Urethrography Research Articles

Role of magnetic resonance imaging in the management of male pelvic fracture urethral injury.

The management of male pelvic fracture urethral injury remains a urological challenge. Pelvic fracture urethral injury can be associated with sequelae, such as urethral gap, erectile dysfunction and urinary incontinence. Delayed anastomotic urethroplasty, the gold standard treatment for urethral gaps caused by pelvic fracture urethral injuries, is technically demanding, and reconstructive urologists should preoperatively obtain as much detailed anatomical information as possible. A combination of antegrade and retrograde urethrography is the fundamental preoperative evaluation, but it cannot accurately assess the urethral gap length, the degree of lateral prostatic displacement, the anatomical relationship of the urethra with its surrounding structures (such as the rectum and dorsal venous complex) or periurethral problems (such as minor fistulae or cavitation). To make up for these limitations of urethrography, magnetic resonance imaging has emerged as a non-invasive, multiplanar and high-resolution modality for the evaluation of pelvic fracture urethral injury. Magnetic resonance imaging has excellent soft-tissue contrast, and can clearly show the urethra and periurethral tissues without the effects of radiation, thus enabling clinicians to anticipate the required ancillary techniques for delayed anastomotic urethroplasty and to predict functional outcomes, such as erectile function and urinary continence, after delayed anastomotic urethroplasty. This review discusses the role of magnetic resonance imaging in the evaluation of pelvic fracture urethral injury and its impact on patient management.

A novel stricture prevention technique in blunt urethral injury: A multi-center retrospective observational study.

PurposeBulbar injury is the most common type of urethral injury. This study investigated the efficacy and safety of a novel technique, local urethral flushing, in preventing stricture formation after blunt bulbar urethra injuries.Materials and MethodsThis retrospective study included 205 males diagnosed with straddle injury-induced bulbar urethra injury at the Shanxi Bethune Hospital and First Hospital of Shanxi Medical University between January 2015 and January 2019. Patients were diagnosed by retrograde urethrography and classified as partial or complete urethral rupture according to the urethral integrity after injury. Complete urethral rupture patients received suprapubic cystostomy and received urethroplasty 3 months later. Patients with partial urethral rupture underwent endoscopic urethral realignment by cystoscopic guide-wire guided catheterization. Patients with both injury types were divided into 3 groups. The treatment groups received urethral flushing with 0.05% dexamethasone through a secondary ureteral catheter that locked at the urethral lesion. The blank control groups received normal saline. The negative control groups had only a single ureteral catheter placed. Patients were assessed for pain during catheterization, infection, and stenosis, and followed for at least 2 years.ResultsStenosis rates and length were significantly reduced in the normal saline groups, and even further reduced in the dexamethasone groups. The negative control groups had significantly higher infection rates than patients in the dexamethasone or saline groups.ConclusionsLocal urethral flushing with dexamethasone could significantly decrease urethral stenosis rates and severity without increasing patients’ discomfort or infection risk.

Clinical Study of Single Stage Dorsolateral Onlay Buccal Mucosal Graft Urethroplasty in Long Segment Anterior Urethral Stricture

1.1. Objectives: To evaluate the results of dorsolateral onlay buccal mucosal graft (BMG) urethroplasty in various types of long segment anterior urethral stricture. 1.2. Materials and Methods: This is a prospective study, conducted in the Department of Urology, Medical College, Kolkata and Burdwan Medical College, Burdwan from April 2017 to March 2021. Forty patients with long segment (more than 1.5 cm) anterior urethral stricture who underwent substitution urethroplasty using dorsolateral onlay BMG urethroplasty were evaluated with detailed history, physical examination, ultrasonography of KUB with PVRU, uroflowmetry, retrograde urethrography and voiding cystourethrography, sono-urethrograms and cystoscopy. After treatment with dorsolateral onlay BMG urethroplasty, they were followed-up with uroflowmetry at 3 monthly interval for one year and RGU and/or urethroscopy if indicated. Success was defined as normal voiding pattern without any intervention post-operatively. 1.3. Results: With nineteen of the forty cases (47.5%), lichen sclerosus formed the single most common etiology. Panurethral strictures were more common. Out of total 40 cases, 33 (82.5%) had successful outcome and 7 (17.5%) were failure. 1.4. Conclusion: We conclude that it is a simple, technically feasible, easily adoptable and finally successful procedure

