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Le W, Wu D, Xu C, Zhou W, Li C. Study on clinical outcomes between non-transecting urethroplasty and lingual mucosal urethroplasty for iatrogenic bulbar urethral stricture treatment. Basic Clin Androl 2023; 33:12. [PMID: 37138233 PMCID: PMC10157920 DOI: 10.1186/s12610-023-00185-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/08/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND This study aimed to compare the clinical outcomes of non-transecting urethroplasty and lingual mucosal urethroplasty in the treatment of iatrogenic bulbar urethral stricture. RESULTS A total of 25 patients with iatrogenic bulbar urethral stricture were enrolled, 12 of whom underwent lingual mucosal urethroplasty, 13 patients who underwent non-transecting urethroplasty. All patients were followed-up and evaluated at 3 postoperative months. Evaluations included urethrography, maximum urine flow rate (Qmax), nocturnal erectile function testing, International Index of Erectile Function (IIEF-5) assessment, and Anxiety Related Scale (SAS) assessment. In terms of operation time, there was a significant difference between non-transecting urethroplasty and lingual mucosal urethroplasty. However, there was no significant intergroup difference in intraoperative blood loss. Both techniques were associated with significantly improved Qmax relative to preoperative rates, but there was no significant difference between the groups in this regard over 3 months of postoperative follow-up. Nocturnal penile tumescence and rigidity results showed that there was no significant change in tip hardness after surgery in the non-transecting urethroplasty group. Moreover, IIEF-5 scores indicated that there was no significant intergroup difference in terms of subjective postoperative erectile function. According to the preliminary psychological evaluations during postoperative follow-up, the anxiety scores of patients undergoing non-transecting urethroplasty significantly improved, but there was no significant change in the mean SAS score among patients who underwent lingual mucosal urethroplasty. CONCLUSION Both surgical methods can achieve the clinical goal of treating iatrogenic bulbar urethral stricture. Non-transecting urethroplasty has the characteristics of short operation time, relative technical simplicity, and retention of the original erectile function of most patients, and the surgical outcomes of non-transecting urethroplasty are not inferior to those of lingual mucosal urethroplasty, and it is a promising technique for widespread use to treat bulbar urethral strictures.
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Affiliation(s)
- Wei Le
- Department of Urology, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China
| | - Denglong Wu
- Department of Urology, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China
| | - Chengdang Xu
- Department of Urology, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China
| | - Weidong Zhou
- Department of Urology, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China
| | - Chao Li
- Department of Urology, Tongji Hospital, Tongji University School of Medicine, 200065, Shanghai, China.
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Xiao Y. An insight of pathological anatomy of urethral stricture and surgical manipulations for children suffered from hypospadias. BMC Urol 2023; 23:40. [PMID: 36934236 PMCID: PMC10024833 DOI: 10.1186/s12894-023-01209-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 03/13/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Manipulation of urethral stricture is difficult and challenging. Accurate analysis and evaluation of the pathological circumstances of narrowed urethra and surrounding tissues were important for cure. The detailed descriptions of anatomic pathology of urethral stricture are rare. An insight of the pathological anatomy of the strictured urethra and the corresponding corrections is essential for an ultimate cure. The aim of the study is to interpret the pathological anatomies of the strictured urethra and the corresponding surgical manipulations. METHODS From April 2007 to April 2020, eight boys who suffered from postoperative urethral stricture for hypospadias correction were studied retrospectively. The pathological anatomies of the strictured urethra were described and the corresponding surgical manipulations were analyzed. RESULTS All eight patients were eventually cured through surgery. The patient age was 2.58-11 years old (mean value of 4.73). The therapeutic duration was 12-130 months (mean value of 47.75). The surgical manipulation was 1-9 times (mean value of 4.5). Curative follow-up was 8-138 months (mean value of 77.75). They were all applied with flap tubularization for their primary urethroplasty. CONCLUSIONS Based on the principal contradiction of the pathological anatomies of the urethral stricture, one-stage or staged surgical manipulations can be applied. After stricture was resolved, refining techniques of Mathieu, TIP, modified Duckett, glanular reconstruction and et al. can be used. Although it was tiring, utilizing the ventral or dorsal penile flap with relatively good blood supply and flexibility to reconstruct the urethra is possible and successful. To reconstruct an anatomically normal urethral tract should be pursued in the primary and consequential procedures for hypospadias and urethral stricture.
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Affiliation(s)
- Yuanhong Xiao
- Department of Pediatric Surgery, Chinese PLA General Hospital, Nan Men Cang 5th, Dongcheng District, Beijing, 100700, China.
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Robotic versus laparoscopic ureteroplasty with a lingual mucosa graft for complex ureteral stricture. Int Urol Nephrol 2023; 55:597-604. [PMID: 36327006 DOI: 10.1007/s11255-022-03385-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Ureteroplasty with a lingual mucosa graft (LMG) for complex ureteral stricture was reported promising. We aimed to compare outcomes of robotic versus laparoscopic ureteroplasty using a LMG (RU-LMG vs. LU-LMG, respectively). METHODS From October 2018 to January 2021, 32 ureteroplasties using LMGs were performed by one experienced surgeon, including 16 robotic and laparoscopic procedures each. Patient demographics and peri-operative, post-operative, and follow-up data were prospectively collected and compared. RESULTS The robotic group had a higher rate of previous reconstruction than the laparoscopic group (62.50% vs. 18.75%; p = 0.012). The stricture length was significantly longer in the robotic group (4.8 ± 1.2 cm) than the laparoscopic group (3.7 ± 1.2 cm; p = 0.013). All procedures were completed successfully without open conversion. The operative time was shorter in the robotic group (192 ± 54 min) than the laparoscopic group (254 ± 46 min; p = 0.001). The robotic group had a shorter length of post-operative stay (6.1 ± 2.4 d vs. 8.9 ± 4.3 d; p = 0.033) but a higher hospital cost (76,801 ± 17,974 vs. 42,214 ± 15,757 RMB; p < 0.001) than the laparoscopic group. The mean follow-up time was 21 ± 7 months for the robotic group and 29 ± 9 months for the laparoscopic group respectively (p = 0.014). No difference was detected in the success rate (93.75% and 100%, respectively; p = 0.309) and complication rate (18.75% and 31.25%, respectively; p = 0.414) between the robotic and laparoscopic groups. CONCLUSION Both RU-LMG and LU-LMG are feasible, effective, and safe for repair of complex ureteral strictures. RU-LMG had a shorter operative time and a shorter length of post-operative stay but a higher hospital cost.
