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Sheehan JL, Naringrekar HV, Misiura AK, Deshmukh SP, Roth CG. The pre-operative and post-operative imaging appearances of urethral strictures and surgical techniques. Abdom Radiol (NY) 2021; 46:2115-2126. [PMID: 33386912 DOI: 10.1007/s00261-020-02879-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 11/28/2022]
Abstract
Urethral strictures arise from a variety of etiologies, most commonly either iatrogenic or inflammatory in the anterior urethra and iatrogenic/surgical or traumatic etiologies in the posterior urethra. Diagnosis and treatment planning depend on urethrography, usually performed with a combination of retrograde urethrography (RUG) and voiding cystourethrography (VCUG) to evaluate the anterior and posterior urethra, respectively. While this is most commonly performed fluoroscopically, sonographic urethrography is an alternative, although at the expense of the posterior urethra, it is only visualized using a transrectal approach. In addition to understand urethral anatomy, familiarity with normal periurethral structures is necessary to avoid misdiagnosis, such as Cowper's ducts, the glands of Littré, and the prostatic and ejaculatory ducts. Surgical management depends on the stricture location, length, and number and options range from balloon dilatation to endoscopic urethrotomy to anastomotic and substitution urethrotomy. Postprocedural management includes urethrography to identify potential complications including urethral leak, graft failure, and stricture recurrence.
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Affiliation(s)
- Jamey L Sheehan
- Department of Radiology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Haresh V Naringrekar
- Department of Radiology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Anne Kathryn Misiura
- Department of Radiology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Sandeep P Deshmukh
- Department of Radiology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher G Roth
- Department of Radiology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
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2
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Ajape AA, Kuranga SA, Olanipekun HB, Mohammed TO. A novel slit-integration method of graft urethroplasty in the prevention of ring recurrence: Short-term results of a pilot study. Investig Clin Urol 2019; 60:319-325. [PMID: 31294142 PMCID: PMC6607076 DOI: 10.4111/icu.2019.60.4.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 04/15/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To describe and evaluate the efficacy of the slit-integration method in the prevention of ring recurrence after graft substitution urethroplasty. Materials and Methods This was a pilot study of selected patients with urethral stricture disease who required urethroplasty from January 2016 to December 2018. Patients were recruited into the study after they granted informed consent about the procedure. Results A total of eight patients were involved in this pilot study. The mean age (±standard deviation, SD) of the patients and the mean stricture length (±SD) were 44.25 (±11.07) years and 3.88 (±1.25) cm, respectively. The peno-bulbar region was the most frequently involved. The majority of the patients, 7 of 8 patients, underwent buccal mucosal graft repair with a mean graft length of 5.88 cm (range, 4–8 cm). There was leak during pericatheter urethrography in one patient. The mean (±SD) urethral calibers of the distal and proximal urethral anastomotic sites following urethroplasty were 26.00 (±1.85) and 25.25 (±1.83) at 1 week after removal of the urethral catheter stent and 27.75 (±0.71) and 27.75 (±0.71) at 12 months postoperatively, respectively. The mean maximum flow rate (±SD) at the 6- and 12-month follow-up was 20.25 (±1.83) and 21.88 (±1.73) mL/s, respectively. Conclusions A slit-graft appropriately quilted into the corresponding urethrotomy incisions at the proximal and distal summit of the urethral stricture segments appears to mitigate the occurrence of ring contracture after urethroplasty. A randomized controlled trial of this technique with additional outcome assessment will be required to validate this observation.
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Affiliation(s)
- Abdulwahab Akanbi Ajape
- Division of Urology, Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Sulyman Alege Kuranga
- Division of Urology, Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Hamid Babajide Olanipekun
- Division of Urology, Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Taofiq Olayinka Mohammed
- Division of Urology, Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Nigeria
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3
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Fuehner C, Dahlem R, Fisch M, Vetterlein MW. Update on managing anterior urethral strictures. Indian J Urol 2019; 35:94-100. [PMID: 31000913 PMCID: PMC6458800 DOI: 10.4103/iju.iju_52_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 03/18/2019] [Indexed: 06/09/2023] Open
Abstract
A number of techniques have been described for managing anterior urethral strictures in men. In this review, we aimed to summarize contemporary considerations regarding the holistic management of such strictures. The efficacy of reported outcomes is compared to provide evidence-based treatment recommendations. For anterior urethral strictures, durable long-term success rates of >90% may be achieved if the procedure is performed in capable hands at a high-volume referral center, even in recurrent strictures after previous open reconstruction. A one-stage urethroplasty is preferable to avoid a protracted treatment course with multiple interventions after dilation and direct vision internal urethrotomy. Staged urethroplasties are useful in complex anterior strictures providing durable success rates. In addition, perineal urethrostomy represents a valid last resort option with sufficient objective and subjective results. A follow-up evaluation should incorporate objective assessments such as radiographic and functional diagnostics as well as subjective, validated, and disease-specific patient-reported outcome measurement tools to allow for a better comparability and to improve individual risk prediction.