Transperineal Urethroplasty for Urethral Distraction Defects Caused by Pelvic Fracture

Purpose: We report the outcomes of transperineal urethroplasty in patients with pelvic fracture urethral distraction defects (PFUDDs) over the past 12 years. Materials and Methods: Patients who received transperineal anastomotic repair of PFUDDs from January 2007 to December 2019 were retrospectively analyzed, specifically focusing on demographic findings, pelvic fracture type, urethral distraction defect length (based on retrograde urethrography and cystography), previous treatments, and ancillary maneuvers during surgery. Simultaneously, differences in clinical factors between successful and failed cases were also analyzed. Results: A total of 36 patients were included, with a final success rate of 83%. The mean age was 40.4 years, whereas the mean urethral distraction defect length was 31.9 mm. Most patients (69%) presented with unstable pelvic fractures. Treatment before referral included endoscopic treatment and urethroplasty in 13 (36%) and 2 cases (6%), respectively. For difficult cases, ancillary procedures, which included corporeal splitting (61.1%) and inferior pubectomy (8.3%), were performed. The postoperative average peak flow rate was 14.9 mL/s in the success group. Age and urethral defect length differed significantly between the success and failure groups. Conclusions: Over the past 12 years, transperineal urethral reconstruction demonstrated a success rate of 83% in 36 patients with PFUDD. Age and urethral defect length were identified as the two main factors affecting surgical prognosis.

Management of urethral strictures after masculinizing genital surgery in transgender men

Transgender men undergoing phalloplasty and metoidioplasty have a high rate of urethral stricture. Evaluation of stricture includes evaluation of symptoms and uroflow, cystoscopy, and retrograde urethrogram. Important anatomic differences between the phallus of cis-gender and transgender men increase the likelihood and complexity of treating urethral strictures in transgender men after surgery. Urethral strictures after masculinizing procedures are more likely to require open surgical treatment and recur after treatment. There is a paucity of data, but less invasive options such as dilation and urethrotomy have had minimal success. Open surgical options with a variety of techniques, including one-stage and two-stage techniques, have higher success rates in treating strictures, but there is minimal comparative data on outcomes. We present a review on management options for urethral reconstruction in transgender men and our data on urethroplasty for these patients.

Buccal mucosal graft urethroplasty in male cats with traumatic complete urethral rupture.

To evaluate the feasibility of buccal mucosal graft urethroplasty for repairing complete urethral rupture in cats. 15 male domestic shorthair cats with traumatic complete urethral rupture. In each cat, a section of buccal mucosa was harvested, sutured, and formed into a tubule by use of an 8F indwelling catheter as support. This tubular graft was connected to both ruptured ends of the urethra to renew the urinary passage. The catheter was left in place until the absence of leakage was confirmed by positive contrast retrograde urethrography. After spontaneous urination was confirmed, cats were discharged from the hospital. Six months later, urethrography was repeated and owners were asked to score their cats' urinary function and quality of life. 13 cats recovered well following surgery, with no complications in the oral cavity or surgical site and no signs of difficulty or discomfort when urinating. Urethrography 2 weeks and 6 months after surgery revealed no stricture or leakage in the abdominal cavity. The 2 remaining cats developed a urethral stricture and underwent second surgery with a successful outcome. At the 6-month follow-up, 14 cats had only mild urinary signs, and 1 cat had incontinency. Owners indicated they were delighted (n = 14) or pleased (1) with their cats' quality of life. Buccal mucosa was found to be a good source of graft tissue for performance of urethroplasty in male cats, yielding satisfactory outcomes with few postoperative complications. The described technique may be suitable for severe and complicated cases of urethral rupture in male cats.