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Multi-Factorial Analysis of Recurrence and Complications of Lingual Mucosa Graft Urethroplasty for Anterior Urethral Stricture: Experience from a Chinese Referral Center. Urology 2021; 152:96-101. [PMID: 33785402 DOI: 10.1016/j.urology.2021.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the risk factors that pertain to stricture recurrence and oral complications. METHODS Patients with long segmented anterior urethral stricture who visited our hospital from 2009 to 2016 were treated with lingual mucosa graft (LMG) urethroplasty. The incidence of complications in all of 128 patients were evaluated. The data were analyzed using the chi-squared test and Fisher's exact test. A multi-factorial regression analysis was performed to identify the risk factors responsible for the recurrence and complications. RESULTS For patients having LMG urethroplasty, there were no significant difference in recurrence of urethral stricture according to the studied variables. Binary logistic regression analysis reveals that previous surgery involving the urethra was a significant predictor of urethral stricture recurrence (odds ratio [OR]=5.07; 95% confidence interval [95% CI], 1.06-24.40; P = .043). The length of the substitute was significantly related to oral morbidity (P = .020), even after controlling for the studied variables. Patients with a harvested oral mucosa longer than 7 cm had a higher risk of oral morbidity than those with a harvested oral mucosa shorter than 7 cm (OR=4.35; 95% CI, 1.35-14.06; P = .014). CONCLUSION Our study shows that LMG urethroplasty is effective for patients with long segmented anterior urethral stricture. Previous urethral surgery was identified as a risk factor to cause recurrence and injury to the tip of the tongue for the oral complications.
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Aldaqadossi HA, Eladawy M, Shaker H, Kotb Y, Elgamal S, Azazy S. Dorsal onlay urethroplasty using lingual mucosal grafts for lichen sclerosis anterior urethral strictures repair: Long-term outcomes. Int J Urol 2020; 27:320-325. [PMID: 32036620 DOI: 10.1111/iju.14187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 12/24/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the long-term outcomes of dorsal onlay urethroplasty using lingual mucosal graft for repairing urethral strictures associated with genital lichen sclerosis. METHODS This study included 36 patients who had lichen sclerosis long anterior urethral strictures that were managed with dorsal onlay urethroplasty using lingual mucosal graft, and were followed up ≥5 years. Preoperatively, we measured the maximum urinary flow rate and the International Prostate Symptom Score, then every 3 months in the first year, and annually thereafter. During follow up, patients with obstructive symptoms were subjected to urethrography and/ or urethroscopy. A successful urethroplasty was defined as normal voiding and no need for further intervention. RESULTS Of the 36 patients, two were lost during the follow up, thus 34 patients were involved in the assessment. After lingual mucosal graft urethroplasty, there were significant improvements in maximum urinary flow rate and International Prostate Symptom Score (P < 0.0001). This improvement was sustained during the 5-year follow-up period. The median follow-up period was 66.5 months (interquartile range 64-70 months). The overall success rate in this study was 88.2%. Postoperative complications that required intervention were reported within the first year in four (11.8%) patients. Oral site complications were mild in the early postoperative period with no long-term complications. CONCLUSIONS Dorsal onlay urethroplasty using lingual mucosal graft is a reliable and durable procedure for repairing lichen sclerosis urethral stricture. It provides a long-term success rate with few failures occurring within the first year. Lingual mucosal graft harvesting is associated with minor, immediate oral complications, and no long-term morbidity.