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Affiliation(s)
- Constantin Fuehner
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte W. Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Bhattar R, Yadav SS, Tomar V. Histopathological changes in oral mucosa in cases of failed augmented urethroplasty. Turk J Urol 2019; 45:206-211. [PMID: 30817277 DOI: 10.5152/tud.2019.67435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 09/19/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE 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. MATERIAL AND METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Rohit Bhattar
- Department of Urology, SMS Medical College, Jaipur, Rajasthan, India
| | - Sher S Yadav
- Department of Urology, SMS Medical College, Jaipur, Rajasthan, India
| | - Vinay Tomar
- Department of Urology, SMS Medical College, Jaipur, Rajasthan, India
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Vaddi SP, Reddy VB, Abraham SJ. Buccal epithelium Expanded and Encapsulated in Scaffold-Hybrid Approach to Urethral Stricture (BEES-HAUS) procedure: A novel cell therapy-based pilot study. Int J Urol 2018; 26:253-257. [PMID: 30468021 PMCID: PMC7379713 DOI: 10.1111/iju.13852] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 10/09/2018] [Indexed: 12/01/2022]
Abstract
Objectives To describe the feasibility of a novel cell‐based endoscopic technique using buccal epithelium, expanded and encapsulated in a thermoreversible gelation polymer scaffold for the treatment of urethral stricture. Methods Six male patients with bulbar urethral stricture ranging from 2.0 to 3.5 cm in length were included in this pilot study. Autologous buccal epithelial cells from a small buccal mucosal biopsy were isolated, cultured and encapsulated in thermoreversible gelation polymer scaffold, and were implanted at the stricture site after a wide endoscopic urethrotomy. Results All the patients voided well, with a mean peak flow rate of 24 mL/s. Urethroscopy carried out at 6 months showed healthy mucosa at the urethrotomy site. However, two of the six patients had recurrence at 18 and 24 months, respectively. Conclusions This endoscopic‐based Buccal epithelium Expanded and Encapsulated in Scaffold‐Hybrid Approach to Urethral Stricture (BEES‐HAUS) technique is a promising alternative for the open substitution buccal graft urethroplasty. It is possible to achieve the benefits of open substitution buccal urethroplasty with this endoscopic technique.
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Affiliation(s)
- Surya P Vaddi
- Department of Urology and Renal Transplantation, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
| | - Vijaya B Reddy
- Department of Urology and Renal Transplantation, Narayana Medical College Hospital, Nellore, Andhra Pradesh, India
| | - Samuel Jk Abraham
- The Mary-Yoshio Translational Hexagon, Nichi-In Center for Regenerative Medicine, Chennai, Tamil Nadu, India.,School of Medicine, Yamanashi University, Yamanashi, Japan.,Edogawa Evolutionary Laboratory of Science, Edogawa Hospital, Tokyo, Japan
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6
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Şimşek A, Yenice MG, Şeker KG, Arıkan Y, Çolakoğlu Y, Şam E, Tuğcu V. Evaluation of the results of dorsolateral buccal mucosal augmentation urethroplasty. Turk J Urol 2018; 45:223-229. [PMID: 29975633 DOI: 10.5152/tud.2018.47827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 02/15/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Evaluation of the results of dorsolateral buccal mucosal augmentation urethroplasty in patients with a long- segment urethral strictures. MATERIAL AND METHODS Twenty male patients who underwent urethroplasty in our clinic between November 2015 and January 2017 were evaluated. The outcomes of single-stage dorsolateral buccal mucosal augmentation urethroplasty were retrospectively evaluated. Patients were followed-up at 2nd-3rd weeks, 3rd and 6th months after the operation. RESULTS Mean age of the patients was 59.45±13.6 years. Mean length of the strictures was 4.59±1.99 cm (3-11 cm) and mean length of buccal mucosal graft was 6.8±1.98 cm (5-13 cm). Mean duration of operation was 149.25±47.39 minutes (95-270 min) and mean blood loss was calculated as 165.5±63.05 mL (75-280 mL). The success rate of dorsolateral buccal mucosal augmentation urethroplasty was calculated as 85% after a mean follow-up of 7.38±2.6 months. There were no perioperative or postoperative complications in the urethroplasty region or the mouth except one patient. Three patients who were found to have a decline in the maximum voiding rate in the postoperative 3rd month were included in the dilation program. CONCLUSION Single-stage dorsolateral buccal mucosal augmentation urethroplasty is a surgical option to be used in the treatment of long segment urethral strictures with high success and low complication rates in experienced hands.
