Oral Mucosa Graft Urethroplasty Research Articles

Treatments of 1242 bulbar urethral strictures: multivariable statistical analysis of results.

We investigated the success rate of different surgical techniques for bulbar stricture repair. Retrospective study of patients with bulbar urethral strictures treated using different techniques. The primary outcome of the study was to evaluate the overall results of treatment (success vs. failure); the secondary outcome was to evaluate the outcome according to any surgical technique. Cysto-urethrography was performed 1month following surgery. Patients underwent clinical evaluation, uroflowmetry and residual urine measurement every 6months for 2years after surgery and later once on year. When patient showed obstructive symptoms, Qmax < 12ml/s, the urethrography was repeated. Patients who underwent further treatment for recurrent stricture were classified as failures. A bivariable and multivariable statistical analysis was performed. Overall, 1242 patients were included in the study with mean age 40years (range 12-84). Median stricture length was 4cm (range 1-8). The median follow-up was 103months (range 12-362). Over 1242 patients, 916 (73.8%) were success and 326 (26.2%) failures. Fourteen different surgical techniques showed a success rate ranging from 87.5 to 14.3%. The multivariable analysis showed that stricture length was an independent predictor factors for failure: p < 0.0001 CI 1146-1509. End-end anastomosis and oral mucosa graft urethroplasty are independent predictor factor of success after internal urethrotomy failure. Our results showed that treatment of bulbar urethral stricture is satisfactory on 73.8% of patients, but with a wide range of success rate (from 14.3 to 87.5%) using different techniques. Oral mucosa is greatly superior to the skin as substitute material.

The hypospadias classification affected the surgical outcomes of staged oral mucosa graft urethroplasty in hypospadias reoperation: An observational study.

The staged graft urethroplasty is a recommended technique for repairing complex hypospadias. This retrospective study aimed to investigate the outcomes of this technique in hypospadias patients undergoing reoperation and to analyze the underlying contributing factors including age, meatus location, and graft and suture type.We retrospectively analyzed 40 hypospadias patients undergoing reoperation who received a staged oral graft urethroplasty, including 15 buccal mucosal grafts and 25 lingual mucosal grafts. Median age at presentation was 18.5 years, and median follow-up was 17.5 months (range 8–30 months). The patients were classified according to their original meatus location.Twenty-five complications developed in 12 of 40 (30%) cases, including 6 fistulas (15%), 7 infections (17.5%), 9 cases of glans dehiscence (22.5%), and 3 cases of stenosis (7.5%). There was no significant difference in the overall complication rates between prepuberty and postpuberty groups. In addition, no significant difference in complications was found between the 2 graft techniques. The complications were significantly higher in the original perineal type compared with the original penoscrotal type (7/10 vs 5/30, P = .0031). Seven patients who originally had perineal hypospadias developed multiple complications.Based on this study, the staged graft urethroplasty is an effective technique in reoperative hypospadias repairs with reasonable complication risk. The hypospadias classification affects the surgical outcomes.

Intermediate-Term Outcomes and Complications of Long Segment Urethroplasty with Lingual Mucosa Grafts

We evaluated outcomes and donor site complications in male patients with complex urethral strictures who underwent urethroplasty using with long strip oral mucosal grafts. We also analyzed whether a lingual mucosa graft is a good substitute for repairing long segment urethral strictures. This retrospective study was done in 81 male patients with complex urethral strictures who underwent oral mucosal graft urethroplasty. Patients with long segment (8 cm or greater) anterior urethral strictures who were considered candidates for long strip lingual mucosa graft urethroplasty were included in study. Oral mucosal graft urethroplasty was performed in 81 patients with complex urethral strictures between August 2006 and December 2014. Mean urethral stricture length was 12.1 cm (range 8 to 20). A single 9 to 12 cm long strip lingual mucosa graft was used in 52 patients, a lingual mucosa graft greater than 12 cm was placed in 17 and a lingual mucosa graft combined with a buccal mucosal graft was used in 12. Mean followup was 41 months (range 15 to 86) postoperatively. The overall urethroplasty success rate was 82.7%. Urethral complications developed in 14 patients (17.3%), including urethral strictures in 10 and urethrocutaneous fistulas in 4. At 12 months 5 patients (6.2%) reported minimal difficulty with fine motor movement of the tongue. Lingual mucosa harvested from the ventrolateral surface of the tongue can provide a wide and long graft that is an excellent urethral substitute. Donor site complications are primarily limited to postoperative year 1. Our study confirms that the lingual mucosa graft is a good substitute for urethral reconstruction and lingual mucosa graft urethroplasty is a valuable procedure to treat long anterior urethral strictures.