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Affiliation(s)
| | - Mahmoud Eladawy
- Department of Urology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Hossam Shaker
- Department of Urology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Youssof Kotb
- Department of Urology, Faculty of Medicine, Ain Shams University, Ain Shams, Egypt
| | - Samir Elgamal
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Samir Azazy
- Department of Urology, Faculty of Medicine, Ain Shams University, Ain Shams, Egypt
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Aldaqadossi HA, Shaker H, Youssof H, Kotb Y, Eladawy M. Outcomes of staged lingual mucosal graft urethroplasty for redo hypospadias repair. J Pediatr Urol 2019; 15:519.e1-519.e7. [PMID: 31303449 DOI: 10.1016/j.jpurol.2019.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 06/11/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The objective of this study was to present the outcomes for redo hypospadias repair using lingual mucosal graft (LMG). PATIENTS AND METHODS Between June 2012 and February 2017, 47 patients underwent staged LMG urethroplasty for redo hypospadias repair. The inclusion criteria were previous failed hypospadias repair with a paucity of local skin that interferes with correction using skin flaps and demands graft urethroplasty. During the first stage, a well-vascularized bed on the tunica albuginea was created. Then, the harvested LMG was secured to the prepared bed. The second-stage urethroplasty was carried out after six months. In this stage, tubularization of the previously implanted LMG was performed. In four cases, tubularization was difficult owing to graft contracture. This difficulty was managed by using the dorsally degloved penile skin as the onlay island flap in three cases and the buccal mucosa onlay graft in the fourth case. In all cases, a second protective layer from the dartos or tunica vaginalis was developed to cover the neourethra. RESULTS The median (interquartile range [IQR]) age of patients at the first stage was 5 (4-6) years, and the median (IQR) duration between both stages was 7 (6-8) months. The median (IQR) follow-up after the second stage was 15 (13-16) months. The median (IQR) number of previous operations was 2 (2-3). The median (IQR) length of the LMG was 3 (2.5-4) cm, and the median (IQR) width was 1 (1-2) cm. No donor-site major complications, but mild oral discomfort in the first week after graft harvesting, were reported in 39 (83%) patients. After the second stage, complications were reported in nine (19.2%) patients, meatal stenosis in five and fistula in four. The reported success rate was 80.9%. DISCUSSION Reconstruction of previously failed hypospadias is a challenge owing to local tissue scarring and a paucity of adjacent healthy tissue. In this study, the LMG was used in two-stage redo hypospadias repair after previous repair failure. In the present study, a success rate of 80.9% was reported after the second stage. According to this study and the published series, harvesting the LMG is associated with minimal immediate donor-site complications and no long-term morbidity. Another advantage of the LMG is easy harvesting with effortlessly reachable tongue in comparison with the buccal mucosa that is deep and requires application of a mouth retractor. CONCLUSIONS Two-stage LMG urethroplasty is a reliable procedure for salvage urethroplasty. Lingual mucosal graft harvesting is easy, with minor oral complications.
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Affiliation(s)
| | - H Shaker
- Fayoum University, Fayoum, Egypt
| | | | - Y Kotb
- Ain Shams University, Ain Shams, Egypt
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Gulani A, Yadav SS, Tomar V, Priyadarshi S, Singh VK. The effect of closure versus nonclosure of lingual mucosa graft harvest site on postoperative morbidity in augmentation urethroplasty: A comparative study. Urol Ann 2019; 11:265-269. [PMID: 31413504 PMCID: PMC6676819 DOI: 10.4103/ua.ua_142_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objectives: The objective of this study is to compare postoperative morbidity of closure versus nonclosure of the lingual mucosa graft (LMG) harvest site in augmentation urethroplasty. Materials and Methods: From January 2015 to November 2016, a total of 42 patients who underwent LMG urethroplasty randomized in 2 groups. In Group 1, donor-harvesting site was left open while in Group 2, donor site was closed. Self-made questionnaires were to assess postoperative pain, difficulty in tongue protrusion, swelling and numbness in graft harvest site, speech impairment, and difficulty in tolerating liquid and regular diet. Results: Mean visual analog scales score was 7.1 in Group 1, and 7.9 in Group 2 on day 0, which was statistically significant. Nearly 90.47% of patients in closure group and 95.23% in nonclosure group were able to swallow liquid diet on day 0 (P = 0.5604). On day 3, 95.71% of patients in Group 1 and 80% in Group 2 were able to swallow soft diet (P = 0.1604). Numbness was present in 80.95% Group 1 and 71.42% in Group 2 on day 0, which improved to 28.57% pts in Group 1 and 33.33% in Group 2 on day 3. On day 3, slurring of speech was more frequent in closure group (80%). However, at the end of a week, there was no difference in both groups. Saliva production was significantly increased in Group 1 in the 1st week. Conclusion: Long-term morbidities of closing or nonclosing the LMG donor site are similar, but in short term, there is less pain, less edema, early recovery of tongue movements in nonclosure groups.
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Affiliation(s)
- Anil Gulani
- Department of Urology, S. M. S. Medical College, Jaipur, Rajasthan, India
| | - Sher Singh Yadav
- Department of Urology, S. M. S. Medical College, Jaipur, Rajasthan, India
| | - Vinay Tomar
- Department of Urology, S. M. S. Medical College, Jaipur, Rajasthan, India
| | - Shivam Priyadarshi
- Department of Urology, S. M. S. Medical College, Jaipur, Rajasthan, India
| | - Vivek Kumar Singh
- Department of Urology, S. M. S. Medical College, Jaipur, Rajasthan, India
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A Comprehensive Review Emphasizing Anatomy, Etiology, Diagnosis, and Treatment of Male Urethral Stricture Disease. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9046430. [PMID: 31139658 PMCID: PMC6500724 DOI: 10.1155/2019/9046430] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 03/31/2019] [Indexed: 12/21/2022]
Abstract
To date, urethral stricture disease in men, though relatively common, represents an often poorly managed condition. Therefore, this article is dedicated to encompassing the currently existing data upon anatomy, etiology, symptoms, diagnosis, and treatment of the disease, based on more than 40 years of experience at a tertiary referral center and a PubMed literature review enclosing publications until September 2018.