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Affiliation(s)
- Abdulmuttalip Şimşek
- Clinic of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Mustafa Gürkan Yenice
- Clinic of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Kamil Gökhan Şeker
- Clinic of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Yusuf Arıkan
- Clinic of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Yunus Çolakoğlu
- Clinic of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Emre Şam
- Clinic of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Volkan Tuğcu
- Clinic of Urology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
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Prakash G, Singh BP, Sinha RJ, Jhanwar A, Sankhwar S. Is circumferential urethral mobilisation an overdo? A prospective outcome analysis of dorsal onlay and dorso - lateral onlay BMGU for anterior urethral strictures. Int Braz J Urol 2017; 44:323-329. [PMID: 29144630 PMCID: PMC6050550 DOI: 10.1590/s1677-5538.ibju.2016.0599] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 08/20/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction For dorsal onlay graft placement, unilateral urethral mobilization is less invasive than standard circumferential urethral mobilization. Apart from success in terms of patency of urethra, other issues like sexual function, overall quality of life and patient satisfaction remain important issues while comparing outcomes of urethroplasty. Aim To prospectively compare the objective as well as subjective outcomes of two approaches. Materials and Methods Between July 2011 and January 2015, 136 adult males having anterior urethral stricture with urethral lumen ≥ 6 Fr. were prospectively assigned between two groups by alternate randomization. Operative time, complications, success rate (no obstructive symptoms, no need of any postoperative intervention, Q max > 15mL/sec), sexual functions (using Brief Male Sexual Function Inventory) were compared. Results Baseline parameters were similar in both groups (68 in each group). Overall success rate was similar in both groups (89 % and 91 % respectively). Improvement in total LUTS scores was similar in groups. Changes in overall health status (VAS and EQ 5D) was equal in both groups. Erectile function score was significantly decreased in DO than DL group while ejaculatory function and sexual desire remained stable after urethroplasty in both groups. Conclusions In anterior urethral stricture buccal mucosa graft provides satisfactory results as onlay technique. No technique whether dorsolateral and dorsal techniques is superior to other. Dorsolateral technique needs minimal urethral mobilization and should be preferred whenever feasible.
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Affiliation(s)
- Gaurav Prakash
- Department of Urology, King George's Medical University, Lucknow, India
| | | | - Rahul Janak Sinha
- Department of Urology, King George's Medical University, Lucknow, India
| | - Ankur Jhanwar
- Department of Urology, King George's Medical University, Lucknow, India
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8
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Gordon RI, Parashis AO, Tatakis DN. Extraoral Uses of Autologous Oral Soft Tissue Grafts: A Different Bridge Between Mouth and Body Health. Clin Adv Periodontics 2017; 7:215-220. [PMID: 31539215 DOI: 10.1902/cap.2017.160076] [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: 10/25/2016] [Accepted: 02/20/2017] [Indexed: 11/13/2022]
Abstract
Focused Clinical Question: Are there any extraoral uses for intraoral soft tissue grafts? Summary: Despite extensive literature on the intraoral uses of soft tissue autografts harvested from oral sites, the periodontal literature is lacking information on the extraoral uses of such grafts. The purpose of this article is to review the autologous use of certain oral soft tissue grafts for extraoral indications. A literature search revealed that several medical specialties, including otolaryngology, ophthalmology, dermatology, plastic surgery, and urology, have a track record of positive outcomes with the use of free gingival, buccal fat pad, and buccal mucosa grafts for a wide variety of reconstructive procedures at diverse body sites. Conclusions: The numerous successful extraoral uses of oral soft tissue autografts underscore the versatility of these tissues in reconstructive surgery and suggest there is potential for collaboration between periodontal and medical specialists for the benefit of patients in need of such reconstructions. Broader awareness of these applications of oral soft tissue grafts could help expand their current uses and would allow practitioners to better answer possible patient inquiries.