Correlation of Sonourethrography Findings of Male Anterior Urethral Stricture with Retrograde Urethrography

Introduction: Imaging plays significant role in diagnosing the male urethral stricture and helps the urologist in determining the treatment protocols. Retrograde urethrography (RGU) had been the standard imaging technique for anterior urethral stricture. Sonourethrography (SUG) as compared to the retrograde urethrography has the advantage of being radiation free. Aim of this study was to compare the sonourethrography findings in anterior urethral stricture with that of retrograde urethrography. Methods: This was an observational study done in 46 patients with clinical symptoms related to lower urinary tract during the period of September 2019 to August 2020 after obtaining informed consent. Ethical clearance was received from Institutional Review Committee, Institute of Medicine. Patients were first evaluated by sonourethrography. Then, retrograde urethrography was done as per the standard protocol of the department. Data were collected in the predesignated proforma including the study variables on sonourethrography and retrograde urethrography and entered in IBM SPSS version 20. The lengths of strictures on sonourethrography and retrograde urethrography were compared. Results: Among 46 patients 21 patients showed anterior urethral strictures on both SUG and RGU with bulbar region as the commonest location. SUG showed all the urethral strictures seen on RGU with significant positive correlation. SUG also showed spongiofibrosis in nine patients. Conclusion: Sonourethrography, an radiation free imaging technique, showed all the strictures seen in retrograde urethrography with added benefit of detection of spongiofibrosis as well.

Fluoroscopic Evaluation of the Male Urethra in the Setting of Trauma

The radiologist plays a key role in evaluation of the male urethra after trauma. In particular, radiologists perform the fluoroscopic procedures commonly used to evaluate for urethral injury: retrograde urethrography (RUG) and voiding cystourethrography (VCUG). Radiologists must effectively illustrate urethral anatomy and pathology while avoiding imaging pitfalls. This review article discusses normal male urethral anatomy, fluoroscopic imaging techniques for evaluation of the male urethra, findings and classification of traumatic urethral pathology, and common treatments of traumatic urethral injury. It is important that radiologists are aware of these key elements to communicate effectively with the treating clinicians.

Management of complex ischial-urethral fistula in neurogenic patients performing clean intermittent self-catheterization.

Neurogenic patients performing clean-intermittent self-catheterization (CIC) may develop an urethral erosion, resulting in ischial-urethral fistulas (I-UF). In this work we present our single-center experience in dealing with this peculiar complication. In this work we included all neurogenic patients performing CIC treated at out Institution for I-UF. All patients had a spinal cord injury or myelomeningocele. We extracted from the patients' medical records the surgical management and postoperative clinical data. We defined failure the persistence of the fistula at X-ray contrast fistulography, retrograde urethrography, or uretrocystoscopy. We treated 11 patients (8 spinal cord injury, 3 myelomeningocele). Four patients have been treated with the placement of a new generation urethral stent (Uventa) after surgical toilette of the skin ulcer and placement of a temporary suprapubic catheter. All patients demonstrated a complete healing of the urethral lesion at stent removal and continued CIC without any difficulty. Four patients have been treated with perineal urethroplasty, requiring a buccal mucosal graft in two cases. In two patients a suprapubic permanent catheter was placed for a simpler bladder management due to the patients' comorbidities. In one case the incidental finding of an high grade muscle invasive urothelial bladder cancer, made it mandatory to perform an uretheroileocutaneostomy. This work represent a unique series of I-UF in neurogenic patients performing CIC. Surgical urethral reconstruction, often with the use of buccal mucosa in large lesions, may be a difficult solution in neurogenic patients, new generation stents (Uventa) represent a minimally invasive, effective, and safe alternative.

Tunica albuginea versus buccal mucosa graft urethroplasty for anterior urethral stricture: A prospective randomised pilot study

ObjectiveThe objective of the study was to compare the outcome of tunica albuginea urethroplasty (TAU) and buccal mucosa graft (BMG) urethroplasty for anterior urethral stricture. MethodsThirty patients who met the inclusion criteria were randomised into two groups: TAU (Group A) and BMG urethroplasty (Group B). Surgical outcome was evaluated with pre- and post-operative work-up involving retrograde urethrogram, voiding cystourethrogram, uroflowmetry, and urethroscopy. Patients were followed up till 1 year. ResultsMean duration of surgery was statistically significant between two groups (p=0.0005). Maximum urine flow rate was comparable when compared between two groups (p=0.22) but statistically significant when compared pre- and post-operatively (p<0.001). At follow-up of 1 year, the successful outcomes were 80% in Group A and 87% in Group B. A total of five patients who had unsuccessful results required redo urethroplasty. Complications were minimal in both the groups. ConclusionTAU provides outcomes equivalent to those of BMG urethroplasty. TAU has less operative time, easy to perform, and beneficial in patients with poor oral hygiene.