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Abrate A, Gregori A, Simonato A. Lingual mucosal graft urethroplasty 12 years later: Systematic review and meta-analysis. Asian J Urol 2019; 6:230-241. [PMID: 31297314 PMCID: PMC6595159 DOI: 10.1016/j.ajur.2019.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/05/2018] [Accepted: 11/05/2018] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the functional results and complications of the lingual mucosal graft (LMG) urethroplasty and to sum up the current state of the art of this surgical technique. Methods A systematic search of PubMed and Scopus electronic databases was performed, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies involving male patients treated with LMG urethroplasty for urethral stricture were included. Complete protocol is available at http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017080121. A meta-analysis comparing functional and long-term oral complication outcomes of LMG and buccal mucosal graft (BMG) was performed, calculating the odds ratio (OR) and 95% confidence interval (CI). Results Twenty original articles were included in the qualitative analysis. Strictures of 1.5-16.5 cm have been treated with LMG urethroplasty, due to the improvement of harvesting technique and very low rate of long-term oral complications. Very good functional results have been reported by different authors for LMG urethroplasty, with lower rate of oral complications than BMG. The meta-analysis included six comparative studies involving 187 and 178 patients treated with LMG and BMG urethroplasty, respectively. An OR of 1.65 (95% CI [0.95-2.87], I 2 = 0%) and 0.18 (95% CI [0.03-1.26], I 2 = 68%) were found for LMG vs. BMG urethroplasty, in terms of success and oral complication rate, respectively. Conclusion LMG urethroplasty can be reasonably considered a first choice technique for urethral stricture with very good results. Oral complications are temporary and minimally disabling, basically less than those for BMG, and depend mainly on the graft extent.
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Affiliation(s)
- Alberto Abrate
- Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Italy
| | - Andrea Gregori
- Department of Urology, ASST Rhodense, G. Salvini Hospital, Garbagnate Milanese, Milan, Italy
| | - Alchiede Simonato
- Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Italy
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Management of failed hypospadias: choosing the right method and achieving optimal results. Int Urol Nephrol 2018; 50:1795-1800. [PMID: 30121720 DOI: 10.1007/s11255-018-1962-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/12/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Because of the complexity of the abnormalities and limited options for reconstruction of failed hypospadias, creating a neourethra presents a challenge to surgeons. We reviewed our experiences with staged urethroplasty strategies to repair the penis of failed hypospadias. MATERIALS AND METHODS We retrospectively reviewed 56 consecutives patients following multiple unsuccessful hypospadias repairs from 2010 to 2016. Patients were divided into the following two groups based on their penile conditions and urethroplasty procedures: staged buccal mucosa graft Bracka urethroplasty (group1) and two-stage urethroplasty with additional buccal mucosa graft augmentation of the dorsal urethral plate (group2). RESULT Median follow-ups were 26.5 months (12-59 months) and 28.6 months (14-59 months) in the group 1 and group 2. After the second stage, three patients (11.1%) in group 1 and two patients (6.89%) in group 2 did not have a meatal opening at the top of the glans. Three patients (11.1%) in group 1 and 4 patients (13.79%) in group 2 had urethrocutaneous fistulas. One patient (3.70%) in group 1 and no patients in group 2 had meatal stenosis. Two patients (6.89%) in group 2 and no patients in group 1 had urethral strictures; all patients with strictures were cured using dilations, so follow-up surgeries were not required. No patients in either group had signs of diverticulum or residual chordee. Three patients (11.1%) in group 1 and 4 patients (13.79%) in group 2 needed reoperations. CONCLUSION Failed hypospadias repairs were often due to the underestimation of the penile conditions at the prior surgery. The results indicated that two-staged strategies were preferred for treating complex situations during the intermediate period of our study. Staged buccal mucosa graft Bracka urethroplasty and two-stage urethroplasty with additional buccal mucosa graft augmentation of the dorsal urethral plate severed as reliable approaches in complex hypospadias cases and could improve the overall success rate.
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Jiang SW, Xu ZH, Zhao YY, Yan L, Zhou ZL, Gu GL. Autologous granulation tissue tubes for replacement of urethral defects: An experimental study in male rabbits. J Pediatr Urol 2018; 14:14.e1-14.e7. [PMID: 29133168 DOI: 10.1016/j.jpurol.2017.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 07/24/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Tubularized urethroplasty is commonly performed in clinical practice using genital skin flaps, bladder mucosa, and buccal mucosa. However, the long-term effects are not satisfying, and donor site morbidities remain a problem. Besides, those grafts are unavailable with malignant conditions of the urinary tract, a history of lichen sclerosis, or oral disease. OBJECTIVE An autologous granulation tissue tube of any required length and diameter can be produced by implanting foreign objects subcutaneously (Summary Fig.). The current study aimed to investigate to what extent of length this fully autologous tissue could be used for tubularized urethroplasty, satisfying urethral patency and tissue regeneration, in male rabbits. STUDY DESIGN Twenty-seven New Zealand male rabbits were randomly divided into three groups. Silastic tubes were implanted subcutaneously in Group 1 and Group 2. By 2 weeks the granulation tissue encapsulating the tubes was harvested. In Group 1, pendulous urethral segments of 1 cm were excised, and urethroplasty was performed with the granulation tissue tube in an end-to-end fashion. In Group 2, a pendulous urethral segment of 1.5 cm was replaced with the tissue tube. In Group 3, a pendulous urethral defect of 1 cm was repaired by re-anastomosis as control. Serial urethrograms were performed at 1, 2 and 6 months postoperatively. Meanwhile, the neo-urethra were harvested and analyzed grossly and histologically. RESULTS The urethrograms showed that all animals in Group 1 maintained a wide urethral caliber. In contrast, animals in Group 2 and Group 3 developed progressive strictures. Histologically, an intact urothelium with one to two cell layers lined the graft by 1 month, which was surrounded by increasing organized smooth muscle in Group 1. By 6 months, the grafts were completely integrated into native urethra. Nevertheless, extensive fibrosis occurred in Group 2 and Group 3. DISCUSSION The tissue successfully maintained patency and guided urethral regeneration across a distance of 1 cm. As an epithelium-free graft, the tissue showed better results than acellular matrix for tubularized urethroplasty compared with previous studies. Nevertheless, several limitations existed: (1) the urethral defect was created in healthy urethra, which could not fully simulate the clinical situation; (2) as a small animal model, rabbit was less informative for clinical problems; (3) the tissue was inadequate for long segmental urethral replacement. Further study is needed before the procedure is used clinically. CONCLUSION An autologous granulation tissue tube grown subcutaneously could be successfully used to repair urethral defects of 1 cm in male rabbits.
