Oral Mucosa Graft Research Articles

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

Current treatment of lichen sclerosus and stricture.

Lichen sclerosus (LS) is a common cause of urethral stricture disease. The purpose of this article is to review the literature over the past 5years, to describe current treatment of lichen sclerosus as it relates to urethral stricture in men. Literature reviews were performed using PUBMED, with search terms "lichen scleros*" and "urethral stenosis", as well as "lichen scleros*" and "urethral stricture". Relevant articles published within the past 5years were selected for review. A summary of current treatment of lichen sclerosus was prepared and synthesized. For LS affecting genital skin, topical steroids are a mainstay of therapy but in advanced cases, surgery may be required such as circumcision. When LS causes urethral stricture, urethral dilatation is unlikely to be successful long term, and surgery is often required, such as meatoplasty, single- or two-stage urethroplasty, or perineal urethrostomy. Oral mucosal grafting is the graft of choice, and usage of genital skin for flaps or grafts is best avoided due to predilection for recurrence. Biopsy and long-term surveillance of LS are recommended, due to its potential association with squamous cell carcinoma development. Although debate still exists regarding the pathogenesis of LS, it is agreed that LS can pose a treatment challenge to physicians and surgeons. Treatment options for LS range from pharmacological to surgical, depending on severity and location of disease, patient factors, and response of previous treatments.

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.

Staged male genital reconstruction with a local flap and free oral graft: a case report and literature review

BackgroundMale genital skin loss is a common disease in urology. However, male genital skin loss accompanying a penile urethra defect is rarely reported. Herein, we describe a novel surgical technique using a composite local flap and oral mucosal graft to reconstruct the penis, which may provide a new solution for patients with similar conditions.Case presentationA 36-year-old male with a penile urethra defect and a large area of genital skin loss required urethral reconstruction. The meatus had descended to the penoscrotal junction. This procedure was divided into three stages. The first stage of the surgery involved burying the nude penile shaft beneath the skin of the left anteromedial thigh for coverage of the skin defect. The second stage consisted of releasing the penis and expanding the size of the urethral plate for further urethroplasty. The third stage consisted of reconstruction of the anterior urethra 6 months later. Postoperatively, the patient reported satisfactory voiding. The maximal flow rate (MFR) was 22.2 ml/s with no postvoiding residual urine at the 24-month follow-up visit. No edema, infection, hemorrhage, or cicatricial retraction were observed. The patient’s erectile function was satisfactory, and his international index of erectile function-5 score (IIEF-5 score) was 23 at the 24-month follow-up visit. Additionally, the presence of nocturnal penile tumescence demonstrated that he had normal erectile function.ConclusionsThis procedure is an effective surgical option for men with complete foreskin and penile urethra defects. It could also be extended as a treatment strategy when composite local or pedicle transposition flaps and free grafts are needed for specific patients.

Single-stage repair of penile urethral stricture using combined dorsal onlay oral mucosa grafting with ventral onlay penile skin flap

To evaluate the clinical effect of single-stage repair of penile urethral stricture using combined dorsal onlay oral mucosa grafting with ventral onlay penile skin flap. We retrospectively reviewed the clinical database of 22 male patients with penile urethral stricture who received single-stage repair using combined dorsal onlay oral mucosa grafting with ventral onlay penile skin flap from November 2015 to October 2018. All the cases had no complications, such as skin fistula. The causes of stricture included iatrogenic (14/22, 63.6%), inflammation (2/22, 9.1%) and idiopathic (6/22, 27.3%). A ventral urethrotomy was made in the segment of stricture and extended proximally and distally until the normal calibre urethra was encountered. The oral mucosa graft was secured to the corpus spongiosum in dorsal onlay fashion or underlying corpora cavernosum after resection of the severe scarred urethra. Then the prepared Orandi fasciocutaneous penile skin flap was secured to edges of corpus spongiosum or oral mucosa graft. A 16 F or 14 F Foley catheter was left in situ for a minimum of 3 weeks, at which time a urethrogram was performed to look for extravasation, and the urethroscopy was performed if necessary. Success was defined as an open urethra with Qmax≥15 mL/s and no need for further surgical intervention. all the 22 patients with a mean age of 52.6 (18-73) years underwent the combined tissue-transfer technique. The mean length of the penile urethral stricture was 5.3 (2.5-10.0) cm and the mean preoperative Qmax was 6.7 mL/s. the mean length of oral mucosa grafts and fasciocutaneous skin flaps were 5.5 (3.2-10.5) cm and 6.0 (3.5-11.0) cm, respectively. The mean operation time was 225 (150-420) minutes and the mean evaluated blood loss was 53 (20.0-110.0) mL. The grafts included buccal mucosa (19/22, 86.4%) and lingual mucosa (3/22, 13.6%). The mean postoperative Q max was 21.2 (15-32) mL/s. A case of skin fistula and 2 cases of recurrent stricture were found, so the technique success rate was 81.8% (18/22) at a mean follow-up of 20.5 (5-51) months. The perioperative complications included 2 cases of infection and skin necrosis, which healed well after conservative treatment. Single-stage repair of penile urethral stricture using combined dorsal onlay oral mucosa grafting with ventral onlay penile skin flap appears to be an excellent option to repair penile urethral stricture with unsalvageable urethral plate and the penile skin is available. The present clinical series showed a successful rate of 81.8% (18/22).