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Affiliation(s)
- Ross I Gordon
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH
| | - Andreas O Parashis
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH.,Private practice, Athens, Greece
| | - Dimitris N Tatakis
- Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH
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Žiaran S, Galambošová M, Danišovič L. Tissue engineering of urethra: Systematic review of recent literature. Exp Biol Med (Maywood) 2017; 242:1772-1785. [PMID: 28893083 DOI: 10.1177/1535370217731289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The purpose of this article was to perform a systematic review of the recent literature on urethral tissue engineering. A total of 31 articles describing the use of tissue engineering for urethra reconstruction were included. The obtained results were discussed in three groups: cells, scaffolds, and clinical results of urethral reconstructions using these components. Stem cells of different origin were used in many experimental studies, but only autologous urothelial cells, fibroblasts, and keratinocytes were applied in clinical trials. Natural and synthetic scaffolds were studied in the context of urethral tissue engineering. The main advantage of synthetic ones is the fact that they can be obtained in unlimited amount and modified by different techniques, but scaffolds of natural origin normally contain chemical groups and bioactive proteins which increase the cell attachment and may promote the cell proliferation and differentiation. The most promising are smart scaffolds delivering different bioactive molecules or those that can be tubularized. In two clinical trials, only onlay-fashioned transplants were used for urethral reconstruction. However, the very promising results were obtained from animal studies where tubularized scaffolds, both non-seeded and cell-seeded, were applied. Impact statement The main goal of this article was to perform a systematic review of the recent literature on urethral tissue engineering. It summarizes the most recent information about cells, seeded or non-seeded scaffolds and clinical application with respect to regeneration of urethra.
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Affiliation(s)
- Stanislav Žiaran
- 1 Department of Urology, Faculty of Medicine, Comenius University in Bratislava, Bratislava 833 05, Slovak Republic
| | - Martina Galambošová
- 2 Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University in Bratislava, Bratislava 811 08, Slovak Republic
| | - L'uboš Danišovič
- 2 Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University in Bratislava, Bratislava 811 08, Slovak Republic.,3 Regenmed Ltd, Bratislava 811 02, Slovak Republic
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10
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Abstract
The gold standard for bulbar urethroplasty has been excision and primary anastomosis. Application of this approach is generally limited to strictures that are 2 cm or less in the bulbar urethra due to penile shortening. Strictures greater than 2 cm are successfully treated with augmentation urethroplasty wherein the narrowed segment is not excised but widened with the use of a skin flap or a tissue graft. Buccal mucosa is the most prevalent tissue for bulbar urethral stricture repair for strictures greater than 2 cm. Outcomes for the different graft locations are similar, approximately 90%.
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Affiliation(s)
- Mya E Levy
- Department of Urology, University of Minnesota, 420 Delaware Street South East, MMC 394, Minneapolis, MN 55455, USA
| | - Sean P Elliott
- Department of Urology, University of Minnesota, 420 Delaware Street South East, MMC 394, Minneapolis, MN 55455, USA.
