Oral Mucosa Graft Research Articles

Effects of C-xylopyranoside derivative on epithelial regeneration in an in vitro 3D oral mucosa model.

Identifying substandard tissue-engineered oral mucosa grafts with a poor epithelium before clinical use is critical to ensure quality assurance/control in regenerative medicine, leading to success of grafting. This study investigated the effects of one of the C-xylopyranoside derivatives, β-D-xylopyranoside-n-propane-2-one (XPP), on oral epithelial regeneration. Using a three-dimensional oral mucosa model, we analyzed changes of the epithelial structure, glycosaminoglycan (GAG) synthesis, the expression levels of basement membrane zone markers, and substrates of Akt/mTOR signaling. Compared with the control, 2mM XPP treatment increased the mean and minimal epithelial thickness, and reduced the variation of epithelial thickness. It also stimulated expressions of decorin and syndecan-1 with change of GAG amount and/or composition, and enhanced the expressions of integrin α6, CD44, and Akt/mTOR signaling substrates. These findings suggest that XPP supplementation contributes to consistent epithelial regeneration. Moreover, upregulation of those markers may play a role in increasing the quality of the oral mucosal epithelium.

One-stage Penile Urethroplasty Using Oral Mucosal Graft and Glue

BackgroundRepair of penile urethral strictures is a challenging problem for which different techniques have been suggested. ObjectiveTo describe a new surgical technique for one-stage penile urethroplasty using an oral graft and glue, and to assess its safety and efficacy. Design, setting, and participantsA retrospective review of medical records for patients who underwent one-stage penile urethroplasty using oral mucosa and glue from February 2013 to October 2014 was performed. Surgical procedureThe penile urethra was opened and the urethral plate was incised to create a wide window within which the oral graft was pasted with glue. The urethra was sutured over the catheter. Outcome measurements and statistical analysisClinical data were collected in a database. Intraoperative and postoperative complications and outcomes were assessed. A descriptive statistical analysis was performed. Results and limitationsFourteen patients were included in the study. Median operative time was 60min. The median postoperative stay was 3 d. Three intraoperative and one postoperative complication occurred. In all patients, voiding cystourethrography 2 wk after surgery failed to show urethral fistula or sacculation. No patients complained of penile chordee or sexual dysfunction after surgery. Median follow-up was 16 mo. Among the 14 patients, 12 (85.7%) procedures were successful and two (14.3%) were failures. Study limitations include the small sample size and short follow-up. ConclusionsAn in vitro study and a one-stage reconstruction of penile urethral strictures with an oral mucosa graft and glue showed that the procedure is safe and efficient, but further studies including larger series of patients and longer follow-up are required. Patient summaryWe report on the repair of penile urethral stricture using one-stage urethroplasty with oral mucosa and glue. This new technique was safe and effective, with limited complications and satisfactory outcomes. We plan to increase the use of this technique in the future.

Cavernoplasty with oral mucosa graft for the surgical treatment of Peyronie's disease

BackgroundPeyronie's disease is a disorder of the tunica albuginea and causes penile curvature, requiring surgical correction when the deformity impedes penetration. Material and methodsRetrospective analysis of the short-term results (penile length, angle of curvature and erectile function) of treating Peyronie's disease in 10 patients through cavernoplasty with oral mucosa graft. Essentially, the treatment included the incision of the fibrotic plaque with electrical scalpel and the subsequent coating of the cavernous defect using a patch of oral mucosa. At month 6, we measured the penile length and curvature and recorded the erectile function using the International Index of Erectile Function-5 (IIEF-5) questionnaire. Finally, the patients were asked “Would you undergo the same operation again?”. ResultsThe mean age was 53.4 years. The average and median follow-up was 22.7 months and 24 months, respectively. The mean preoperative curvature was 68.5° (50°–90°), the mean penile length was 11.2cm (9–15) and the mean IIEF-5 score was 16.1 (8–25). The mean postoperative penile length was 10.7cm, and the mean IIEF-5 score was 18.9. The differences between the preoperative and postoperative values were not statistically significant (p=ns). One patient developed erectile dysfunction. In all cases, the residual curvature was <20°. Nine patients (90%) stated that they would undergo the same operation. ConclusionsThe short-term results suggest that cavernoplasty with oral mucosa graft can be an alternative to traditional grafts for surgically correcting Peyronie's disease.

