Library at Tufts University were all systematically queried for any combination of the terms “colonic mucosa”, “rectal mucosa”, “urethroplasty”, and “urethral reconstruction”. All literature matches were reviewed to construct the chronology of colonic mucosa use in urethral reconstruction. RESULTS: Thyrmos’ initial description of rectal mucosa graft urethroplasty in the Eastern scientific literature in 1902 failed to gain the attention of the Western scientific community. Brief mention of rectal mucosa as “yield[ing] some results” for urethral repair in an abstract from the 1918 Urologic Congress in Paris indicates international communication, but lack of concept adoption. Descriptions of urethroplasty using colonic mucosa grafts did not appear again in the medical literature until Paul Mitofanoff of France published his work with colonic mucosa grafts in rats in 1994. Between 2002 and 2009, Yue-Min Xu et al of China applied the concept of colonic mucosa grafts to long-segment, complex urethral reconstruction in which oral mucosa grafts were inadequate in length or unavailable. Their preclinical studies in a dog model and subsequent clinical series achieved colonic mucosa grafts up to 21 centimeters (cm) in length, but required concurrent bowel resection. In 2016, Vanni et al described the first minimally invasive harvest of rectal mucosa grafts up to 15 cm in length for long-segment urethral reconstruction using a transanal endoscopic microsurgical (TEM) technique. This approach circumvented the need for bowel resection and minimized associated gastrointestinal morbidity. In 2019, this was expanded upon in a multi-institutional study by Granieri et al by including a wider variety of minimally invasive graft harvest techniques with either TEM or robotic transanal minimally invasive surgery (R-TAMIS). CONCLUSIONS: Colonic mucosa use in urethral reconstruction has been described in urologic literature for nearly as long as oral mucosa use. Modern-day literature highlights that it remains a viable alternative graft option with minimal donor site morbidity, especially in the era of minimally invasive tissue harvest techniques. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e288-e289 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elizabeth Pagura* More articles by this author Jaime Cavallo More articles by this author Alexander Rozanski More articles by this author Leonard Zinman More articles by this author Alex Vanni More articles by this author Expand All Advertisement PDF downloadLoading ...

Outcome of Dorsolateral OnlAy OMG Urethroplasty for Anterior Urethral Stricture

Objective: To determine the feasibility, safety, efficacy and short term outcome of using new surgical technique for repair of anterior urethral stricture Introduction: The conventional approach for management of long segment anterior urethral stricture is a two stage Johansons repair along with the use of free grafts if required. Now a days the preferred management of urethral stricture involving long segments of anterior urethra is dorsal only oral mucosa Augmentation urethroplasty which requires circumferential mobilization of urthera that might cause ischaemia of urethra in addition of chordee. For that we adopted new technique (kulkarnis) of dorsolateral onlay buccal mucosal graft one sided anterior urethroplasty in which only unilateral urethral mobilization done through perineal approach. Materials and Methods: A total of 50 patients underwent urethroplasty for anterior urethral strictures using dorsolateral onlay BMG from April 2010 to December 2012 at NIKDU, JBFH, BSMMU and BDM Hospital. We selected 16 to 70 years old male (mean age 39 years) underwent a one-sided dorsolateral oral mucosal graft urethroplasty. The mean (range) stricture length was 6.5 (4.5-9) cm in patients with single bulbar urethral involvement and 10.5 (8.5–15.0) cm in patients with panurethral strictures. Free graft was taken from oral mucosa either lower lip or cheeks. Follow up was done by uroflowmetry at 3rd week, after removal of penile catheter and repeat at 3rd and at 6th month. In addition to uroflometry – RGU &amp; MCU was done at 3rd month and Urethrocystoscopy was done at 6th month follow up. The results were classified into the following outcomes. Success was defined as a maximum flow rate of &gt;10 ml/sec, normal RGU, and/or urethroscopy (with a 19 Fr. sheath). Failure was defined as the presence of obstructive urinary tract symptoms, Qmax &lt;10 ml/sec, stricture diagnosed on retrograde urethrogram/ urethroscopy, and the need for any postoperative urethral intervention. Result: The overall follow up was 12-30 months. Of the 50 patients 45 (90%) had a successful outcome and 5(12%) had failure. 3 failure treated by OIU and 2 by meatal dilatation. No significant donor site defect was observed. Bangladesh Journal of Urology, Vol. 16, No. 2, July 2013 p.37-42

Stricture of Urethra: Patterns and Outcomes of Management from a Single Centre in Pakistan Over 7 Years.