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Eshiobo I, Ehizomen E, Omosofe F, Onuora V. Buccal mucosal graft urethroplasty for proximal bulbar urethral stricture: A revisit of the surgical technique and analysis of eleven consecutive cases. Niger Med J 2016; 57:266-271. [PMID: 27833245 PMCID: PMC5036297 DOI: 10.4103/0300-1652.190603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Urethral stricture disease is prevalent, and many surgical techniques have been developed to treat it. Currently, urethroplasty for bulbar strictures implies ventral or dorsal stricturotomy and a buccal mucosa graft (BMG) patch. OBJECTIVE To describe the surgical approach of the ventral patch BMG urethroplasty for proximal bulbar urethral stricture and to analyze 11 consecutive cases for whom the technique was used. PATIENTS AND METHODS The diagnosis of urethral stricture was confirmed with a combined retrograde urethrography and micturating cystourethrography. A single team exposed the urethra, harvested, and planted the BMG in the lithotomy position under general anesthesia. The oral preoperative preparation was done with oraldene (hexetidine) mouth wash three times daily beginning from the 2nd preoperative day. The buccal mucosa was harvested from the left inner cheek in all the patients. The donor site was left unclosed but packed with wet gauze. Data related to age, preoperative adverse conditions, stricture length, urine culture result, perineal/oral wound complications, postoperative residual urine volume, and duration of hospital stay were recorded. RESULTS Eleven patients with proximal bulbar urethral stricture had BMG urethroplasty from August 2013 to October 2015. Stricture length ranged from 2 to 5 cm. In six (54%) of the men, the stricture resulted from urethritis thereby constituting the most common etiology of urethral stricture in this study. The preoperative adverse conditions were age above 70 in three, diabetes mellitus in two, severe dental caries in one, and recurrent stricture in two. All of them were able to resume reasonable oral intake 72 h postoperatively. One (9.2%) had perineal wound infection, while two (18.2%) still had mild pain at donor site 4 weeks postoperatively. Ten (90.9%) of the 11 patients had <30 ml residual urine volume at 2 months of follow-up. CONCLUSION Urethritis is still a common cause of urethral stricture in this rural community. Ventral onlay buccal mucosal graft urethroplasty for proximal bulbar urethral stricture is safe, even in certain adverse preoperative conditions. Buccal mucosa from the cheek is however now preferred.
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Affiliation(s)
- Irekpita Eshiobo
- Department of Surgery, Urology Division, Irrua Teaching Hospital, Irrua, Edo State, Nigeria
| | - Esezobor Ehizomen
- Department of Surgery, Plastic Surgery Division, Irrua Teaching Hospital, Irrua, Edo State, Nigeria
| | - F. Omosofe
- Department of Anesthesia, Irrua Teaching Hospital, Irrua, Edo State, Nigeria
| | - V. Onuora
- Department of Surgery, Urology Division, Irrua Teaching Hospital, Irrua, Edo State, Nigeria
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12
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Joshi P, Kaya C, Kulkarni S. Approach to bulbar urethral strictures: Which technique and when? Turk J Urol 2016; 42:53-9. [PMID: 27274887 DOI: 10.5152/tud.2016.12989] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Bulbar urethra is the most common site of anterior urethral stricture and this stricture develops secondary to idiopathic (40%), iatrogenic (35%), inflammatory (10%), and traumatic (15%) causes. Various techniques and approaches with buccal mucosal graft have been described. We wanted to describe different techniques of repair with specific advantages.
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Affiliation(s)
- Pankaj Joshi
- Kulkarni Center for Reconstructive Urology, Pune, India
| | - Cevdet Kaya
- Department of Urology, Marmara University School of Medicine, İstanbul, Turkey
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13
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14
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Buccal mucosal graft interposition in the treatment of recurrent vesicovaginal fistula: A report on two cases. Taiwan J Obstet Gynecol 2015; 54:773-5. [PMID: 26701001 DOI: 10.1016/j.tjog.2015.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To present the use of autologous buccal mucosa graft (BMG) in the treatment of recurrent vesicovaginal fistula (VVF). CASE REPORTS In 2011, two women, aged 45 years and 56 years, were admitted due to recurrent VVF. Both women had previously undergone abdominal hysterectomies for benign conditions and, subsequently, vaginal VVF repair due to vaginal urine leakage. On admission, the younger woman had a round fistula, with a diameter of 1.5 cm, located on the left side, supratrigonally; the other woman had an ellipsoidal fistula measuring 2.5 cm × 1.5 cm, located medially and supratrigonally. Both women underwent suturing of the VVF with the interposition of BMG. After the last treatment, both women were cured. CONCLUSION Treatment of recurrent VVF with the interposition of BMG is a good alternative to the use of other tissue grafts. Larger series are needed to confirm the advantages of this method.
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15
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Management of Long-Segment and Panurethral Stricture Disease. Adv Urol 2015; 2015:853914. [PMID: 26779259 PMCID: PMC4686630 DOI: 10.1155/2015/853914] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 11/05/2015] [Indexed: 01/18/2023] Open
Abstract
Long-segment urethral stricture or panurethral stricture disease, involving the different anatomic segments of anterior urethra, is a relatively less common lesion of the anterior urethra compared to bulbar stricture. However, it is a particularly difficult surgical challenge for the reconstructive urologist. The etiology varies according to age and geographic location, lichen sclerosus being the most prevalent in some regions of the globe. Other common and significant causes are previous endoscopic urethral manipulations (urethral catheterization, cystourethroscopy, and transurethral resection), previous urethral surgery, trauma, inflammation, and idiopathic. The iatrogenic causes are the most predominant in the Western or industrialized countries, and lichen sclerosus is the most common in India. Several surgical procedures and their modifications, including those performed in one or more stages and with the use of adjunct tissue transfer maneuvers, have been developed and used worldwide, with varying long-term success. A one-stage, minimally invasive technique approached through a single perineal incision has gained widespread popularity for its effectiveness and reproducibility. Nonetheless, for a successful result, the reconstructive urologist should be experienced and familiar with the different treatment modalities currently available and select the best procedure for the individual patient.