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 ...

PD16-05 LONG TERM RESULTS OF FEMALE URETHRAL RECONSTRUCTION USING DORSAL ONLAY LINGUAL MUCOSAL GRAFT

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) I1 Apr 2016PD16-05 LONG TERM RESULTS OF FEMALE URETHRAL RECONSTRUCTION USING DORSAL ONLAY LINGUAL MUCOSAL GRAFT Sameer Trivedi, Udai Shankar Dwivedi, Sartaj Wali Khan, V S Rathee, Pushpendra Shukla, and Aditya Kumar Singh Sameer TrivediSameer Trivedi More articles by this author , Udai Shankar DwivediUdai Shankar Dwivedi More articles by this author , Sartaj Wali KhanSartaj Wali Khan More articles by this author , V S RatheeV S Rathee More articles by this author , Pushpendra ShuklaPushpendra Shukla More articles by this author , and Aditya Kumar SinghAditya Kumar Singh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1157AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urethral strictures are an uncommon cause of bladder outlet obstruction in females and are treated empirically with various modalities like dilatation and internal urethrotomy with varying outcomes. Female urethroplasty utilizing a variety of tissues (Vaginal or labial grafts/flaps, oral mucosal grafts) has been described with variable degree of success in short term but long term data are lacking. In this study, we have analyzed long term results of dorsal onlay lingual mucosal graft (LMG) urethroplasty in management of female urethral stricture. METHODS Between Oct 2006 & Oct 2010, 40 female patients diagnosed as having urethral stricture underwent LMG urethroplasty. Mean age was 44 years (23 – 71 years). Pre-operative mean Qmax was 7.5 ml/s (2.2 – 13.4 ml/s) and urethral calibration revealed a urethral lumen of <14 Fr in all patients. Dorsal onlay LMG urethroplasty was performed using the technique previously described by us. After 15 days, patients underwent a trial of voiding and VCUG. Patients were then followed at 3, 12, 24, 36, 48 and 60 months with uroflowmetry and a detailed questionnaire. VCUG was advised at 6- and 12-month follow-ups and cystoscopy performed if required. Criteria for successful reconstruction were a Qmax of =15 mL/s with no postoperative instrumentation. RESULTS Mean urethral stricture and harvested graft length were 2.45 cm and 2.95 cm, respectively. All patients showed symptomatic improvement with mean Qmax increasing from 7.5 ml/s to 28.7ml/s at 3 months. At 3 months, 5 patients had a Qmax<15ml/sec and 4 of these patients required urethral dilatation while 1 patient had a urethral lumen > 14 Fr and reported significant improvement. At 1 year, all 36 successful patients were symptom free with mean Qmax of 27.6 ml/s (18.2 ml/s – 37 ml/s). At 3 and 5 years, 4 out of 36 patients were lost to attrition. In the remaining 32 patients, mean Qmax was 26.3 ml/s and 25.8 ml/s at 3 and 5 years respectively. None of these patients required any ancillary procedures. Overall success rate was 90% with 4 out of 40 patients requiring urethral dilatations postoperatively. None of the patients reported any urinary incontinence. CONCLUSIONS Dorsal onlay LMG urethroplasty is a simple, safe & effective surgical option with good long term results in the management of female urethral stricture with minimal risk of urinary incontinence & high success rates. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e395-e396 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Sameer Trivedi More articles by this author Udai Shankar Dwivedi More articles by this author Sartaj Wali Khan More articles by this author V S Rathee More articles by this author Pushpendra Shukla More articles by this author Aditya Kumar Singh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP52-14 NATURAL HISTORY OF PATIENTS WITH HYPOSPADIAS WHO UNDERWENT SURGICAL REPAIR: AN OBSERVATIONAL DESCRIPTIVE ANALYSIS WITH A FINAL SURPRISE