Total upper and lower eyelid reconstruction using periosteal flap canthoplasty combined with auricular cartilage and oral mucosa grafts

Extensive full-thickness defects of both the upper and the lower eyelids continue to be a challenge for reconstructive surgeons. Ectropion of the lower eyelid and an unnatural canthal shape are pitfalls to be avoided in total eyelid reconstruction. We here present a case in which an extensive full-thickness defect of the upper and lower eyelids after tumor resection was successfully reconstructed by means of periosteal flap canthoplasty from the infraorbital margin. A 73-year-old woman had in situ melanoma on her left eyelids. The lids were almost completely removed as a result of tumor resection. The conjunctival defect was covered with oral mucosa. And the tarsal layer was reconstructed with auricular cartilage. A periosteal flap pedicled at the origin of the lateral canthal tendon was harvested from the infraorbital margin. The flap was fixed with sutures on the cartilage graft for the lower eyelid. The cartilage graft for the upper eyelid was sutured laterally on the basal portion of the periosteal flap as the lateral canthus. The skin defect of the upper eyelid was covered with a bipedicled orbicularis oculi flap and skin graft. The lower eyelid was reconstructed with a combination of an angular artery transposition flap and a cheek rotation flap. Thirteen months after the surgery, the reconstructed eyelids had good function without ectropion. And the reconstructed canthus had a natural sharp shape. Total eyelid reconstruction using periosteal flap canthoplasty combined with auricular cartilage and oral mucosa grafts is useful for extensive full-thickness defects of the upper and lower eyelids. Level of evidence: Level V, therapeutic study.

Vicryl Tack for graft fixation during bulbar urethroplasty

Urethral stricture disease continues to be a prevalent condition with significant morbidity. Oral mucosal graft augmentation urethroplasty for long segment bulbar urethral strictures is an established management option. Here the authors outline the results of their pilot study designed to evaluate the efficacy of using two innovative steps for graft augmentation.

Effect of oral mucosal transplantation on the expression of EGF and VEGF-C during skin wound repair.

This study evaluated the effects of oral mucosal transplantation on epidermal growth factor (EGF) and vascular endothelial growth factor C (VEGF-C) in skin wound repair. Sixty-four rats were randomly separated into group A, B, C and D (16 rats in each group). The right abdomen skin was excised 1, 3, 5 and 7 days after injury, respectively. Oral mucosa of the rat tongue was transplanted to the right abdomen skin. Fourteen days after the healing of the oral mucosa graft, the rat skin full-thickness model was prepared at the transplant site (the study group) and the contralateral site (the control group). Rats in each group were anesthetized and sacrificed at 1, 3, 5 and 7 days after injury. Expression of EGF and VEGF-C in skin tissue was detected by RT-qPCR and ELISA. At 3 days, expression levels of EGF and VEGF-C mRNA and protein in skin tissue were significantly higher than those at 1 day (P<0.05). At 5 days, expression levels of EGF and VEGF-C mRNA and protein in skin tissue were significantly higher than those at 3 days (P<0.05). At 7 days, expression levels of EGF mRNA and protein in skin tissue were significantly lower than those at 5 days (P<0.05), while VEGF-C levels were significantly increased (P<0.05). Expression levels of EGF and VEGF-C mRNA and protein in the skin tissue of the study group were significantly lower than those in the control group at all days (P<0.05). EGF and VEGF-C may be involved in scar formation, and play an important role in the process of skin wound repair.