V12-13 TWO-SIDED DORSAL PLUS VENTRAL ORAL GRAFT URETHROPLASTY FOR LONG ANTERIOR URETHRAL STRICTURES

You have accessJournal of UrologyReconstruction1 Apr 2016V12-13 TWO-SIDED DORSAL PLUS VENTRAL ORAL GRAFT URETHROPLASTY FOR LONG ANTERIOR URETHRAL STRICTURES Fikret Fatih Onol, Sinasi Yavuz Onol, Ahmet Bindayi, Ahmet Tahra, Eyup Veli Kücük, and Ugur Boylu Fikret Fatih OnolFikret Fatih Onol More articles by this author , Sinasi Yavuz OnolSinasi Yavuz Onol More articles by this author , Ahmet BindayiAhmet Bindayi More articles by this author , Ahmet TahraAhmet Tahra More articles by this author , Eyup Veli KücükEyup Veli Kücük More articles by this author , and Ugur BoyluUgur Boylu More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2139AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Substitution urethroplasty provides good functional results in bulbar and penile urethral strictures. However, treatment of long (extending from external meatus to bulbar urethra) and tight strictures remains a challenge. One-sided (dorsal or ventral) substitution urethroplasty may not be sufficient in long strictures with a narrow urethral plate. In recent years, we have opted to use two-sided oral mucosa graft (OMG) in such cases. We describe our technique of two-sided OMG urethroplasty in long and tight strictures. METHODS Among the 83 men that underwent anterior urethroplasty in our clinic between 2010 and 2015, 23 (27.7%) had long (>80mm) or multiple strictures. Clinical evaluation included assessment of subjective symptoms with the AUA symptom score and patient-reported outcome measure for urethral stricture (USS-PROM), uroflowmetry, and combined retrograde urethrography/voiding cystourethrography. We performed two-sided urethral augmentation in patients with a tight stricture (ie. urethral caliber <5 Fr). Under lithotomy position, the entire anterior urethra was exposed through penile invagination from the midline perineal incision. OMG was first placed as ′dorsal inlay′: urethra was split along the stricture both ventrally and dorsally without mobilizing it from its bed, and the graft was secured in the dorsal urethral defect. A ′ventral onlay′ OMG was then augmented to the narrowest segment of the stricture. Foley catheter was removed after 2 to 3 weeks. Patients were followed postoperatively at 1st, 3rd, and 6th months, and annually thereafter. Cure was defined as a normal-appearing flow curve at the last postoperative visit and absence of any restenosis requiring additional intervention. RESULTS Two-sided OMG technique was used in 7 patients. Mean stricture length was 137.9±40.4 mm (range: 80 to 190 mm). With a median follow-up of 32 months (range: 6 to 58), 85.7% were cured. One patient developed recurrent stricture and underwent internal urethrotomy. Mean AUA symptom score decreased from 19.8±10.2 preoperatively to 3.2±1.6 postoperatively (p=0.02). Similarly, baseline USS-PROM LUTS score decreased from 10±4.6 to 1.5±1.4 postoperatively. Mean maximum flow rate (ml/sec) increased from 4.2±1.6 preoperatively to 28.2±10.8 postoperatively (p=0.03). CONCLUSIONS Two-sided dorsal plus ventral oral graft urethroplasty appears as an effective technique for long anterior urethral strictures. The two-sided OMG may facilitate the reconstruction of a wide-caliber urethral lumen in tight strictures. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1070 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Fikret Fatih Onol More articles by this author Sinasi Yavuz Onol More articles by this author Ahmet Bindayi More articles by this author Ahmet Tahra More articles by this author Eyup Veli Kücük More articles by this author Ugur Boylu More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A comparative study of lingual mucosal graft urethroplasty with buccal mucosal graft urethroplasty in urethral stricture disease: An institutional experience.