To determine the outcomes of urethroplasty and its complications from a large cohort of patients managed in a single centre. Descriptive study. Department of Urology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, from January 2010 to December 2016. A total of 546 patients with stricture urethra at different locations underwent urethroplasty from January 2010 to December 2016 were included. All patients had an ascending urethrogram followed by retrograde ± antegrade urethroscopy to assess the location and length of the stricture. Technique of urethroplasty was chosen according to the site, length and etiology. Following appropriate procedure, patients were followed up in the dedicated urethral stricture clinic. Procedure was considered successful if either no further therapeutic intervention was required and the maximum flow rate (Qmax) was >20 ml/sec with a voided volume of at least 200 mls. The procedure was regarded as unsuccessful, if further treatment was required or Qmax was <10ml/sec. A total of 546 patients with mean age of 32.3 +13.1 years (range: 12-74) involving anterior (n=323, 59.2%) or posterior (n=223, 40.8%) urethra were treated. Mean follow-up was 43.6 months (range: 3-84). The success rates of bulbar urethral strictures after excision and primary anastomosis (EPA) was 93. 3%, non-transecting urethroplasty 84.6% and oral mucosal graft (OMG), 81.8%. In penile urethral strictures, OMG, Orandi procedure and Johanson's techniques yielded success rates of 88.4%, 66.6% and 57.1%, respectively. In posterior urethral strictures, after excision and bulboprostatic anastomosis, good results were seen in 88.3%. In pan-urethral strictures, abdominal skin graft repair, combined tissue transfer and OMG urethroplasty yielded success rates of 74%, 78.5% and 75%, respectively. The complications/ adverse events were encountered in 251 / 546 (45.9%) patients in this series. Anastomotic urethroplasty yielded best outcomes followed by OMG urethroplasty. In the long-term follow-up, erectile dysfunction (ED), infertility and recurrence of stricture are the main complications which need individualised management.

Oral ucosal Grafts in One-stage Urethroplasty for Panurethral Strictures

Objectives: Panurethral strictures are complex and extensive strictures that involve the penile and bulbar urethra. Management of these patients is challenging. In the last two decades, oral mucosal grafts have gained widespread popularity as the most versatile substitute tissue for urethral reconstruction. This paper presents the short- term outcome of our experience in the use of oral mucosal grafts in one-stage urethroplasty in patients with panurethral strictures. Patients and Methods: Between April 2012 and January 2017, 62 men were evaluated and had one-stage oral mucosa urethroplasty for panurethral strictures. Results: The mean age of the patients was 50 years with a range of 11-75 years. Aetiological factors were poorly treated urethritis 39 (62.9%), indwelling urethral catheterization 18 (29.0%), trauma 1 (1.6%) and lichen sclerosis 1 (1.6%). Reasons for urethral catheterization were for intraoperative monitoring 9 (50.0 %), relief of acute urine retention 4 (22.2%) and others 4 (22.2%). Fifty-two patients (83.9%) had preliminary urinary diversion by supra-pubic cystostomy before urethroplasty. The mean OMG length was 11.7cm and donor sites were buccal in 37 (59.7%), combined buccal and labial in 20 (32.3%). Fifty-seven (88.7%) patients had satisfactory voiding on removal of the urethral catheter. Donor site complications were reactionary haemorrhage 1 patient, stay suture lip injury 1, pain and numbness in 6 (9.6%) patients. Superficial wound infections were recorded in 6(9.7%) patients. The duration of follow-up ranged from 1-29 months; mean 6 months. There was no mortality. Conclusion: Panurethral strictures are common in our practice mainly resulting as complication of poorly treated urethritis and urethral catheterization. Urethral reconstruction by one-stage oral mucosa graft urethroplasty is feasible, has good, short-term outcome though it may be associated with minor donor site complications. Larger number of patients and longer- term follow up are needed to assess the durability of the procedure

Female Urethral Strictures: Review of Diagnosis, Etiology, and Management.

