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Güler Y. Comparison of closure versus non-closure of the intraoral buccal mucosa graft site in urethroplasties. A systematic review and meta-analysis. Arab J Urol 2022; 21:18-30. [PMID: 36818369 PMCID: PMC9930765 DOI: 10.1080/2090598x.2022.2097613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/30/2022] [Indexed: 11/02/2022] Open
Abstract
Aim To assess postoperative oral morbidity through meta-analysis of comparative studies for closure or non-closure of the buccal mucosa graft harvest area in patients undergoing urethroplasty. Methods A systematic literature review was conducted in January 2022. Randomized controlled studies were assessed according to the Cochrane collaboration guidelines. Postoperative pain, difficult mouth opening, alteration of oral salivation, perioral numbness, and tolerance of solid and liquid intake results were assessed. Standard mean differences and risk ratios with 95% confidence intervals were estimated for relative risk. Assessment was performed with subgroup analyses according to time points. Results This meta-analysis included 373 patients in 7 randomized studies. The oral pain overall pooled effect estimates were investigated for the time points of day 0-1, day 3-7 and months 1-6. According to corrected effect estimates after sensitivity analysis, at the day 0-1 time point, the non-closure group was significantly superior compared to the closure group. But there was no difference at the other time points and in total. The overall pooled effect estimates for difficult mouth opening were investigated at 4 time points (day 1, days 5-7, months 1-3 and months 6). After sensitivity analysis, the overall pooled effect estimates at 6 months were significantly superior for the non-closure group. There were no significant differences between the non-closed and closed groups based on the overall pooled-effect estimates for oral numbness, salivary secretion alteration, and tolerance of liquid and solid food variants. Conclusion The non-closure group was more advantageous in terms of oral pain in the early postoperative period. There were no differences between the groups in terms of alteration of salivation, oral numbness and toleration of liquid/solid food. Although the non-closed group seems more advantageous in terms of ease in mouth movements, more studies are needed to prove this.
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Affiliation(s)
- Yavuz Güler
- İstanbul Rumeli University, Private Safa Hospital, Urology Department, İstanbul, Turkey
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Hwang EC, de Fazio A, Hamilton K, Bakker C, Pariser JJ, Dahm P. A Systematic Review of Randomized Controlled Trials Comparing Buccal Mucosal Graft Harvest Site Non-Closure versus Closure in Patients Undergoing Urethral Reconstruction. World J Mens Health 2021; 40:116-126. [PMID: 33663028 PMCID: PMC8761239 DOI: 10.5534/wjmh.200175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/11/2020] [Accepted: 12/25/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose To assess the effects of buccal mucosal graft site non-closure versus closure on postoperative oral morbidity for male undergoing augmentation urethroplasty for urethral stricture. Materials and Methods We included randomized controlled trials. Inclusion criteria were male over the age of 18 with urethral stricture disease requiring reconstruction with buccal mucosal graft harvest. Primary outcomes of the review were postoperative oral pain, need for secondary oral procedures and cosmetic defects. Results We included 5 studies with 346 randomized patients with urethral strictures, of whom 260 completed the trials. In terms of primary outcomes, non-closure graft site may reduce oral pain on postoperative day #1 (standard mean difference [SMD] 0.24 lower; 95% confidence interval [CI] 0.61 lower to 0.12 higher; low certainty evidence [CoE]) but we are uncertain how this impacts pain on postoperative days 3 to 6 (SMD 0.35; 95% CI 0.12 to 0.81 higher; very low CoE). We are also very uncertain as to how it affects the need for secondary oral procedures (risk ratio [RR] 0.22; 95% CI 0.01 to 4.28; very low CoE). Non-closure may increase the risk of cosmetic defects (RR 2.40; 95% CI 0.93 to 6.22; low CoE). Conclusions This review describes the trade-off for buccal mucosal graft site non-closure versus closure for various patient-important outcomes; decision-making will likely hinge on the relative value individual patients and surgeons place on them. The supporting evidence was rated as low and very low, thereby signaling substantial underlying uncertainty and the need for better trials.
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Affiliation(s)
- Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Hwasun, Korea
| | - Adam de Fazio
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Kallie Hamilton
- Minneapolis VA Health Care System, Specialty Care, Minneapolis, MN, USA
| | - Caitlin Bakker
- Health Sciences Libraries, University of Minnesota, Minneapolis, MN, USA
| | - Joseph J Pariser
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Philipp Dahm
- Department of Urology, University of Minnesota, Minneapolis, MN, USA.,Minneapolis VA Health Care System, Specialty Care, Minneapolis, MN, USA.