Aims:A prospective study to compare the outcomes of lingual versus buccal mucosal graft urethroplasty in patients with long segment anterior urethral strictures disease.Materials and Methods:The study included 30 patients for buccal mucosal graft urethroplasty (group I) and 30 patients for lingual mucosal graft urethroplasty (group II) for treatment of long segment (>3 cm) incomplete anterior urethral stricture disease using single-stage dorsal onlay free oral mucosal graft urethroplasty by Barbagli's technique between February 2013 to September 2014. All patients underwent complete evaluation of the stricture including inspection of the oral cavity.Results:The results of urethroplasty in between two group were not significant (P > 0.05) in terms of Qmax (P = 0.63), mean postoperative AUA symptom score (P = 0.83), operative time (P = 0.302) intra operative blood loss (P = 0.708), duration of postoperative hospitalization (P = 0.83), but slurring of speech complications was seen in group II, but not in group I. Long-term complications of salivary disturbance, tightness of the mouth, persistent pain at graft site, perioral numbness, seen only in group I (BMGU).Conclusion:LMG urethroplasty is an excellent alternative to BMG urethroplasty with comparable results of urethroplasty and minimal donor site complications.

Penile inversion through a penoscrotal incision for the treatment of penile urethral strictures.

PurposeThis article describes a novel technique for the repair of penile urethral strictures and establishes the safety, feasibility, and efficacy of this innovative surgical approach.Materials and MethodsPatients with urethral strictures underwent a one-sided anterior dorsal oral mucosal graft urethroplasty through a penoscrotal inversion technique. The clinical outcome was considered a failure when any instrumentation was needed postoperatively, including dilatation.ResultsFive patients underwent the novel procedure. The patients' mean age was 58 years. The cause of stricture was instrumentation in 2 cases (40%), lichen sclerosis in 1 case (20%), and failed hypospadias repair in 2 cases (40%). The mean stricture length was 3 cm. The overall mean (range) follow-up was 6 months (range, 3–9 months). Of the 5 patients, 4 (80%) had a successful outcome and 1 (20%) had a failed outcome. The failure was successfully treated by use of a meatotomy.ConclusionsThe penile inversion technique through a penoscrotal incision is a viable option for the management of penile urethral strictures with several advantages to other techniques: namely, no penile skin incision, a single-stage operation, and supine positioning.

One-stage dorsal lingual mucosal graft urethroplasty for the treatment of failed hypospadias repair.

The aim of this study was to retrospectively investigate the outcomes of patients who underwent one-stage onlay or inlay urethroplasty using a lingual mucosal graft (LMG) after failed hypospadias repairs. Inclusion criteria included a history of failed hypospadias repair, insufficiency of the local skin that made a reoperation with skin flaps difficult, and necessity of an oral mucosal graft urethroplasty. Patients were excluded if they had undergone a failed hypospadias repair using the foreskin or a multistage repair urethroplasty. Between January 2008 and December 2012, 110 patients with failed hypospadias repairs were treated in our center. Of these patients, 56 underwent a one-stage onlay or inlay urethroplasty using LMG. The median age was 21.8 years (range: 4–45 years). Of the 56 patients, one-stage onlay LMG urethroplasty was performed in 42 patients (group 1), and a modified Snodgrass technique using one-stage inlay LMG urethroplasty was performed in 14 (group 2). The median LMG urethroplasty length was 5.6 ± 1.6 cm (range: 4–13 cm). The mean follow-up was 34.7 months (range: 10–58 months), and complications developed in 12 of 56 patients (21.4%), including urethrocutaneous fistulas in 7 (6 in group 1, 1 in group 2) and neourethral strictures in 5 (4 in group 1, 1 in group 2). The total success rate was 78.6%. Our survey suggests that one-stage onlay or inlay urethroplasty with LMG may be an effective option to treat the patients with less available skin after failed hypospadias repairs; LMG harvesting is easy and safe, irrespective of the patient's age.

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.

Ventral Oral Mucosal Onlay Graft Urethroplasty in Nontraumatic Bulbar Urethral Strictures: Surgical Technique and Multivariable Analysis of Results in 214 Patients