Histopathological changes in oral mucosa in cases of failed augmented urethroplasty.

Histopathological changes in oral (buccal or lingual) mucosa after exposure to urine are still not completely understood. We evaluated these changes in free oral mucosal graft integrated in human urethra. Total 19 patients with recurrent urethral stricture after oral mucosa urethroplasty (buccal 12 and lingual 7) were prospectively evaluated. Intraoperatively integrated buccal or lingual mucosal graft sample that was previously engrafted to urethra was completely excised along with healthy oral mucosa, and it was sample processed for histopathological evaluation by dedicated pathologist. Preoperative clinical data were properly collected from all the study participants. The mean age of the patients was 30 years, and the mean preoperative peak flow rate was 4.2 mL/s. Etiology of initial stricture was idiopathic in 13 (68.42%) patients and traumatic urethral catheterization in 6 (31.58%) patients. Mean interval from previous buccal mucosal urethroplasty to current urethroplasty was 21.9 months (range 12-46 months). On repeat urethroplasty, the mean stricture segment length was 59.2 (38-77) mm [60.08 (38-74.6) mm buccal, and 58.32 (39.6-77) mm lingual]. These integrated oral mucosal grafts maintained their histopathological characteristics in all patients except some kind of changes like submucosal fibrosis in seven (58.33%) cases of buccal and vacuolar degeneration in five (71.42%) cases of lingual mucosal urethroplasty. Histopathological characteristics of integrated oral (buccal and lingual) mucosal grafts were maintained even on exposure to urine except some changes like submucosal fibrosis and vacuolar degeneration. Impact of these changes require further research.

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.

EDITORIAL COMMENT

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

PT016 - Augmentation urethral reconstuction using tissue-engineered oral mucosa graft MukoCell®

PT016 - Augmentation urethral reconstuction using tissue-engineered oral mucosa graft MukoCell®

Rectal Mucosa Graft Take in Staged Urethroplasty

When an oral mucosa graft is not a viable option for urethroplasty, colonic mucosa grafts have served as a promising alternative since described by Igor A. Thyrmos in 1902.1 In previous studies, colonic mucosa graft retrieval required sigmoid resection2-3 which limited adoption of this technique. We previously described the success of a minimally-invasive transanal endoscopic microsurgical technique of rectal mucosa graft harvest for urethroplasty.4 Here, we pictorially demonstrate the take of a transanal endoscopically harvested rectal musosa graft used in a 2-stage anterior urethroplasty (to our knowledge, the first such 2-stage procedure) with 6 months of follow-up.

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.

Ocular Surface Reconstruction Using Circumferentially-trephined Autologous Oral Mucosal Graft Transplantation in Limbal Stem Cell Deficiency.

PurposeTo investigate the effects of transplantation of a circumferentially-trephined autologous oral mucosal graft using a vacuum trephine on ocular surface reconstruction in patients with limbal stem cell deficiency.MethodsPatients with a limbal stem cell deficiency who underwent transplantation of autologous oral mucosal graft performed by a particular surgeon in Seoul National University Hospital were included. The medical records of these five patients were retrospectively reviewed. The lower labial mucosal graft inside the inferior lip was trephined to a depth of 250 µm using a donor vacuum trephine with a 9-mm diameter. Outside markings were made using a 14-mm intraoperative keratometer. The oral mucosal graft was dissected under a microscope using a Beaver mini-blade as either a ring or a crescent-shaped strip with a 5-mm width. The mucosal graft was transplanted onto the limbus in the limbal-deficient eye. Best-corrected visual acuity and corneal status were measured during the follow-up period.ResultsFour patients were diagnosed with Stevens-Johnson syndrome and one was diagnosed with atopy-associated immune keratitis. The mean follow-up period was 10.4 ± 2.9 months. After 4 months, visual acuity improved in all patients, and the mean improvement in logarithm of the minimum angle of resolution visual acuity was 0.526 ± 0.470 (range, 0.15 to 1.10). Corneal surface erosion and neovascularization decreased in four patients, and stromal opacity decreased in two patients. The engraftments maintained ocular surface stabilization in four of the five patients at the last follow-up.ConclusionsTransplantation of circumferential autologous oral mucosal grafts may be effective for the treatment of limbal stem cell deficiency.