stricture was approached through perineal incision with penile invaginationto provide access to the entire length of anterior urethra in 1 stage. One sided, dorsal onlay technique was performed. Two/three oral mucosal grafts were placed dorsally. In redo cases where prior dorsal approach was used, a full-length ventral incision with dorsal inlay grafts was inserted. Postoperatively catheter was removed at 4 weeks. Follow up interval was at 3,6,9,12 months and subsequently yearly. RESULTS: Median patient age was 48.8 years, mean stricture length 14 cm and median follow-up 46 months. 184(57.75%) patients had LS and 134(42.25%) had other causes. Success rate for LS and non-LS was same 85.2%. Retention with suprapubic catheter (SPC) suggests obliterative stricture. Success rate decreased to 57.10% if patient had retention or SPC. On analysis of retention, it was seen in 60.3% patients with iatrogenic cases. Last 3 years 26 patients were referred with retention and SPC. Of this 17(65.33%.) were because iatrogenic cause The outcome was considered a success if the patient required no further instrumentation, including dilation or urethrotomy. The success rate was 89.39% for primary urethroplasty and 57.85% in patients in redo group. Most recurrent strictures developed at the proximal end of the graft. Only 3/318 patients had raised creatinine/renal failure. So raised creatinine and renal failure is less likely with panurethral stricture. CONCLUSIONS: Repair of panurethral stricture in 1 stage with 1-side dissection and dorsal onlay of oral mucosa graft is a minimally invasive technique that is simple, fast, safe, effective and reproducible by any surgeon. The incidence of iatrogenic panurethral strictures is on the rise. Iatrogenic strictures are more likely to be obliterative with early presentation.

Urethral Reconstruction with Rectal Mucosa Graft Onlay: A Novel, Minimally Invasive Technique

Alternative grafts are needed for patients who are not suitable candidates for oral mucosa graft harvest or who have a paucity of oral mucosa graft available for reconstruction. Circumferential colonic mucosal grafts have demonstrated feasibility for urethral reconstruction, although sigmoid resection has been required for graft retrieval. We report the feasibility and short-term outcomes of urethral reconstruction using a rectal mucosa graft harvested by a novel, minimally invasive, transanal endoscopic microsurgical technique. We retrospectively reviewed the records of all patients who underwent transanal endoscopic microsurgical rectal mucosa graft harvest and onlay urethroplasty since the technique was first implemented in 2013. Graft failure was defined as inability to pass a 16Fr cystoscope in the grafted urethra. All 4 strictures were bulbopendulous with a median length of 13.5 cm (range 10 to 21). Median followup was 18 months (range 12 to 28). Stricture etiology was lichen sclerosus in 3 patients and failed hypospadias interventions in 1. Three patients had undergone at least 1 prior urethroplasty. In 1 patient stricture recurred in the graft 10 months following reconstruction. There were no colorectal complications. To our knowledge this is the first study demonstrating urethral reconstruction using a rectal mucosa graft harvested by the transanal endoscopic microsurgical technique. Initial data revealed that this technique is feasible and safe, and minimizes graft harvest morbidity. Transanal endoscopic microsurgical harvest of a rectal mucosa graft may provide an alternative graft material for patients with long segment urethral strictures who are not candidates for oral mucosa graft harvest. Further experience and longer followup are needed to validate these findings.

Management of panurethral strictures

IntroductionPan-urethral stricture, involving the penile and bulbar urethra, is a common urological problem on the South Asian subcontinent. It represents a particularly difficult challenge to manage and there is a relative paucity of literature on the subject. In India, Lichen Sclerosus (LS) is the most common cause of pan-urethral stricture, followed by iatrogenic causes.2 stage surgery is not scientific in lichen sclerosus as this is a disease of genital skin. We present our experience of pan-urethral stricture repair using a single-stage, one-sided dissection, dorsal onlay repair with oral mucosa graft. Subjects and methodsWe retrospectively reviewed the records of 318 consecutive men undergoing management of pan-urethral stricture from June 1995 to December 2014. The median age was 44.6 years and the mean stricture length 14cm. The median follow-up was 59 months. The strictures were approached through a perineal incision, limiting dissection to only one side of the urethra. The penis was invaginated to provide access to the entire length of anterior urethra in a single-stage, and two oral mucosal grafts were dorsally placed. ResultsThe outcome was considered a success if the patient needed no further instrumentation, including dilation or urethrotomy. The overall success rate was 84.90%, with a success rate of 89.39% in primary urethroplasty, and 57.85% in patients who had previous failed urethroplasty. Most recurrent strictures occurred at the proximal end of the graft. ConclusionsRepair of pan-urethral stricture in a single-stage, with one-sided dissection and dorsal onlay of oral mucosa, is a minimally invasive technique that is simple, fast, safe, effective and reproducible in the hand of any surgeon.