BackgroundThe ventral oral mucosal onlay graft is suggested in proximal bulbar strictures where the thick spongiosum provides excellent support to the graft. Some technical steps used in this technique are currently under debate in the literature. ObjectiveTo describe the surgical steps of this urethroplasty and investigate predictive factors of success using a multivariable logistic regression analysis. Design, setting, and participantsThis is a descriptive observational retrospective study of 214 patients who underwent urethroplasty for bulbar urethral strictures between May 1999 and November 2010 in a single high-volume center. Study inclusion criteria were patients presenting nontraumatic bulbar urethral strictures ranging from 1.3cm to 6.8cm in length. Exclusion criteria were traumatic strictures, panurethral strictures, lichen sclerosus, and failed hypospadias repair. Surgical procedureThe oral graft was placed on the ventral bulbar urethral surface and pushed as proximally as possible using dedicated instruments and surgical techniques. Outcome measurements and statistical analysisThe primary outcome measure was the objective result, defined as the absence of stricture recurrence at follow-up. The objective outcome was considered a failure when any postoperative instrumentation was needed. Multivariable logistic regression analysis was developed. All tests were two sided with a significance level set at 0.05. Results and limitationsMedian follow-up was 54 mo. Of the 214 patients, 183 (85.5%) were successful and 31 (14.5%) were failures. The preoperative maximum flow rate (Qmax) was a significant predictor of surgical outcome (odds ratio: 1.352; p = 0.001). Age, length, and type of stenosis, and previous treatment were not significant predictors of surgical outcome (all p > 0.05). The limitation of our survey is the absence of a subjective evaluation or the use of specific tools, such as a questionnaire. ConclusionsVentral oral graft urethroplasty represents a valid option in nontraumatic bulbar strictures. Preoperative Qmax may be predictive of urethroplasty failure.

Which type of urethroplasty in failed hypospadias repair? An 8-year follow up

ObjectiveTo report our 8-year follow up for redo hypospadias repair. MethodsA total of 56 patients with previous failed hypospadias repair were included in our study. Patients' data were analyzed regarding age, number of previous repairs, meatal location, procedure performed, operative time and complications. Patients were followed up for 3 to 102 (mean 52) months. ResultsPatient age ranged from 15 to 204 (mean 90.7) months. Forty-two patients had a single previous hypospadias repair, eleven had two previous repairs and three had four previous repairs. Of the 56 patients, 16 underwent oral mucosal graft urethroplasty, 15 onlay island flap, 14 parameatal flap, 10 tubularized incised plate urethroplasty, and 1 tubularized preputial flap. Complications were encountered in 16 (28.5%) patients in the form of graft contracture in 3, meatal stenosis in 2, urethral stricture in 2 including the patient with tubularized flap, urethra-cutaneous fistula in 7, bleeding in 1 and skin disruption in 1. The final complication rate was 25%. ConclusionsDecision making in redo hypospadias surgery depends mainly on local tissue availability and the degree of tissue scarring. The characteristics of oral mucosal graft make it suitable for urethroplasty in the absence of local donor tissues. A long-term follow up for redo hypospadias repair is required to assess the late neourethral stricture and residual penile curvature.

VID-03.07 Hybrid Minimally Invasive Oral Mucosal graft Urethroplasty for Pan-Anterior Urethral Strictures

VID-03.07 Hybrid Minimally Invasive Oral Mucosal graft Urethroplasty for Pan-Anterior Urethral Strictures

Urethral Ultrasound as a Screening Tool for Stricture Recurrence After Oral Mucosa Graft Urethroplasty

To evaluate the efficacy of sonourethrography (SUG) in combination with voiding pattern analysis to determine success after oral mucosa graft (OMG) urethroplasty. OMG urethroplasty is a standard treatment for men with recurrent urethral stricture. Because of its performance, the optimum follow-up algorithm remains controversial. Forty-nine patients (mean age 51 years) who underwent OMG urethroplasty were retrospectively identified. All men were subjected to a validated voiding questionnaire (International Prostate Symptom Score [IPSS]), SUG, uroflowmetry, and residual urine measurement. The predictive value was analyzed with regard to stricture recurrence or patency as well as to urethral diameter. Retrograde urethrography was done to confirm the diagnosis. Strictures were bulbar in 39, penile in 4, and combined in 6 patients. Mean stricture length was 3.8 cm (range 1-10). Mean follow-up after surgery was 35 (range 15-70) months. SUG showed a mean diameter of 7.6 mm for bulbar grafts and 4.6 mm for penile grafts. Stricture recurrence was seen in 4 (8%) patients, yielding a significantly lower urethral width of 2.3 mm (P<.005). Retrograde urethrography confirmed the patency status in all. The average maximum flow rate after successful repair was 36.6 mL/s, whereas those with recurrent strictures showed rates of 11.2 (P<.03). Similar results were achieved for residual urine (P<.05). IPSS values increased from 5.1 to 12.5 in patients with recurrence (P<.01). An algorithm consisting of SUG, uroflowmetry, residual urine and IPSS assessment reliably identifies stricture recurrence. Routine retrograde urethrography may therefore be unnecessary in the follow-up of OMG urethroplasty.