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16
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Chakrabarti A, Maity N, Shaikh F, Jahangir T. Surgical Management of Benign Coloesophageal Stricture: a Novel Technique. Indian J Surg 2015; 77:1447-9. [PMID: 27011596 PMCID: PMC4775591 DOI: 10.1007/s12262-014-1177-4] [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: 11/07/2013] [Accepted: 09/18/2014] [Indexed: 11/24/2022] Open
Abstract
Benign coloesophageal anastomotic stricture in postoperative colon bypass patients suffering from the corrosive stricture of the upper esophagus is a challenging problem. Failure of repeated endoscopic balloon dilatation makes way for revisional operative techniques like free jejunal grafts or interposition skin tube based on radial vessels. The situation arising from the morbidity of such reconstructive procedures, at times, becomes more complex than the stricture itself [1]. This clinical scenario has compelled us to innovate with a much simpler technique using buccal mucosal graft (BMG) to manage these strictures. Currently, the utility of BMG is mostly limited to urethral reconstruction. Overtime, it has become an ideal urethral substitute. Here, we present a case series of five patients who have been subjected to coloesophagoplasty with BMG and have demonstrated excellent results. With a median follow-up of 13 months, all patients have fully recovered and are taking solid and liquid foods satisfactorily. Thus, the option of coloesophagoplasty with BMG should always be kept in consideration while planning a revision surgery for a small-segment benign coloesophageal anastomotic stricture in the corrosive injury of the esophagus, considering the ease and excellent outcome.
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Affiliation(s)
- Amitabha Chakrabarti
- />Department of CTVS, KPC Medical College Kolkata, Kolkata, India
- />RTIICS, Kolkata, India
| | - Niranjan Maity
- />Department of CTVS, Medical College Kolkata, Kolkata, India
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Vasudeva P, Nanda B, Kumar A, Kumar N, Singh H, Kumar R. Dorsal versus ventral onlay buccal mucosal graft urethroplasty for long-segment bulbar urethral stricture: A prospective randomized study. Int J Urol 2015; 22:967-71. [DOI: 10.1111/iju.12859] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 06/02/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Pawan Vasudeva
- Department of Urology; V. M. Medical College and Safdarjang Hospital; New Delhi India
| | - Biswajit Nanda
- Department of Urology; V. M. Medical College and Safdarjang Hospital; New Delhi India
| | - Anup Kumar
- Department of Urology; V. M. Medical College and Safdarjang Hospital; New Delhi India
| | - Niraj Kumar
- Department of Urology; V. M. Medical College and Safdarjang Hospital; New Delhi India
| | - Harbinder Singh
- Department of Urology; V. M. Medical College and Safdarjang Hospital; New Delhi India
| | - Rohit Kumar
- Department of Urology; V. M. Medical College and Safdarjang Hospital; New Delhi India
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Osman NI, Hillary C, Bullock AJ, MacNeil S, Chapple CR. Tissue engineered buccal mucosa for urethroplasty: progress and future directions. Adv Drug Deliv Rev 2015; 82-83:69-76. [PMID: 25451857 DOI: 10.1016/j.addr.2014.10.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/22/2014] [Accepted: 10/03/2014] [Indexed: 01/15/2023]
Abstract
PURPOSE Autologous buccal mucosa is commonly utilized in the surgical treatment of urethral strictures. Extensive strictures require a larger quantity of tissue, which may lead to donor site morbidity. This review assesses progress in producing tissue engineered buccal mucosa as an alternative graft material. RESULTS Few clinical studies have introduced cells onto biological or synthetic scaffolds and implanted resulting constructs in patients. The available studies show that buccal mucosa cells on acellular human dermis or on collagen matrix lead to good acute stage tissue integration. Urothelial cells on a synthetic substrate also perform well. However while some patients do well many years post-grafting, others develop stricture recurrence. Acellular biomaterials used to treat long urethral defects in animals commonly lead to fibrosis. CONCLUSIONS Tissue engineered buccal mucosa shows promise as a substitute for native tissue. The fibrosis which occurs months post-implantation may reflect the underlying disease process recurring in these patients.