Cavernoplastia con injerto de mucosa oral para el tratamiento quirúrgico de la enfermedad de La Peyronie

BackgroundPeyronie's disease is a disorder of the tunica albuginea and causes penile curvature, requiring surgical correction when the deformity impedes penetration. Material and methodsRetrospective analysis of the short-term results (penile length, angle of curvature and erectile function) of treating Peyronie's disease in 10 patients through cavernoplasty with oral mucosa graft. Essentially, the treatment included the incision of the fibrotic plaque with electrical scalpel and the subsequent coating of the cavernous defect using a patch of oral mucosa. At month 6, we measured the penile length and curvature and recorded the erectile function using the International Index of Erectile Function-5 (IIEF-5) questionnaire. Finally, the patients were asked “Would you undergo the same operation again?”. ResultsThe mean age was 53.4 years. The average and median follow-up was 22.7 months and 24 months, respectively. The mean preoperative curvature was 68.5° (50°-90°), the mean penile length was 11.2cm (9-15) and the mean IIEF-5 score was 16.1 (8-25). The mean postoperative penile length was 10.7cm, and the mean IIEF-5 score was 18.9. The differences between the preoperative and postoperative values were not statistically significant (P=ns). One patient developed erectile dysfunction. In all cases, the residual curvature was <20°. Nine patients (90%) stated that they would undergo the same operation. ConclusionsThe short-term results suggest that cavernoplasty with oral mucosa graft can be an alternative to traditional grafts for surgically correcting Peyronie's disease.

Effects of Contracted Anophthalmic Socket Reconstruction with Oral Mucosa Graft

Purpose: This study is executed to identify and report the treatment effects of oral mucosa grafting of prosthetic eye patients who have shallow conjunctival socket caused by socket contraction. Methods: Conjunctival sac reconstruction was performed by using the lower lip mucosa to 11 eyes of 11 patients diagnosed with contracted conjunctival sac at the ophthalmic clinic from August 2009 to May 2015, and a retrospective analysis was performed with medical record data from the patients who were followed-up after surgery. Results: Within the follow-up period, prosthetic eye insertion was possible for all 11 eyes of the 11 patients. All of them were satisfied in an aesthetic aspect, and were able to maintain deep conjunctival sac without receving findings of graft absorption, or re-contracted or shallow conjunctival sac during the follow-up period. On the donor region, normal epithelialization occurred. Concerning the donor region for the first week after surgery, the mean score of the patients' pain was 3.18 ± 0.94 points measured by a numerical rating scale, and no infection, bleeding, contraction, or cicatrix was revealed during the follow-up period. There were hypoesthesia, pararthria, and paresthesia (tingling sense) for post-complications from the donor region, and four patients out of the 11 patients complained of discomfort resulting from post-complications; whereas the remaining seven patients did not complain of discomfort. Conclusions: Oral mucosa can be considered as a good graft for contracted conjunctival sac reconstruction for patients who cannot wear a prosthetic eye. J Korean Ophthalmol Soc 2016;57(2):188-194

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.

Ocular Manifestations of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Steven-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare and some- times life-threatening hypersensitivity mucocutaneous disease triggered mostly by medi- cation and infections Major involving tissues are the mucous membranes of oral, gastroin- testinal, respiratory, integument, and gynecologic tissues. Even after recovering from skin problems without sequelae, survivors can have serious ocular complications leading to blindness despite local and systemic therapy. There is no definite effective systemic and lo- cal treatment for SJS/TEN. Early detection and aggressive treatment are important for the long-term prognosis of the eye. Eyelid margin and palpebral conjunctiva and fornix should be checked thoroughly to detect the cicatrical changes that make chronic ocular surface failure such as limbal cell deficiency and complete ocular surface keratinization. Amniotic membrane transplantation and cultivated oral mucosal graft are beneficial to reduce the risk of ocular surface failure.

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.

Two-Stage Repair for Severe Proximal Hypospadias Using Oral Mucosal Grafts: Combination of a Modified Bracka Method and a Modified Byars Flap Method: Should Local Flaps be Used for Urethral Reconstruction in Hypospadias Repair?

Two-Stage Repair for Severe Proximal Hypospadias Using Oral Mucosal Grafts: Combination of a Modified Bracka Method and a Modified Byars Flap Method: Should Local Flaps be Used for Urethral Reconstruction in Hypospadias Repair?