The Use of Topical Hyaluronic Acid and Silver Sulfadiazine (Altergen®) in Patients Undergoing Two-Stage Anterior Urethroplasty with Oral Mucosal Graft

This investigative pilot study was conducted with the objective of evaluating the therapeutic effect of a cream containing hyaluronic acid (HA) and silver-sulfadiazine (Altergen®, IBSA Farmaceutici Italia, S.r.l.) in adult patients undergoing two-stage urethroplasty using an oral mucosal graft for anterior urethral strictures due to failed hypospadias repair. We used a cream (Altergen®) containing the following active ingredients: 100 g HA, 0.20 mg sodium salt, and 1 g silver-sulfadiazine. During the period of January 2009 - May 2010, 40 patients, mean age 24 years, who had undergone hypospadias surgery during childhood were enrolled in the study, according to some inclusion and exclusion criteria (age &gt;18 years, with the absence of diabetes, neurovascular disease, lichen sclerosus or other dermatological lesions). All 40 patients had navicularis or penile urethral strictures and underwent two-stage urethroplasty using an oral mucosa graft. Post-operatively, 20 patients (50%) were treated with a cream containing HA and silver-sulfadiazine (Altergen®) and 20 patients (50%) were treated using a standard topical treatment (iodopovidone 10% gel). All patients underwent a follow-up at 6, 15, 30, 60 and 120 days after surgery. Out of the 20 patients treated with the HA and silver-sulfadiazine-containing cream (Altergen®), 18 (90%) showed good and complete healing of the graft implant 30 days after surgery. Of the 20 patients not treated with the HA and silver-sulfadiazine-contaning cream (Altergen®), 13 (65%) showed good and complete healing of the graft implant 30 days after surgery. These results were constant in all follow-ups in both patient groups. In patients who underwent a navicularis or penile two-stage oral mucosal graft urethroplasty, the use of a HA and silver-sulfadiazine-containing cream was associated with a higher success rate of the graft implant and a lower incidence of post-surgical complications compared to the controls.

Ventral bulbar augmentation: a new technical modification of oral mucosa graft urethroplasty for stricture of the proximal bulbar urethra.

Complication rates with ventral onlay technique of oral mucosa graft urethroplasty have been attributed to the poor ventral support for the graft. We herein describe a new technique which overcomes these problems and also discuss the short-term follow-up. In a prospective study conducted between January 2006 and June 2008, 13 patients with proximal stricture of the bulbar urethra underwent ventral bulbar augmentation. In this technique, the graft was sutured only to the bulbar urethra and the rest of spongiosal tissue was closed superficially. Longitudinal incisions were given in the partial depth of the bulb, adjacent to the suture line and were sutured together over the first suture line. The mean follow-up period was 16.4 months (range, 6 to 30 months). Two of the patients developed restricture; one at the proximal anastomosis of the graft with native urethra and one at the distal anastomosis. Remaining 11 patients have satisfactory postoperative uroflow rates and are doing well. The success rate at the last follow-up was 84.6%. This technique exploits the local bulbar anatomy by successfully moving the lateral bulbar tissue medially, below the ventrally placed mucosal graft. This results in a thicker ventral bulbar platform which provides enhanced support to the graft.