SIGNIFICANCE OF TILA TAILA, MADHU &amp; SAINDHAV LAVANA UTTARBASTI IN THE STRICTURE OF URETHRA IN MALES – A CASE STUDY

We can correlate stricture of the urethra with Mutra marga sankoch or Mutrotsanga which is a common disease of the urinary tract. Gradual urethral dilatation, transurethral resection of urethral stricture, urethrotomy, urethroplasty etc. are examples of some common surgeries which are practised today to cure stricture of urethra. But recurrence rate is high after all these surgeries while the cure rate is low. Many years ago, in our ancient texts, it is mentioned that uttarbasti can be beneficial for the management of such types of urinary tract diseases. In the present case, a 45-year-old male patient came to the OPD of Shri Krishna Government Ayurvedic College &amp;Hospital, Kurukshetra, Haryana. He had complaints of retention of urine, painful micturition, straining &amp; dribbling of urine for the last 5- 6 years and also patient had to catheterize himself daily in the morning for micturition. So, after taking proper history, clinical examination and investigations (retrograde urethrography) the case was diagnosed as anterior ure- thral stricture and the patient was treated with Ayurvedic para surgical procedure i.e., Tila taila, madhu &amp; lavana uttarbasti to cure stricture of urethra. We got significant results after this study. Hence, through this article, we tried our best to re-establishes the effect of Tila taila, madhu &amp; saindhava lavana uttarbasti in males for the stricture of the urethra. Keywords: Urethral stricture, Mutramarga sankoch, Mutrotsanga, Uttarbasti, Madhu, Saindhava lavana.

Congenital anterior urethral diverticulum of the distal penis: A case report

Congenital Anterior Urethral Diverticulum (CAUD) is a rare congenital anomaly. We describe a case of CAUD in a 3-year-old male child, with a history of recurrent urinary tract infections, referred to our clinic for diagnosis and treatment of penile swelling and weak micturition. On physical examination, a painless oval area of swelling, located on the ventral and left lateral aspect of the penis and extending from the corona to the base of the penis, was observable. The swelling was fluctuating in nature and compressible, collapsing completely with applied pressure, with urine dripping through the urethral meatus. Cytobacterial urinalysis, routine blood analysis, and renal analysis were normal. Ultrasound examination revealed normal kidneys and bladder. A retrograde urethrogram revealed a large anterior urethral diverticulum. The patient underwent open diverticulectomy with urethroplasty. The recovery was uneventful and the catheter was removed on postoperative day 10. Six months post-surgery, the patient had no complaints. One difficulty in the management of CAUD is distinguishing it from other anterior urethral malformations. Treatment of a CAUD is informed by the type of diverticulum and should be performed early to avoid complications associated with urinary obstructio

Aggressive primary urethral malignancy masquerading as stricture urethra: Unusual presentation of a rare malignancy

Bladder outlet obstruction in an elderly male patient is most of the time diagnosed as prostatomegaly or stricture urethra unless there is a high index of suspicion for other differential diagnoses. Rare tumors like urethral malignancy may be misdiagnosed due to their varied and delayed mode of presentation. Here, we present a case of a patient who presented with acute urinary retention and was suspected to be a stricture urethra which ultimately turned out to be an aggressive urethral tumor. Investigations such as retrograde urethrogram, ultrasound, or cystoscopy which are the most common diagnostic modalities in a patient with lower urinary tract symptoms may not diagnose urethral tumors. Delayed diagnosis is common in these tumors resulting in a lesser chance for curative treatment. A high index of suspicion with a lesser threshold for investigations like MRI is pivotal for early diagnosis in these patients.

Urinary bladder duplication in coronal plane in a dog

AbstractAn 8‐year‐old female intact Yorkshire terrier was presented with a 1‐year recurrent urinary tract infection. Abdominal ultrasound, computed tomography, positive contrast retrograde urethrography and cystoscopy were performed, revealing a tubular structure continuous with the ventral wall of the bladder connected with the urethra by an ostium ventral to the internal urethral orifice. Excision of the tubular structure was performed. Histopathological results were consistent with urinary bladder tissue. One year after surgery no clinical signs were reported. To the authors’ knowledge, this is the first report of urinary bladder duplication in the coronal plane with a single urethra in a dog.