The selection of procedures for the treatment of panurethral stricture secondary to lichen sclerosus and the histological evidence of urethral involvement

Objective To explore the procedure selection and outcomes of treatment for the patients with severe panurethral strictures secondary to lichen sclerosus (LS) and evaluated the bulbar urethral specimens histologically. Methods Seventy-eight patients with severe panurethral strictures of LS underwent one-stage urethroplasty using different mucosal grafts between January 2003 and December 2014. The mean age was 48 years (range 38-72). The mean stricture length was 14.3±2.6 cm (range 11.0-22.0). Midline perineal incisions or circumcoronal and midline perineal incisions were used and two procedures were chosen as follow: ①the strictured urethras were dissected from the corpora cavernosa only along the left side and the stricture urethras were opened by a dorsal longitudinal incision which extended about 1.5 cm into the proximal healthy urethras. The strictured urethras were augmented using oral mucosal grafts(1.5 to 2.0 cm in width and an appropriate in length) (n=50); ② for the patients whose urethras were very narrow or obliterated, the urethras were reconstructed using colonic mucosal graft(3 cm in width and an appropriate in length)after the severe strictured urethras were excised (n=28). Biopsies were taken separately from the urethral meatus and bulbar urethral specimens. Results All of the 78 patients were followed up for 6-110 months (mean of 48.3 months). Sixty-nine patients (88.5%) urinated well, with the mean urinary peak flow rate of 23.4 ml/s (range 15.2-47.0 ml/s), and urethrography showed that each had a patent urethra with adequate lumen. Complications associated with urethra occurred in 9 patients (11.5%). Three patients developed urinary fistula secondary to infection, which required surgical correction; 6 patients developed meatal stenosis 3-11 months postoperatively, and all voided well after meatoplasty. The incidence of LS-positive biopsies was 100.0% in the glans and 88.5% in the meatus. In the bulbar urethral mucosa, the histological alteration in all biopsies was squamous metaplasia of the hyperplasia, and no histological evidence of typical LS was documented. However, homogenization of the collagen with diffuse lymphocyte infiltration was observed in the bulbar urethral specimens of 2 patients, and squamous metaplasia of the hyperplasia with serious orthokeratosis that was similar to its cutaneous counterpart was found in another 2 patients. Conclusions Our study suggests that urethroplasty with oral mucosal grafts is effective to treat panurethral stricture associated with LS. Urethroplasty with a colonic mucosal graft is suitable for repairing very severe strictured or obliterated urethra. No histological evidence of typical LS is observed in the bulbar urethral specimens. Key words: Urethral stricture; Lichen sclerosus; Colonic mucosa; Urethral reconstruction

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.

Editorial Comment

This is a multicenter collaborative study about sexual and ejaculatory function after staged penile urethroplasty. As Patel et al 1 Patel D.P. Elliott S.P. Voelzke B.B. et al. Patient-reported sexual function after staged penile urethroplasty. Urology. 2015; 86: 395-400 Abstract Full Text Full Text PDF Scopus (24) Google Scholar note, surgical success following staged penile urethroplasty with oral mucosa grafts has been well described; however, little is known about how the surgery affects sexual function. Patient-Reported Sexual Function After Staged Penile UrethroplastyUrologyVol. 86Issue 2PreviewTo evaluate sexual function after staged penile urethroplasty with oral mucosal graft (OMG). Full-Text PDF ReplyUrologyVol. 86Issue 2PreviewWe thank Dr. Buckley1 for her thoughtful editorial comments. Our analyses are likely underpowered to detect a change in preoperative vs postoperative Sexual Health Inventory for Men (SHIM) and Male Sexual Health Questionnaire Ejaculatory Domain (MSHQ-EjD) scores, given the small sample size and limited questionnaire completion. However, our results do add to the current literature to help guide reconstructive urologists when counseling patients considering staged penile urethroplasty. Importantly, a significant percentage of patients reported a change in penile curvature, length, and/or sensitivity on our nonvalidated posturethoplasty questionnaire. Full-Text PDF