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Affiliation(s)
- Shi-Wei Jiang
- Department of Urology, Qilu Hospital, Shandong University, Jinan, PR China
| | - Zhong-Hua Xu
- Department of Urology, Qilu Hospital, Shandong University, Jinan, PR China
| | - Yuan-Yuan Zhao
- Department of Propaganda, Shandong Provincial Traditional Chinese Medical Hospital, Jinan, PR China
| | - Lei Yan
- Department of Urology, Qilu Hospital, Shandong University, Jinan, PR China
| | - Zun-Lin Zhou
- Department of Urology, Qilu Hospital, Shandong University, Jinan, PR China
| | - Gang-Li Gu
- Department of Urology, Qilu Hospital, Shandong University, Jinan, PR China.
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Comparison of lingual mucosa and buccal mucosa grafts used in inlay urethroplasty in failed hypospadias of pre-pubertal boys in a Chinese group. PLoS One 2017; 12:e0182803. [PMID: 28817617 PMCID: PMC5560762 DOI: 10.1371/journal.pone.0182803] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 07/25/2017] [Indexed: 11/25/2022] Open
Abstract
Objective The purpose of this study was to compare the outcomes of the buccal mucosa and lingual mucosa used in children who received multiple failed hypospadias surgeries. Method We conducted a retrospective study of 62 children who received buccal or lingual mucosa graft urethroplasty in our hospital between 2012 and 2015. The ages ranged from 3.5–11 y. All cases included multiple failed hypospadias procedures, and the subjects received previous operations 2–3 times. All patients underwent one-stage operations. Thirty-three cases were treated with lingual mucosa grafts. The patient ages ranged from 3.5 to 11 y (median 7.5 y), and they had previous operations 2–3 times (mean 2.8±0.7). Grafts ranged from lengths of 2–6 cm (mean 5.1±0.46 cm) and widths of 0.5–1.5 cm (mean 1.2± 0.16 cm). Our follow-up was 5 to 12 m (mean 8.3±1.2 m). Twenty-nine cases were treated with buccal mucosa grafts. The patient ages ranged from 4 to 9.2 y (median 7.0 y), and they had previous operations 2–3 times (mean 2.5±0.2). Grafts ranged from lengths of 2–5.3 cm (mean 4.9± 0.28 cm) and widths of 0.5–1.5 cm (mean 1.0±0.11 cm). Our follow-up was 5 to 12 m (mean 7.9±0.5 m). The results were tested with SPSS 18.0. The rates of complications were compared by a chi-square test, and pre-operative conditions were compared by t test. Results For the outcomes of the two groups, there was no significant difference between the groups in terms of age, preoperative surgery time, and the length and width of the grafts (p>0.05). For the lingual mucosa graft group, fistula: 2/33 (6.0%), stricture: 1/33(3.0%), ventral curvature: 2/33(6.0%), complications: 5/33(15.0%), success rate: 28/33(84.8%), Hose score: 14.34±0.95, peak flow: 6.5 ml/s-12.0 ml/s, and mean peak flow: 9.3±0.4 ml/s. For the buccal mucosa graft group, fistula: 2/29(6.8%), stricture: 2/29(6.8%), ventral curvature: 1/29 (3.4%), complication rate: 5/29(17.0%), success rate: 24/29 (83.0%), Hose score: 14.28±1.03, peak flow: 6.5 ml/s-12.0 ml/s, and mean peak flow: 9.2±0.2 ml/s. There were no differences between the two groups for overall success, complication rates, peak flow, and the Hose scores(P>0.05). Conclusion The lingual mucosal graft and the buccal mucosa graft both achieved good outcomes, and the lingual mucosa graft made up for the shortcomings of the buccal mucosa graft, which provided a reliable way to treat the multiple failed hypospadias surgeries in pre-pubertal boys.
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Sakr A, Elkady E, Abdalla M, Fawzi A, Kamel M, Desoky E, Seleem M, Omran M, Elsayed E, Khalil S. Lingual mucosal graft two-stage Bracka technique for redo hypospadias repair. Arab J Urol 2017; 15:236-241. [PMID: 29071158 PMCID: PMC5651942 DOI: 10.1016/j.aju.2017.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/12/2017] [Accepted: 06/04/2017] [Indexed: 11/23/2022] Open
Abstract
Objectives To report our initial experience in redo hypospadias repair with a lingual mucosal graft (LMG) using a two-stage Bracka technique. Patients and methods This study was prospectively conducted and included 26 patients with hypospadias with failed previous repairs. All the patients had a LMG using a two-stage Bracka technique. In the first stage, the harvested LMG, from the ventro-lateral surface of the tongue, was implanted in a well-prepared vascularised bed in the ventral aspect of the penis. After 6 months, tubularisation of the well-taken graft was completed. Tunica vaginalis or a dartos flap was used as second-layer coverage of the neourethra. Success was defined as acceptable aesthetic and functional outcomes without any additional surgical interventions. Results The mean (SD) patient age was 5.15 (1.6) years. The mean (SD) LMG length was 3.82 (0.9) cm and the width was 1.5 (0.5) cm. The mean (SD) number of previous repairs was 2.76 (1.1). The mean (SD) follow-up was 12 (2) months. Donor-site complications included: pain in all patients, with a pain score of >3 on the visual analogue pain scale (0–10) in 10 (38%); and speech problems in 19 (73%). First-stage complications were graft loss (n = 2) and contracture (n = 1). The second stage was completed in 23 patients resulting in the following significant complications: meatal stenosis plus fistula (n = 2), breakdown (n = 1). Successful hypospadias repair was achieved in 77% (20/26) of the patients. Conclusion Lingual mucosa is a reliable and versatile graft material in the armamentarium of two-stage Bracka hypospadias repair with the merits of easy harvesting and minor donor-site complications.