Ability of photocurable gelatin to prevent stricture recurrence after urethral dilation in rabbits.

To evaluate the ability of photocurable gelatin to prevent stricture recurrence after urethral dilation in a rabbit urethral stricture model. We created urethral strictures in the bulbar urethras of 10 male Japanese white rabbits using electrocoagulation. After 1 month, the rabbits were randomly divided into Group A (n = 5; urethral stricture dilation and the local application of photocurable gelatin using a ruthenium photoinitiator and irradiation with a light-emitting diode light [λ = 455 nm, 50 mW/cm2 ] for 1 min) and Group B (n = 5; dilation only). Urethral stricture status was evaluated 1-2 months later by retrograde urethrography and urethroscopy. The lumen ratio (urethral width at the stricture site to the normal urethral width on retrograde urethrography) was calculated. Urethral patency was considered to be improved when the urethral lumen could accommodate a 10-Fr urethroscope without resistance. Urethral specimens were harvested for histopathological examination. The mean lumen ratio did not differ significantly between Groups A and B before dilation (25.8% vs 23.4%; P = 0.40), but differed significantly after dilation (65.5% vs 27.3%, respectively; P = 0.03). Urethral patency improved in all rabbits in Group A (100%) versus one rabbit in Group B (20%; P = 0.02). The mean circumference of the regenerated urethral epithelium at the stricture site was larger in Group A than in Group B (14 mm vs 6.6 mm; P = 0.06). Photocurable gelatin can reduce urethral stricture recurrence after dilation in a rabbit model.

Retrograde urethrography, sonouretrography and magnetic resonance urethrography in evaluation of male urethral strictures. Should the novel methods become the new standard in radiological diagnosis of urethral stricture disease?

PurposeTo verify which of the diagnostic modalities: Voiding cystouretrography (VCUG), Sonouretrography (SUG) or Magnetic resonance uretrography (MRU) is the most accurate in the assessment of urethral strictures in males and in what cases the application of novel imaging techniques benefits most.Methods55 male patients with a diagnosis of urethral stricture, were enrolled in this prospective study. Initial diagnosis of urethral stricture was based on anamnesis, uroflowmetry and VCUG. Additional imaging procedures—SUG and MRU were performed before the surgery. Virtual models and 3D printed models of the urethra with the stricture were created based on the MRU data. Exact stricture length and location were evaluated by each radiological method and accuracy was verified intraoperatively. Agreement between SUG and MRU assessments of spongiofibrosis was evaluated. MRU images were independently interpreted by two radiologists (MRU 1, MRU 2) and rater reliability was calculated.ResultsMRU was the most accurate [(95% CI 0.786–0.882), p < 0.0005] with an average overestimation of 1.145 mm (MRU 1) and 0.727 mm (MRU 2) as compared with the operative measure. VCUG was less accurate [(95% CI 0.536–0.769), p < 0.0005] with an average underestimation of 1.509 mm as compared with operative measure. SUG was the least accurate method [(95% CI 0.510–0.776), p < 0.0005] with an average overestimation of 2.127 mm as compared with the operative measure. There was almost perfect agreement of MRU interpretations between the radiologists.ConclusionsVCUG is still considered as a ‘gold standard’ in diagnosing urethral stricture disease despite its limitations. SUG and MRU provide extra guidance in preoperative planning and should be considered as supplemental for diagnosing urethral stricture. Combination of VCUG and SUG may be an optimal set of radiological tools for diagnosing patients with urethral strictures located in the penile urethra. MRU is the most accurate method and should particularly be considered in cases of post-traumatic or multiple strictures and strictures located in the posterior urethra.