Patient-Reported Sexual Function After Staged Penile Urethroplasty

To evaluate sexual function after staged penile urethroplasty with oral mucosal graft (OMG). We identified men with completed staged penile urethroplasty with OMG from the Trauma and Urologic Reconstruction Network of Surgeons database between January 1, 2010 and May 1, 2014. Our primary outcome was change in total Sexual Health Inventory for Men (SHIM) and total Male Sexual Health Questionnaire Ejaculatory Domain (MSHQ-EjD) Short Form at baseline vs after the second stage of the procedure. Second, we assessed subjective changes in penile curvature, length, and sensation. Thirty-three patients were included with a mean age of 45years and mean body mass index of 27.6kg/m(2). Urethral strictures arose from failed hypospadias repair in 52% and lichen sclerosus in 27%. Fifty-two percent of patients reported a previous urethroplasty. The median follow-up time between the second stage procedure and postoperative questionnaires was 6.3months (interquartile range: 3.5-13.3). There was no significant change in the total SHIM (Δ0.64, 95% confidence interval [CI]:-3.00∼1.72) and MSHQ-EjD (Δ1.55, 95% CI:-1.53∼4.63) scores preoperatively vs postoperatively. In addition, 32% reported improved and 52% no change in satisfaction with sexual intercourse (SHIM Q5). Forty percent of patients reported reduced and 45% no change in bother with ejaculation after surgery (MSHQ-EjD Q4). Men reported new penile curvature (23%), loss of penile length (55%), and altered penile sensitivity (45%) after surgery. Patients undergoing staged penile urethroplasty with OMG are likely to have minimal changes in erectile and ejaculatory function postoperatively, although many may experience new penile curvature, reduced penile length, and/or reduced penile sensitivity.

Sealing of the Gap between the Conjunctiva and Tenon Capsule to Improve Symblepharon Surgery

To report the surgical outcome of "sealing the gap" in treating symblepharon caused by various etiologies other than recurrent pterygium. Retrospective, interventional case series. Sixteen eyes of 14 patients with pathogenic symblepharon were consecutively operated by conjunctival recession, sealing the gap between recessed conjunctiva and Tenon capsule with a running 9-0 nylon suture, and covering of the bare sclera with amniotic membrane. For severe symblepharon where there was conjunctival shortening, oral mucosa graft was added. Outcome measures include ocular surface inflammation, fornix reformation, and restoration of ocular motility. The underlying causes of symblepharon included Stevens-Johnson syndrome (n= 6), chemical burn (n= 5), ocular cicatricial pemphigoid (n= 1), thermal burn (n= 1), following excision of conjunctival squamous cell carcinoma (n= 1), conjunctival scarring following exposed buckle (n= 1), and immune dysregulation (n= 1). Twelve eyes (75%) had an average of 1.6 ± 0.9 previous surgeries. Before surgery, ocular motility restriction was significantly correlated with the severity of symblepharon. During the follow-up period of 17.1 ± 13.6months, 13 eyes (81.3%) achieved complete success, 2 eyes (12.5%) achieved partial success, and 1 eye with immune dysregulation had failure (6.3%). There was no correlation between the success rate and the severity of symblepharon. After surgery, the ocular motility and inflammation were significantly improved. Visual acuity had improved in 2 of 15 eyes. Sealing the gap between the conjunctiva and Tenon capsule is an important step in the surgical management of pathogenic symblepharon. This method not only avoids the use of mitomycin C, but also creates a strong barrier to prevent recurrence, restore ocular surface integrity, reform a deep fornix, and regain full ocular motility.

Outcome of buccal mucosal patch graft in the Management of recurrent hypospadias urethrocutaneous fistula

Background: urethrocutaneous fistula after hypospadias surgery repair is the most common complication and remains a frustrating problem for surgeon and the patient. The problem is exacerbated because the urethrocutaneous fistula may recur which adds more demands surgery.Objectives: The purpose of this study is to evaluate of the use of oral mucosal graft for management of recurrent urethrocutaneous fistula after hypospadias repair.Patients and Methods: twelfth patients with age ranging from 4 year to 15 years were presented with history of recurrent fistula. Most of fistula were located in proximal penile and penoscrotal region (58.3%) . those patients were repaired by using oral mucosal graft with mean postoperative follow up period up to 6 months.Results: analysis of results showed 10 out of 12 cases (83.3%) had a final successful outcome with no recurrent fistula during follow up period. The two patients with failed repair were candidate for another attempt for fistula repair later on. No donor site morbidity was observed in all patients.Conclusion: Oral mucosal graft showed very good take and promising results when used for management of recurrent urethrocutaneous fistula after hypospadias repair.