V1537 ONE-SIDED ANTERIOR URETHROPLASTY: A NEW DORSAL ONLAY GRAFT TECHNIQUE

You have accessJournal of UrologyReconstruction1 Apr 2010V1537 ONE-SIDED ANTERIOR URETHROPLASTY: A NEW DORSAL ONLAY GRAFT TECHNIQUE Sanjay Kulkarni and Guido Barbagli Sanjay KulkarniSanjay Kulkarni Pune, India More articles by this author and Guido BarbagliGuido Barbagli Arezzo, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1289AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES This video demonstrates our new surgical technique for the repair of anterior urethral strictures in order to preserve vascular supply to the urethra and its entire muscular and neurogenic support. METHODS Twenty four patients (mean age 46 years) underwent a new one-sided anterior dorsal oral mucosal graft urethroplasty. A midline perineal incision is made. The bulbar urethra is dissected from the corpora cavernosa only along the left side.Along the right side, the urethra remains attached to the corpora cavernosa preserving its lateral blood supply.On the left side, the urethra is partially rotated and the stricture is incised dorsally along its entire length.The oral mucosal graft is spread and fixed over the corpora cavernosa.The right urethral margin is sutured to the dorsally placed BMG on the right side.A 16F silicone Foley catheter is inserted. The bulbar urethra, with the intact bulbospongiosum muscle, is rotated to its original position over the graft.4-zero polyglactin sutures are used to suture the urethral margin onto the corpora cavernosa and the graft on the left side. In patients with panurethral strictures a midline perineal incision is made. By invaginating the penis into the perineal incision, the penile and bulbar urethra is similarly dissected, only along the left side,opened dorsally.A wide meatotomy is performed dorsally from the meatus through the urethra inside the glans. The first oral mucosa graft is sutured to the dorsal edge of the meatus and pushed inside the opened penile urethra and fixed to the corpora cavernosa. Another oral mucosa graft is applied to the corpora cavernosa opposite the bulbar urethra.The ventral urethral plate is sutured to the dorsally spread and fixed BMGs.There is no penile incision.Hypospadiac meatus is avoided.The catheter is left in place for three weeks. RESULTS Clinical outcome was considered a failure when any postoperative instrumentation was needed. Mean follow-up was 22 months (range 12 to 55 months). Out of the 24 patients, 22 (91.6%)had a successful outcome and 2 (8.4%) were failures. One failure was treated using definitive perineal urethrostomy and second underwent successful internal urethrotomy. CONCLUSIONS While performing dorsal placement of the graft the full circumferential dissection of the urethra is unnecessary.Preservation of the one-sided vascular supply to the urethra and its muscular and neurogenic support represents a significant step toward perfecting the surgical technique of urethral reconstruction using a minimally invasive approach. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byKulkarni S, Joshi P and Venkatesan K (2012) Management of Panurethral Stricture Disease in IndiaJournal of Urology, VOL. 188, NO. 3, (824-830), Online publication date: 1-Sep-2012. Volume 183Issue 4SApril 2010Page: e593 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sanjay Kulkarni Pune, India More articles by this author Guido Barbagli Arezzo, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Does tobacco consumption influence outcome of oral mucosa graft urethroplasty?

In a prospective study, outcome of oral mucosa graft urethroplasty (OMGU) was assessed in patients suffering from stricture of the urethra. Patients who underwent OMGU between July 2005 and December 2007 were included in this prospective study. Forty-eight patients with stricture of the urethra were divided into 2 groups of those who consumed tobacco and had poor oral hygiene and those who did not consume tobacco and had satisfactory oral hygiene. The oral cavity was inspected. The type of tobacco consumption and the duration of exposure to tobacco were noted. The mean follow-up was 18.2 months (range, 6 to 36 months). The patients were evaluated to assess the outcome of OMGU. The final outcome was analyzed in 42 patients. Thirty-one patients were asymptomatic and/or satisfied with their urinary flow rate, who were considered to have a successful outcome (73.8 %). Successful outcome in patients who consumed tobacco was significantly less (58.3%) compared to that in the tobacco nonusers (94.4%; P = .008). Failure rate of OMGU was higher in patients who consumed tobacco and had a poor oral hygiene, which might be due to adverse effects of these substances on the oral mucosa, leading to a poor graft quality.

尿道狭窄症に対する口腔粘膜を用いた尿道形成術

We evaluated the efficacy and outcome of one-stage oral mucosa graft urethroplasty, which is currently the procedure of choice for treating lengthy and complicated urethral strictures not amenable to excision and primary end-to-end anastomosis. Seven patients 33 to 74 years old (mean age = 53.7) underwent one-stage oral mucosa graft urethroplasty for a stricture in either the bulbar urethra (four patients), penile urethra (two patients), or pan-anterior urethra (one patient). Three of the strictures were due to trauma, one was due to inflammation, and one was due to a failed hypospadia repair. The other two were iatrogenic. All patients had previously undergone either internal urethrotomy or repeated urethral dilation. Three patients received a tube graft, three received a ventral onlay, and one received a dorsal onlay. A free graft of oral mucosa was harvested from the inside of each patient's left cheek, and if necessary to obtain a sufficient length, the harvest was extended to include mucosa from the lower lip and the right cheek. The graft lengths ranged from 2.5 to 12 cm (mean = 4.6 cm). A urethral catheter was left in place for 3 weeks postoperatively. While no severe complications at the donor site were observed during follow-up periods ranging from 3 to 55 months (mean = 14 months), two patients who had received a tube graft developed distal anastomotic ring strictures that were managed by internal urethrotomy. The other five required no postoperative urological procedure even though one who had received a ventral onlay developed a penoscrotal fistula. Oral mucosa is an ideal urethral graft, and oral mucosa graft urethroplasty is an effective procedure for repairing complicated urethral strictures involving long portions of the urethra.