ROLE OF SONOURETHROGRAM IN EVALUATION OF SHORT SEGMENT ANTERIOR URETHRAL STRICTURE

INTRODUCTION: Retrograde urethrography (RGU) is the standard imaging study for the evaluation of anterior male urethra. Sonourethrography(SUG) offers comparable information with added advantages. MATERIAL AND METHODS: 196 males with anterior urethral stricture studied. RGU/MCU, sonourethrogram and urethroscopy done in all and information regarding urethral stricture was compared keeping urethroscopy as gold standard. Strictures &gt; 4 cm were excluded. Chiou et al classication used to classify urethral stricture on SUG. Bulbar urethra was the most common si RESULTS &amp; DISCUSSION: te for urethral stricture. Sensitivity of sonourethrography for location of stricture was &gt;98%. Strength of agreement between SUG and urethroscopy for location of stricture was very good. Number of the strictures were diagnosed with higher accuracy on urethroscopy than SUG and RGU respectively. Kappa value for number of strictures was suggestive of very good agreement between SUG &amp; urethroscopy. Length of stricture in urethroscopy was better correlating with SUG. Both RGU and SUG were equally sensitive in location and number of stricture while RGU correlated poorly in the bulbar urethra, older studies also showing RGU underestimating the length of stricture in bulbar urethra. Sonourethrography also providing additional information regarding periurethral pathologies. The complications encountered during RGU were contrast intravasation, pain during the procedure, urethral bleeding and UTI after the procedure. During sonourethrography no signicant complication noted. CONCLUSIONS: Sonourethrography is a multiplanar, easily available and cost-effective technique for evaluating anterior urethra without radiation exposure. When compared with RGU, sonourethrography is equally efcacious with added important technical advantages which help surgeons to plan surgical procedure.

MP67-19 THE IMPACT OF AN INTERNATIONAL PARTNERSHIP ON THE TREATMENT OF MEN WITH BULBAR URETHRAL STRICTURES AND PELVIC FRACTURE URETHRAL INJURIES (PFUI) IN VIETNAM

You have accessJournal of UrologyGlobal Health/Humanitarian (MP67)1 Sep 2021MP67-19 THE IMPACT OF AN INTERNATIONAL PARTNERSHIP ON THE TREATMENT OF MEN WITH BULBAR URETHRAL STRICTURES AND PELVIC FRACTURE URETHRAL INJURIES (PFUI) IN VIETNAM Hung Do, Justin DeGrado, and Joel Gelman Hung DoHung Do More articles by this author , Justin DeGradoJustin DeGrado More articles by this author , and Joel GelmanJoel Gelman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002028.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In Vietnam, there is a high incidence of bulbar urethral straddle and pelvic fracture urethral injuries (PFUI) due to the prevalent use of motor bikes for transportation. Urethral strictures have historically been managed with suprapubic tubes, periodic dilation, or 1 or more attempts at urethroplasty that often fail. A United States - Vietnam outreach relationship was established to improve treatment success and decrease the societal burden of urethral stricture disease. We report the impact of this partnership METHODS: A Faculty Urologist at a major Vietnamese teaching hospital (Binh Dan Hospital in HCMC) with an interest in developing expertise in urethroplasty was identified. The Urologist travelled to the United States to receive observational exposure to urethral imaging and surgery. In addition, yearly 2-week trips were established from 2014-present. The initial focus was patient evaluation, urethral imaging (retrograde urethrogram and voiding cystourethrogram), and decision making. This included the first use of flexible cystoscopes in Vietnam. The subsequent focus was operative, mostly anastomotic urethroplasty, with the mentor-mentee. IVUmed provided 2-3 Resident Scholarships for each outreach trip. Binh Dan hospital was provided urethroplasty specific instruments and their first flexible cystoscope. An imaging and follow-up protocol was established which included 4-month cystoscopy to assess outcomes. A database was created to prospectively evaluate success rate over the 2016-2020 study period. RESULTS: Bulbar anastomotic urethroplasty was performed in 97 men. Of the 40 that returned for 4-month cystoscopy, there were 5 recurrences (success rate=87.5%). Posterior urethroplasty for PFUI was performed in 101 men. Of the 74 that returned for 4-month cystoscopy, with 32/74 of those being revision surgery, there were 4 recurrences (success rate=94.6%) with 3 of the 4 failures in re-do cases. With a mean follow-up (defined as time interval between surgery and most recent visit) of 5.0 months (bulbar) and 9.5 months (PFUI), there were no additional recurrences identified, defined as obstructive symptoms or need for intervention. CONCLUSIONS: In Vietnam, the development of an international partnership at a hospital with the necessary infrastructure has been associated with the establishment of a high success rate for bulbar and posterior urethroplasty. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e517-e517 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hung Do More articles by this author Justin DeGrado More articles by this author Joel Gelman More articles by this author Expand All Advertisement Loading ...