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Affiliation(s)
- N I Osman
- Kroto Research Institute, University of Sheffield, Sheffield, UK; Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
| | - C Hillary
- Kroto Research Institute, University of Sheffield, Sheffield, UK; Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
| | - A J Bullock
- Kroto Research Institute, University of Sheffield, Sheffield, UK
| | - S MacNeil
- Kroto Research Institute, University of Sheffield, Sheffield, UK
| | - C R Chapple
- Department of Urology, Royal Hallamshire Hospital, Sheffield, UK.
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Soave A, Steurer S, Dahlem R, Rink M, Reiss P, Fisch M, Engel O. Histopathological characteristics of buccal mucosa transplants in humans after engraftment to the urethra: a prospective study. J Urol 2014; 192:1725-9. [PMID: 24998481 DOI: 10.1016/j.juro.2014.06.089] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2014] [Indexed: 01/28/2023]
Abstract
PURPOSE Histopathological changes in buccal mucosa transplants after engraftment to the urethra and exposure to urine remain nebulous. We investigated histopathological changes in buccal mucosa transplants integrated into the urethra in humans. MATERIALS AND METHODS We prospectively evaluated 22 patients with recurrent urethral stricture after buccal mucosa urethroplasty between November 2012 and October 2013. All patients underwent repeat buccal mucosa urethroplasty performed by a single surgeon. Intraoperatively we harvested a sample of the integrated buccal mucosa transplant previously engrafted to the urethra, a sample of healthy urethra, a sample of freshly harvested buccal mucosa from the contralateral inner cheek and a sample of fibrotic tissue from the area of the current stricture. A dedicated uropathologist performed meticulous histopathological examination of all tissue samples using hematoxylin and eosin staining. Preoperative clinical data were also collected on all patients. RESULTS The mean interval from previous to current buccal mucosa urethroplasty was 22.2 months (range 4.1 to 76.0). Mean stricture length at repeat urethroplasty was 52.7 mm (range 30.0 to 70.0). Histopathological characteristics of the integrated buccal mucosa transplants were completely preserved in all patients, consisting of thick sheets of stratified nonkeratinized squamous epithelium with a stratum spinosum. Transplants were not partially or entirely overgrown with urothelium. CONCLUSIONS Buccal mucosa transplants retain their histopathological characteristics and are not overgrown with urothelium after urethral engraftment and urine exposure in humans. These findings may explain the superiority of buccal mucosa transplants on the outcome of substitution urethroplasty compared to that of other materials.
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Affiliation(s)
- Armin Soave
- Departments of Urology and Pathology (SS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Stefan Steurer
- Departments of Urology and Pathology (SS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Dahlem
- Departments of Urology and Pathology (SS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Rink
- Departments of Urology and Pathology (SS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Reiss
- Departments of Urology and Pathology (SS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Departments of Urology and Pathology (SS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Engel
- Departments of Urology and Pathology (SS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Outcomes of dorsal and ventral buccal graft urethroplasty at a tertiary hospital in Uganda. ISRN UROLOGY 2014; 2014:316819. [PMID: 24944835 PMCID: PMC4040201 DOI: 10.1155/2014/316819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 03/30/2014] [Indexed: 11/23/2022]
Abstract
Purpose. Although the use of buccal mucosa in substitution urethroplasty has been practiced for some years, it has not been free of controversy over which surgical technique is the most appropriate to use. There is paucity of data in Sub-Saharan Africa about its success; this study presents the outcomes of dorsal and ventral buccal graft urethroplasty at a sub-Saharan tertiary hospital. Methods. This is a prospective study in which buccal mucosa was used for ventral and dorsal grafts; followup was up to two years. All patients provided informed written consent for the procedures. Results. Seventy-two patients with bulbar urethral strictures underwent buccal graft one-stage urethroplasty. Mean age was 55 years; etiology of the strictures was postinflammatory due to urethritis from sexually transmitted infections 97% (70/72) and trauma 3% (2/72). Buccal mucosa grafts were harvested from the cheek using a two-team approach. Grafts were placed on the ventral and dorsal urethral surfaces in 32 and 40 cases, respectively; the success rate was 84 and 80%, respectively. Repeated urethroplasty was successfully done among 10% (7/72) and patients reported resolution of symptoms in the follow-up period. Conclusion. There was no difference between dorsal and ventral onlay buccal graft outcomes for bulbar urethral strictures. The success rate was 80 to 84%.