Donor site morbidity in oral mucosa graft urethroplasty: implications of tobacco consumption

BackgroundThe purpose of this prospective study was to evaluate the donor site morbidity in patients who have undergone oral mucosa graft urethroplasty for stricture of the urethra. The impact of smoking and oral consumption of tobacco and/or paan masala on the donor site was also assessed. This study is probably the first of its kind where the affect of smoking, paan masala and tobacco chewing on the donor site morbidity has been documented.MethodsForty-eight patients suffering from stricture of the urethra underwent oral mucosa graft urethroplasty between July 2005 and December 2007. The patients were divided into two groups (users or non-users) based on tobacco consumption and oral hygiene. The donor site was evaluated at frequent intervals for pain, swelling, numbness, bleeding, salivation and tightness of mouth.ResultsDonor site morbidity was more in users with poor oral hygiene. Pain scores were higher amongst the users and the morbidity persisted longer in the users compared to non-users with good oral hygiene.ConclusionPatients who consume tobacco and have poor oral hygiene should be warned regarding poorer outcomes after oral mucosa graft urethroplasty.

One‐sided anterior urethroplasty: a new dorsal onlay graft technique

To investigate the feasibility, tolerability, safety and efficacy of using a new surgical technique for the repair of anterior urethral strictures to preserve vascular supply to the urethra and its entire muscular and neurogenic support. In all, 24 patients (mean age 46 years) underwent a new one-sided anterior dorsal oral mucosal graft urethroplasty while preserving the lateral vascular supply to the urethra, the central tendon of the perineum, the bulbospongiosum muscle and its perineal innervation. The cause of stricture was instrumentation in three cases (12%), unknown in five (21%), infection in four (17%), and lichen sclerosus in 12 (50%). The stricture site was bulbar in 12 cases (50%) and panurethral in 12 (50%). The mean stricture length was 4.2 cm in patients with bulbar strictures and 10 cm in patients with panurethral strictures. Of 24 patients, 20 patients (83%) had received previous treatments. Clinical outcome was considered a failure when any postoperative instrumentation was needed, including dilatation. The overall mean (range) follow-up was 22 (12-55) months. Of the 24 patients, 22 (92%) had a successful outcome and two (8%) were failures. One failure was treated using definitive perineal urethrostomy and another failure underwent successful internal urethrotomy. The preservation of the one-sided vascular supply to the urethra and its entire muscular and neurogenic support should represent a slight but significant step toward perfecting the surgical technique of urethral reconstruction using a minimally invasive approach.

Oral mucosal grafts urethroplasty for the treatment of long segmented anterior urethral strictures

To evaluate the efficacy and safety of using oral mucosal grafts for urethroplasty in the treatment of complex segmented urethral strictures. Between January 2002 and January 2008, 25 cases of long or multi-segmented urethral strictures (10-18 cm, mean 11.72) were treated using combined two oral mucosal graft urethroplasty. Of the 25 patients, combined double buccal mucosal graft (BMG) urethroplasty was performed in nine patients, double lingual mucosal graft (LMG) urethroplasty in seven patients and combined lingual and buccal mucosal graft urethroplasty in nine patients. Follow-up was obtained for 6-72 months (mean 26.83) post-operatively. Urethrocutaneous fistulas developed in two patients. Urethral strictures developed in one patient undergoing BMG urethroplasty; the patient underwent five urethral dilations, after which he voided well with a urinary peak flow of 26.4 ml/s. Meatal stenosis developed in one patient undergoing LMG and a second operation was required, after which the patient voided well (urinary peak flow of 28.7 ml/s). The other patients voided well and urinary peak flow rates ranged from 16.8 to 49.2 ml/s (mean 28.65 ml/s). Combined two oral mucosal grafts substitution urethroplasty is an effective technique for the treatment of long, segmented urethral strictures.