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Affiliation(s)
- Ahmed Sakr
- Department of Urology, Zagazig University, Faculty of Medicine, Zagazig, Egypt
| | - Ehab Elkady
- Department of Urology, Zagazig University, Faculty of Medicine, Zagazig, Egypt
| | - Mohamed Abdalla
- Department of Urology, Zagazig University, Faculty of Medicine, Zagazig, Egypt
| | - Amr Fawzi
- Department of Urology, Zagazig University, Faculty of Medicine, Zagazig, Egypt
| | - Mostafa Kamel
- Department of Urology, Zagazig University, Faculty of Medicine, Zagazig, Egypt
| | - Esam Desoky
- Department of Urology, Zagazig University, Faculty of Medicine, Zagazig, Egypt
| | - Mohamed Seleem
- Department of Urology, Zagazig University, Faculty of Medicine, Zagazig, Egypt
| | - Mohamed Omran
- Department of Urology, Zagazig University, Faculty of Medicine, Zagazig, Egypt
| | - Ehab Elsayed
- Department of Urology, Zagazig University, Faculty of Medicine, Zagazig, Egypt
| | - Salem Khalil
- Department of Urology, Zagazig University, Faculty of Medicine, Zagazig, Egypt
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Urethral Reconstruction Using Mesothelial Cell-Seeded Autogenous Granulation Tissue Tube: An Experimental Study in Male Rabbits. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1850256. [PMID: 28337443 PMCID: PMC5350385 DOI: 10.1155/2017/1850256] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/24/2017] [Accepted: 01/26/2017] [Indexed: 11/30/2022]
Abstract
Objective. This study was to evaluate the utility of the compound graft for tubularized urethroplasty by seeding mesothelial cells onto autogenous granulation tissue. Methods. Silastic tubes were implanted subcutaneously in 18 male rabbits, of which nine underwent omentum biopsies simultaneously for in vitro expansion of mesothelial cells. The granulation tissue covering the tubes was harvested 2 weeks after operation. Mesothelial cells were seeded onto and cocultured with the tissue for 7 days. A pendulous urethral segment of 1.5 cm was totally excised. Urethroplasty was performed with mesothelial cell-seeded tissue tubes in an end-to-end fashion in nine rabbits and with unseeded grafts in others as controls. Serial urethrograms were performed at 1, 2, and 6 months postoperatively. Meanwhile, the neourethra was harvested and analyzed grossly and histologically. Results. Urethrograms showed cell-seeded grafts maintained wide at each time point, while strictures formation was found in unseeded grafts. Histologically, layers of urothelium surrounded by increasingly organized smooth muscles were observed in seeded grafts. In contrast, myofibroblasts accumulation and extensive scarring occurred in unseeded grafts. Conclusions. Mesothelial cell-seeded granulation tissue tube can be successfully used for tubularized urethroplasty in male rabbits.
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Li HB, Xu YM, Fu Q, Sa YL, Zhang J, Xie H. One-stage dorsal lingual mucosal graft urethroplasty for the treatment of failed hypospadias repair. Asian J Androl 2017; 18:467-70. [PMID: 26228042 PMCID: PMC4854106 DOI: 10.4103/1008-682x.157545] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
| | - Yue-Min Xu
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital and Shanghai Eastern Institute for Urologic Repair and Reconstruction, Shanghai, China
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Development of a cell-seeded modified small intestinal submucosa for urethroplasty. Heliyon 2016; 2:e00087. [PMID: 27441265 PMCID: PMC4946073 DOI: 10.1016/j.heliyon.2016.e00087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 01/28/2016] [Accepted: 03/01/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To explore the feasibility of a modified 3D porous small intestinal submucosa (SIS) scaffold seeded with urothelial cells (UC) for surgical reconstruction in a rabbit model. MATERIAL AND METHODS Eighteen New England white male rabbits were divided into three groups and a 0.8 × 1.5 cm(2) section of the anterior urethral mucosa was removed from each animal. Ventral onlay urethroplasty was performed with a 1.0 × 1.7 cm(2) SIS scaffold that was either cell-seeded and treated with 5% peracetic acid (PAA) (n = 6), or cell-seeded and untreated (n = 6), or unseeded and treated with 5% PAA (n = 6). Animals were sacrificed at 6 months post-repair and retrograde urethrography and histological analyses performed. RESULTS In animals implanted with cell-seeded and PAA treated SIS scaffolds, urethrography showed wide-caliber urethra without any signs of stricture or fistulae, and histological analyses confirmed a complete urethral structure. In contrast, ulceration and fistula occurred in the reconstructed urethra of animals implanted with cell-seeded but untreated SIS scaffolds, and evident stricture was present in the unseeded, PAA treated group. Histological analyses demonstrated less urothelial coverage and smooth muscle in the cell-seeded and untreated SIS scaffold group, and serious fibrosis formation occurred in the unseeded, treated group. CONCLUSIONS A modified 3D porous SIS scaffold seeded with UC and treated with PAA produces better urethroplasty results than cell-seeded untreated SIS scaffolds, or unseeded PAA treated SIS scaffolds.