MP22-19 ASSESSING THE VALUE OF A NOVEL MRI PROTOCOL IN PATIENTS UNDERGOING POSTERIOR URETHROPLASTY FOR PELVIC FRACTURE URETHRAL DISTRACTION DEFECT (PFUDD)

INTRODUCTION AND OBJECTIVE:Voiding cystourethrogram (VCUG) plus retrograde urethrogram (RGU) is the standard of care after PFUDD. However, the relation between the urethral defect and the pubic bon...

PD22-09 THE IMPACT OF PREOPERATIVE ORAL HEALTH ON BUCCAL MUCOSAL GRAFT HISTOLOGY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) II (PD22)1 Sep 2021PD22-09 THE IMPACT OF PREOPERATIVE ORAL HEALTH ON BUCCAL MUCOSAL GRAFT HISTOLOGY Jane Kurtzman, Sun-Ming Pan, Shawn Mendonca, Shyam Sukumar, Yue Lai, and Steven Brandes Jane KurtzmanJane Kurtzman More articles by this author , Sun-Ming PanSun-Ming Pan More articles by this author , Shawn MendoncaShawn Mendonca More articles by this author , Shyam SukumarShyam Sukumar More articles by this author , Yue LaiYue Lai More articles by this author , and Steven BrandesSteven Brandes More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002011.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Oral mucosa is the first choice for urethral augmentation in patients undergoing urethroplasty for stricture disease. Previous studies have elucidated the unique anatomic and histologic properties of oral mucosa which make it a viable and durable graft, as well as established criteria and contraindications for selecting patients for oral graft harvesting. However, no prior literature has investigated the impact of preoperative oral health on buccal mucosal histology and graft take. METHODS: We analyzed all consenting patients who underwent buccal mucosal graft (BMG) urethroplasty at our institution from 2018-2020. Validated oral health surveys, the Oral Health Impact Profile (OHIP-14) and the Kayser-Jones Brief Oral Health Status Exam (BOHSE) were completed preoperatively. A staff pathologist analyzed BMG histology and quantified oral mucositis (OM) using a modified Oral Mucosa Rating Scale. Each patient underwent a retrograde urethrogram (RUG) at postoperative week 3 to assess for a urinary leak. Individual age-adjusted linear regression models were used to explore the association between BOHSE, OHIP-14 and OM and BMG epithelial thickness, lamina propria thickness and delta stretch. RESULTS: We analyzed 51 patients, median age 40 years (IQR 31–58). Mean BOHSE score was 1.1 and OHIP-14 score was 1.4. 37 grafts were assessed in pathology. Median epithelial thickness was 530 microns and lamina propria thickness was 150 microns. Age-adjusted linear regression demonstrated that as BOHSE score, OHIP-14 score and OM score increased (i.e. oral health worsened), average epithelial thickness of the grafts decreased (p=0.001; p=0.01; p=0.05, respectively). Higher BOHSE scores also significantly correlated with thinner average lamina proprias (p=0.05) and decreased delta stretch lengthwise (p=0.028). The two patients with postoperative urine leaks and pathology available for review had elevated OM scores and lamina propria thicknesses well-below the cohort median, 50 microns and 60 microns, respectively. CONCLUSIONS: This is the first study to demonstrate that oral health conditions impact graft histology and stretch. Though much remains to be learned, our finding that worse oral health conditions correlate with adverse histology emphasizes the importance of optimizing preoperative oral health and raises the question of if preoperative mucosal biopsy could help inform surgical decision making and discussions regarding surgical success. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e383-e383 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jane Kurtzman More articles by this author Sun-Ming Pan More articles by this author Shawn Mendonca More articles by this author Shyam Sukumar More articles by this author Yue Lai More articles by this author Steven Brandes More articles by this author Expand All Advertisement Loading ...