In this review, we describe the incidence, diagnosis, and management of urethral strictures in women. Definitive repair of urethral strictures in women traditionally utilizes vaginal and labial flaps. Oral mucosal buccal graft urethroplasty also has high success rates, with larger series demonstrating feasibility and durability. Urethral strictures in women are very rare. When they do occur, they are often difficult to diagnose, requiring a high index of suspicion. Women with urethral strictures often present with symptoms of obstructed urinary flow, such as incomplete emptying, straining, and elevated postvoid residual. First line, minimally invasive treatment consists of urethral dilation and urethrotomy, though urethrotomy is rarely performed. Repeat urethral dilation has low success rates compared with urethroplasty, which is a more definitive treatment.

The outcomes of Kulkarni's one-stage oral mucosa graft urethroplasty in patients with panurethral stricture: a single centre experience.

To present the results of our one-stage oral mucosa graft urethroplasty series for panurethral strictures. We included the first 35 patients who had one stage oral mucosa graft urethroplasty with one side dissection of the urethra which was described by Kulkarni, between January 2015 and June 2018 and had at least 6months follow-up. From the first case, all data were recorded prospectively and patient age, etiology of the stricture, comorbidities, previous treatments, postoperative maximal flow rate, pre and post-operative erectile function, perioperative and postoperative complications and quality of life questionnaire for this study. The mean patient age was 58.8 and mean stricture length was 13.6 (10-16)cm. Patients had previously 1-17 procedures. Patients had a mean peak flow rate of 25.4ml/sec at the first postoperative visit. During the follow-up period, six patients had recurrence and managed with urethral dilation (1), direct vision internal urethrotomy (2), meatoplasty (1) and re-urethroplasty (2). The responses to the questions about satisfaction from the surgery showed that 31 (88.6%) patients were satisfied with the surgery, 33 (94.3%) would prefer this procedure again, if needed, and 31 (88.6%) patients recommended this procedure to others. When patients were grouped according to age, recurrence rate was 35.7% in patients older than 65years and 4.8% in patients ≤ 65years old. Our study showed that Kulkarni's one-stage oral mucosa graft urethroplasty technique has a high success rate. The patient satisfaction is high because of the good functional outcomes and low complication rate.

Everted saphenous vein graft for long anterior urethral strictures in men with tobacco-exposed oral mucosa: A prospective nonrandomized study.

Introduction:Oral mucosal graft (OMG) is the gold standard for urethral substitution but has poor results in long anterior urethral strictures and chronic tobacco-exposed oral mucosa. Saphenous vein has been recently described for long-segment anterior urethral stricture with successful initial results. Our objective was to compare the early outcomes of everted saphenous vein graft (eSVG) substitution urethroplasty in patients with tobacco-exposed oral mucosa and OMG urethroplasty in patients with nontobacco-exposed oral mucosa for long anterior urethral strictures.Materials and Methods:30 patients with long anterior urethral strictures underwent substitution urethroplasty using Dorsolateral onlay approach. Fifteen patients with healthy oral mucosa underwent OMG urethroplasty (Group 1) and 15 patients who had unhealthy oral mucosa due to chronic tobacco exposure underwent eSVG urethroplasty (Group 2). Outcomes were assessed with the International Prostate Symptom Score (IPSS); uroflowmetry; donor and recipient site complications at 1, 3, and 6 months; and symptomatic assessment thereafter. Retrograde urethrogram was done at 3 months in both the groups. Successful urethroplasty was defined as satisfactory voiding (Qmax>15 ml/s) and no need for endoscopic dilatation/direct vision internal urethrotomy in follow-up.Results:Mean stricture and harvested graft length were 10.8 cm and 12.33 cm in Group 1, while in Group 2 were 13.6 cm and 15.73 cm, respectively. Nine of 13 patients in Group 1 (69.2%) and 11 of 14 in Group 2 (78.5%) with a minimum follow-up till 18 months had successful outcome at an average follow-up of 23.13 months. Donor and recipient site complications were comparable in both the groups. At 18 months, mean IPSS and Qmax in successful patients were 7.9 and 25.6 ml/s in Group 1, while in Group 2 were 8.0 and 22.6 ml/s.Conclusions:Outcomes of great saphenous vein graft urethroplasty are comparable to OMG, and it is an acceptable option in long-segment anterior urethral stricture patients with chronic tobacco-exposed oral mucosa.