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Zhang K, Zhou S, Zhang Y, Xu Y, Jin S, Sa Y, Zhang J, Xie H, Lazzeri M, Barbagli G, Chen R, Fu Q. Anterior Urethra Reconstruction With Lateral Lingual Mucosa Harvesting Technique. Urology 2016; 90:208-12. [PMID: 26802794 DOI: 10.1016/j.urology.2016.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/10/2016] [Accepted: 01/12/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe a new technique for harvesting the long lingual mucosal graft (LMG) to repair the long-segment urethral strictures. METHODS We performed a retrospective observational study of patients from whom LMGs were harvested from the lateral lining of the tongue for the long-segment anterior urethral strictures repair from 2012 to 2014 at the Shanghai Sixth People's Hospital. Patients who had 12 months minimum follow-up were included. Patients with incomplete clinical records were excluded. The LMG was applied on the urethra according to the dorsal onlay technique. RESULTS The primary outcome of the study was the postoperative failure-free survival rate. The secondary outcome was the rate of early and late complications at the harvesting site. Success was defined as Qmax >12 ml/s and no postoperative procedures. One hundred and one patients were included. Median stricture length was 7.1 ± 3.6 cm; median LMG length was 7.2 ± 3.6 cm. The success rate was 81.2% with a median follow-up of 23 months. Complications at the donor site had occurred in 41 patients at 6-months follow-up, and persisted in 18 patients at the 12-months follow-up. A bilateral harvest and harvest length were the main factors influencing complication rate (P = .0038 for 6 months and P = .1112 for 12 months). Almost half of donor site complications subsided within 12 months (P = .0018). CONCLUSION In patients requiring long oral grafts >7 cm to repair anterior strictures, a valid option is to harvest the graft from the lateral lining of the tongue.
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Affiliation(s)
- Kaile Zhang
- The Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Shukui Zhou
- The Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yumeng Zhang
- The Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yuemin Xu
- The Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Sanbao Jin
- The Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Yinglong Sa
- The Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Jiong Zhang
- The Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Hong Xie
- The Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Massimo Lazzeri
- Center for Reconstructive Urethral Surgery, Centro Chirurgico Toscano, Arezzo, Italy
| | - Guido Barbagli
- Center for Reconstructive Urethral Surgery, Centro Chirurgico Toscano, Arezzo, Italy
| | - Rong Chen
- The Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Qiang Fu
- The Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China.
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Lumen N, Vierstraete-Verlinde S, Oosterlinck W, Hoebeke P, Palminteri E, Goes C, Maes H, Spinoit AF. Buccal Versus Lingual Mucosa Graft in Anterior Urethroplasty: A Prospective Comparison of Surgical Outcome and Donor Site Morbidity. J Urol 2016; 195:112-7. [DOI: 10.1016/j.juro.2015.07.098] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2015] [Indexed: 11/16/2022]
Affiliation(s)
- N. Lumen
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | | | - W. Oosterlinck
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - P. Hoebeke
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - E. Palminteri
- Center for Urethral and Genitalia Reconstructive Surgery, Arezzo, Italy
| | - C. Goes
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - H. Maes
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - A.-F. Spinoit
- Department of Urology, Ghent University Hospital, Ghent, Belgium
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Wong E, Fernando A, Alhasso A, Stewart L. Does Closure of the Buccal Mucosal Graft Bed Matter? Results From a Randomized Controlled Trial. Urology 2014; 84:1223-7. [DOI: 10.1016/j.urology.2014.06.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 06/08/2014] [Accepted: 06/27/2014] [Indexed: 10/24/2022]
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20
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Shenfeld O. Complications of Urethroplasty. ADVANCED MALE URETHRAL AND GENITAL RECONSTRUCTIVE SURGERY 2014. [DOI: 10.1007/978-1-4614-7708-2_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Buccal versus lingual mucosal graft urethroplasty for complex hypospadias repair. J Pediatr Urol 2013; 9:754-8. [PMID: 23009885 DOI: 10.1016/j.jpurol.2012.08.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Accepted: 08/31/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To compare surgical outcomes and donor site complications of buccal and lingual mucosa used as ventral onlay graft for complex hypospadias cases. PATIENTS & METHODS Forty four cases with complex hypospadias after failed previous surgery were prospectively included. All had severely scarred penile skin with reasonable residual urethral plate. Cases were categorized into two groups: Group I (23) where buccal mucosal graft [BMG] was used and group II (21) where lingual mucosal graft [LMG] was used. Donor site complications as well as functional and esthetic outcomes were recorded for each group. RESULTS Mean follow up was 20.8 months (range 12-24). Average graft harvesting time was 24 min for BMG and 19 min for LMG. Donor site pain was reported with both techniques but recovery was earlier with LMG. Slurred speech and difficult tongue protrusion were reported with lingual but not buccal grafts; however mouth tightness, peri-oral numbness and persistent oral discomfort were reported only with buccal grafts. Successful urethroplasty was obtained in 78.2% of BMG compared to 76.1% of LMG. CONCLUSION Surgical outcomes of LMG urethroplasty were comparable to those of BMG in complex hypospadias cases. Compared to buccal mucosa, LMG is easy to harvest, with minimal donor site complications.