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Siegel J, Tausch TJ, Simhan J, Morey AF. Innovative approaches for complex penile urethral strictures. Transl Androl Urol 2014; 3:179-85. [PMID: 26816766 PMCID: PMC4708172 DOI: 10.3978/j.issn.2223-4683.2014.04.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Urethral strictures are a common urologic disease that arises from varied etiologies. These strictures range in severity from simple, short lesions to complex, long defects. Likewise, the management approach varies based on the complexity of the lesion. We reviewed the literature of urethral stricture disease and its management. In particular we have focused on complex strictures of the male penile urethra. Often these cases cannot be managed with traditional reconstructive techniques and require newer approaches. Furthermore tissue engineered graft materials provide a possible tissue source for future reconstructive endeavors.
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Abstract
Male urethral stricture disease is prevalent and has a substantial impact on quality of life and health-care costs. Management of urethral strictures is complex and depends on the characteristics of the stricture. Data show that there is no difference between urethral dilation and internal urethrotomy in terms of long-term outcomes; success rates range widely from 8-80%, with long-term success rates of 20-30%. For both of these procedures, the risk of recurrence is greater for men with longer strictures, penile urethral strictures, multiple strictures, presence of infection, or history of prior procedures. Analysis has shown that repeated use of urethrotomy is not clinically effective or cost-effective in these patients. Long-term success rates are higher for surgical reconstruction with urethroplasty, with most studies showing success rates of 85-90%. Many techniques have been utilized for urethroplasty, depending on the location, length, and character of the stricture. Successful management of urethral strictures requires detailed knowledge of anatomy, pathophysiology, proper patient selection, and reconstructive techniques.
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Affiliation(s)
- Lindsay A Hampson
- Department of Urology, University of California, 400 Parnassus Avenue, Suite A-610, Box 0738, San Francisco, CA 94143-0738, USA
| | - Jack W McAninch
- Department of Urology, University of California, 400 Parnassus Avenue, Suite A-610, Box 0738, San Francisco, CA 94143-0738, USA
| | - Benjamin N Breyer
- Department of Urology, University of California, 400 Parnassus Avenue, Suite A-610, Box 0738, San Francisco, CA 94143-0738, USA
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Combining ventral buccal mucosal graft onlay and dorsal full thickness skin graft inlay decreases failure rates in long bulbar strictures (≥6 cm). Urology 2013; 81:899-902. [PMID: 23465157 DOI: 10.1016/j.urology.2012.11.055] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 11/15/2012] [Accepted: 11/19/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the efficacy of augmenting ventral onlay buccal urethroplasty using a using a double-sided graft technique by adding a second, full-thickness skin graft (FTSG) dorsally in long strictures ≥4 cm, we hypothesized that a double-sided graft technique would improve surgical outcomes over buccal mucosal graft (BMG) ventral onlay urethroplasty alone. METHODS Retrospective chart review was performed comparing 15 patients who had undergone double-sided BMG + FTSG urethroplasty for long strictures ≥4 cm to a cohort group of 115 patients who had undergone BMG onlay urethroplasty for strictures of similar length. Comparisons of age, stricture lengths, time-to-failure, follow-up intervals, and failure rates were analyzed. Further analysis included age and stricture length matched control comparisons between BMG + FTSG patients to BMG only patients. RESULTS Mean patient age, stricture length, and time to stricture recurrence were 44 years, 5.1 cm, and 10 months, respectively, in the BMG group. For the BMG + FTSG group, mean age was 52 years, stricture length 5.9 cm, and time to recurrence was 9 months. Overall, the BMG group had a decreased failure rate; 17% compared to 21%. Further analysis showed BMG ventral onlay had decreased failure rates for strictures <6 cm; 16% compared to 33%. However, for strictures ≥6 cm, the BMG + FTSG had a 0% failure rate compared to 24% in the BMG ventral onlay group (P = .005). CONCLUSION Combined BMG and FTSG urethroplasty for very long bulbar urethral strictures ≥6 cm improve success rates compared to using BMG urethroplasty alone.
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