Гистопатологическая оценка эволюции трансплантатов слизистой оболочки ротовой полости, используемых для аугментационной уретропластики

The clinical efficiency of oral mucosa grafts used for augmentation urethroplasty has been proven. However, a small number of studies in literature are dedicated to the determination of pathologic changes in grafts during the engraftment in the urethra. to assess the histopathologic evolution of oral mucosa graft used for augmentation urethroplasty. A total of 15 patients aged 19-67 years with penile and combined penile/bulbar urethral strictures of length 3.5-11 cm were undergone to two-staged urethroplasty by Asopa technique. In 9 cases the pathologic study of oral mucosa grafts after sampling (buccal mucosa in 5 cases and lip mucosa in 4 cases) and 6 months after their engraftment in the urethra during the second stage of urethroplasty was performed. In other 6 cases the graft tissue in patients with recurrent stricture that occurred 12-24 months after tubularization and requiring additional intervention was studied. The general structure of mucosal graft was preserved 6 months after sampling. The dystrophic changes in epithelium, inflammatory infiltration and foci of fibrosis in subepithelial layer were observed. Buccal grafts were distinguished by a smaller epithelium thickness and the presence of keratinization foci. The grafts also retained their structure after 12-24 months. A decrease in the severity of chronic inflammatory reaction and the absence of keratinization of the squamous buccal epithelium were found. The stricture in the area of anastomosis was characterized by the presence of sclerotic and fibrous connective tissue covered with urothelium. The oral mucosa grafts completely preserve their histologic structure during 1-2 years and they are not involved in recurrence of urethral stricture, which develops in the area of anastomosis between graft and native urethra.

Модификация двухэтапной операции bracka с сохранением и тубуляризацией уретральной площадки при коррекции проксимальной гипоспадии

Surgical treatment of proximal hypospadias is associated with a number of difficulties and unsuccessful repeated interventions. The changing approaches to the treatment of hypospadias with the revision of the attitude to urethral plate provide new opportunities in resolving this problem. to improve the results of surgical correction of hypospadias by creating "artificial" urethra that is very close to a native one in its functional qualities. From 2011 to 2017 . two-stage urethroplasty using Bracka technique was used in 41 patients with a proximal hypospadias aged 1-16 years. From those, 32 patients were undergone to primary intervention (78%), and 9 boys previously had unsuccessful urethroplasty performed by different techniques (22%). Oral mucosa graft was used in 9 patients (22%), and in other 32 cases inner preputial skin was harvested (78%). The classical and modified Bracka technique were performed in 19 and 22 cases, respectively. The urethral plate was preserved in 22 cases and "artificial" urethra was created by its tubularization, which contributes to the reduction of the required length of the harvested prepucial graft. The complication rate in patients after classical Bracka technique was 31.6% (n=6) in comparison with 4.5% in group of the modified urethroplasty (n=1). Thus, the efficiency of modified technique was significantly better than that of the classical intervention (<0,05). The preservation and use of urethral plate for urethroplasty during the two-stage surgical correction of the proximal hypospadias allows to decrease the total length of "artificial" urethra and to improve the properties of the newly formed urethra.

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.