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Xu YM, Feng C, Sa YL, Fu Q, Zhang J, Xie H. Outcome of 1-stage urethroplasty using oral mucosal grafts for the treatment of urethral strictures associated with genital lichen sclerosus. Urology 2013; 83:232-6. [PMID: 24200196 DOI: 10.1016/j.urology.2013.08.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 08/14/2013] [Accepted: 08/15/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To report the outcome of 1-stage urethroplasty using lingual mucosal grafts (LMGs) and buccal mucosal grafts (BMGs) for the treatment of male urethral strictures associated with genital lichen sclerosus (LS). MATERIALS AND METHODS This was a descriptive, observational retrospective study of male patients with urethral strictures who underwent 1-stage mucosal graft urethroplasty using different substitute materials for reconstructive urethral surgery. Study inclusion criteria were patients with histologically proven LS presenting with urethral strictures. Exclusion criteria were patients without histologically proven LS, traumatic strictures, failed hypospadias, and malignant lesions. Successful reconstruction was defined as normal voiding with a peak flow >12 mL/s, no obstructive symptoms, and no postoperative procedure, including dilation. RESULTS Between January 2003 and December 2011, urethral strictures in 54 patients were considered associated with genital LS according to the inclusion and exclusion criteria, and 36 underwent 1-stage urethroplasty using oral mucosal grafts. The median age was 52 years (range, 32-80 years). The median stricture length was 12.5 ± 1.6 cm (range, 6-18 cm). One-stage single-sided dorsal LMG urethroplasty was performed in 22 of 36 patients. The remaining 14 patients received the same procedure combined with dual BMGs (n = 5) or with LMG combined with BMG (n = 9). The success rate was 88.9%. Postoperative urinary fistula occurred in 1 patient, and meatal stenosis developed in 3 patients. Mean follow-up was 38.7 months (range, 12-110 months). CONCLUSION Our survey suggests that 1-stage urethroplasty with single or combined LMGs or BMGs may be an effective option to treat urethral stricture associated with LS.
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Affiliation(s)
- Yue-Min Xu
- Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University and Shanghai Eastern Institute for Urologic Repair and Reconstruction, Shanghai, China.
| | - Chao Feng
- Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University and Shanghai Eastern Institute for Urologic Repair and Reconstruction, Shanghai, China
| | - Ying-Long Sa
- Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University and Shanghai Eastern Institute for Urologic Repair and Reconstruction, Shanghai, China
| | - Qiang Fu
- Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University and Shanghai Eastern Institute for Urologic Repair and Reconstruction, Shanghai, China
| | - Jiong Zhang
- Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University and Shanghai Eastern Institute for Urologic Repair and Reconstruction, Shanghai, China
| | - Hong Xie
- Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiaotong University and Shanghai Eastern Institute for Urologic Repair and Reconstruction, Shanghai, China
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Sharma AK, Chandrashekar R, Keshavamurthy R, Nelvigi GG, Kamath AJ, Sharma S, Venkatesh GK. Lingual versus buccal mucosa graft urethroplasty for anterior urethral stricture: A prospective comparative analysis. Int J Urol 2013; 20:1199-203. [DOI: 10.1111/iju.12158] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 03/06/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Adittya K Sharma
- Department of Urology; Institute of Nephro-Urology; Bangalore Karnataka India
| | | | | | - Girish G Nelvigi
- Department of Urology; Institute of Nephro-Urology; Bangalore Karnataka India
| | - Ananth J Kamath
- Department of Urology; Institute of Nephro-Urology; Bangalore Karnataka India
| | - Satyam Sharma
- Department of Urology; Institute of Nephro-Urology; Bangalore Karnataka India
| | - GK Venkatesh
- Department of Urology; Institute of Nephro-Urology; Bangalore Karnataka India
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De Filippo RE, Kornitzer BS, Yoo JJ, Atala A. Penile urethra replacement with autologous cell-seeded tubularized collagen matrices. J Tissue Eng Regen Med 2012; 9:257-64. [PMID: 23172803 DOI: 10.1002/term.1647] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 07/27/2012] [Accepted: 10/15/2012] [Indexed: 11/06/2022]
Abstract
Acellular collagen matrices have been used as an onlay material for urethral reconstruction. However, cell-seeded matrices have been recommended for tubularized urethral repairs. In this study we investigated whether long segmental penile urethral replacement using autologous cell-seeded tubularized collagen-based matrix is feasible. Autologous bladder epithelial and smooth muscle cells from nine male rabbits were grown and seeded onto preconfigured tubular matrices constructed from decellularized bladder matrices obtained from lamina propria. The entire anterior penile urethra was resected in 15 rabbits. Urethroplasties were performed with tubularized matrices seeded with cells in nine animals, and with matrices without cells in six. Serial urethrograms were performed at 1, 3 and 6 months. Retrieved urethral tissues were analysed using histo- and immunohistochemistry, western blot analyses and organ bath studies. The urethrograms showed that animals implanted with cell-seeded matrices maintained a wide urethral calibre without strictures. In contrast, the urethras with unseeded scaffolds collapsed and developed strictures. Histologically, a transitional cell layer surrounded by muscle was observed in the cell-seeded constructs. The epithelial and smooth muscle phenotypes were confirmed with AE1/AE3 and α-actin antibodies. Organ bath studies of the neourethras confirmed both physiological contractility and the presence of neurotransmitters. Tubularized collagen matrices seeded with autologous cells can be used successfully for long segmental penile urethra replacement, while implantation of tubularized collagen matrices without cells leads to poor tissue development and stricture formation. The cell-seeded collagen matrices are able to form new tissue, which is histologically similar to native urethra.
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Affiliation(s)
- Roger E De Filippo
- Division of Urology, Saban Research Institute, Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA
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van den Heever A, Lazarus J, Naudé J, Wiechers L, Tsheisi M. Retrospective outcome analysis of urethroplasties performed for various etiologies in a single South African center. AFRICAN JOURNAL OF UROLOGY 2012. [DOI: 10.1016/j.afju.2012.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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