Salvaging the dehisced glans penis

The glans penis may show a deep groove (surgically favorable), or may appear flat with an absent sulcus (unfavorable). Glans dehiscence following hypospadias repair, especially after multiple surgeries, frequently results in a scarred, obliterated, or absent urethral plate. The glans penis appears to be flat and grooveless. This study reported on the outcome of a two-stage salvage repair for glans dehiscence in 49 consecutive patients. Retrospective chart review was performed for all patients who underwent repair for glans dehiscence following hypospadias repair. Between January 2009 and April 2015, 49 children aged 16 months to 18 years presented with glans dehiscence following hypospadias repair. The prior number of operations ranged from one to six. Eleven children had urethral fistulas, and seven had chordee. In the first stage, the flat glans was incised deeply to visualize, but spare, the corpora. Thereafter, a free graft of oral mucosa harvested either from the lower lip or cheek, or the residual preputial skin, was sutured to the glans cleft. The grafts were fenestrated, quilted in the midline, and a tie-over dressing was applied. Any fistula or chordee was repaired during the first stage. The neo-plate was tubularized 6-12 months later, and urine drainage with a catheter was maintained for 10-14 days. In 11 patients, skin flaps appeared dusky, and nitroglycerine ointment 2% was applied for 24h to enhance the blood supply of the tissues. Subsequently, six of these children received nine or ten 90-minhyperbaric oxygen therapy sessions. Following the first stage, two patients developed hypertrophy of the mucosal grafts, and one skin graft contracted. These three patients underwent revision using a second buccal mucosal graft harvested from the cheek. One recurrent fistula was closed during the second stage. Following the second stage two patients developed a urethral fistula, and the distal sutures broke down in one patient, resulting in an over-sized meatus. None developed meatal stenosis or glans dehiscence. Graft initial take and subsequent behavior were unpredictable, but the two stage approach optimized the process of take and healing. Glans dehiscence was repaired safely and successfully by developing a deep groove, with creation of a new urethral plate followed by tubularization in two stages.

This Month in Adult Urology

No AccessJournal of UrologyThis Month in Adult Urology1 Aug 2018This Month in Adult Urology Joseph A. Smith Joseph A. SmithJoseph A. Smith More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.05.009AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail References 1 : Diagnostic accuracy of multiparametric magnetic resonance imaging and fusion guided targeted biopsy evaluated by transperineal template saturation prostate biopsy for the detection and characterization of prostate cancer. J Urol2018; 200: 309. Link, Google Scholar 2 : A single center evaluation of the diagnostic accuracy of multiparametric magnetic resonance imaging against transperineal prostate mapping biopsy: an analysis of men with benign histology and insignificant cancer following transrectal ultrasound biopsy. J Urol2018; 200: 302. Link, Google Scholar 3 : Prevalence and characteristics of urinary incontinence in a treatment seeking male prospective cohort: results from the LURN study. J Urol2018; 200: 397. Link, Google Scholar 4 : A phase II, randomized, multicenter study comparing 10 months versus 4 months of degarelix therapy in prolonging the off treatment interval in men with localized prostate cancer receiving intermittent androgen deprivation therapy for biochemical recurrence following radical local therapy. J Urol2018; 200: 335. Link, Google Scholar 5 : Anterior urethroplasty using a new tissue engineered oral mucosa graft: surgical techniques and outcomes. J Urol2018; 200: 448. Link, Google Scholar 6 : Targeted antimicrobial prophylaxis does not always prevent sepsis after transrectal prostate biopsy. J Urol2018; 200: 361. Link, Google Scholar 7 : Impact of androgen deprivation therapy on self-reported cognitive function in men with prostate cancer. J Urol2018; 200: 327. Link, Google Scholar 8 : Cystic renal cell carcinoma: a report on outcomes of surgery and active surveillance in patients retrospectively identified on pretreatment imaging. J Urol2018; 200: 275. Link, Google Scholar 9 : Testis sparing surgery for benign testicular masses: diagnostics and therapeutic approaches. J Urol2018; 200: 353. Link, Google Scholar 10 : Perioperative immunonutrition modulates inflammatory response after radical cystectomy: results of a pilot randomized controlled clinical trial. J Urol2018; 200: 292. Link, Google Scholar 11 : Three-year treatment outcomes of water vapor thermal therapy compared to doxazosin, finasteride and combination drug therapy in men with benign prostatic hyperplasia: cohort data from the MTOPS trial. J Urol2018; 200: 405. Link, Google Scholar © 2018 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 200Issue 2August 2018Page: 215-217 Advertisement Copyright & Permissions© 2018 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph A. Smith More articles by this author Expand All Advertisement PDF downloadLoading ...