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Wang A, Chua M, Talla V, Fernandez N, Ming J, Sarino EM, DeLong J, Virasoro R, Tonkin J, McCammon K. Lingual versus buccal mucosal graft for augmentation urethroplasty: a meta-analysis of surgical outcomes and patient-reported donor site morbidity. Int Urol Nephrol 2021; 53:907-918. [PMID: 33415488 DOI: 10.1007/s11255-020-02720-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/07/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aimed at comparing surgical outcomes and patient-reported donor site morbidity between lingual mucosal graft (LMG) and buccal mucosal graft (BMG) through a meta-analysis of comparative studies. METHODS A systematic literature search was performed in January 2019 including non-randomized comparative studies and randomized controlled trials (RCT). The assessed data included urethroplasty outcomes, complications, and donor site morbidities such as pain, bleeding, swelling, numbness, difficulty speaking, difficulty eating, mouth opening, and difficulty with tongue protrusion. RESULTS A total of 632 patients (LMG 323, BMG 309) from 12 comparative studies (four RCTs and eight non-randomized) were included in the meta-analysis. Overall pooled effect estimates revealed no significant difference on reported surgical outcomes and operative stricture-related complications. The LMG group reported a higher proportion of patients with difficulty speaking (RR 6.96, 95% CI 2.04-23.70) and difficulty with tongue protrusion (RR 12.93, 95% CI 3.07-54.51) within 30 days post-op. In comparison, the BMG group had significantly more incidence of early post-procedural donor site swelling (RR 0.39, 95% CI 0.25-0.61) and numbness within 30 days post-op (RR 0.48, 95% CI 0.23-0.97) and 3-6 months (RR 0.52, 95% CI 0.30-0.90) post-op. CONCLUSION The evidence suggests no overall significant difference between LMG and BMG with regard to urethroplasty outcomes at 1-year follow-up. While patients undergoing LMG urethroplasty have a higher chance of experiencing difficulty with speech and difficulty with tongue protrusion within 1 month of surgery, the BMG group is more likely to experience early donor site swelling and mouth opening difficulty within 30 days post-op, as well as oral numbness for up to 6 months.
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Affiliation(s)
- Andrew Wang
- Department of Urology, Eastern Virginia Medical School, Devine-Jordan Center for Reconstructive Surgery and Pelvic Health Urology of Virginia, 225 Clearfield Avenue, Virginia Beach, Norfolk, VA, 23462, USA
| | - Michael Chua
- Department of Urology, Eastern Virginia Medical School, Devine-Jordan Center for Reconstructive Surgery and Pelvic Health Urology of Virginia, 225 Clearfield Avenue, Virginia Beach, Norfolk, VA, 23462, USA.,Division of Urology, Hospital for Sick Children, University of Toronto, Toronto, Canada.,Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines
| | | | - Nicolas Fernandez
- Division of Urology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Jessica Ming
- Department of Surgery, Urology Division, University of New Mexico, Albuquerque, NM, USA
| | - Esther May Sarino
- Reference Services, Brickell Medical Science Library, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Jessica DeLong
- Department of Urology, Eastern Virginia Medical School, Devine-Jordan Center for Reconstructive Surgery and Pelvic Health Urology of Virginia, 225 Clearfield Avenue, Virginia Beach, Norfolk, VA, 23462, USA
| | - Ramón Virasoro
- Department of Urology, Eastern Virginia Medical School, Devine-Jordan Center for Reconstructive Surgery and Pelvic Health Urology of Virginia, 225 Clearfield Avenue, Virginia Beach, Norfolk, VA, 23462, USA
| | - Jeremy Tonkin
- Department of Urology, Eastern Virginia Medical School, Devine-Jordan Center for Reconstructive Surgery and Pelvic Health Urology of Virginia, 225 Clearfield Avenue, Virginia Beach, Norfolk, VA, 23462, USA
| | - Kurt McCammon
- Department of Urology, Eastern Virginia Medical School, Devine-Jordan Center for Reconstructive Surgery and Pelvic Health Urology of Virginia, 225 Clearfield Avenue, Virginia Beach, Norfolk, VA, 23462, USA.
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D'hulst P, Muilwijk T, Vander Eeckt K, Van der Aa F, Joniau S. Patient-reported outcomes after buccal mucosal graft urethroplasty for bulbar urethral strictures: results of a prospective single-centre cohort study. BJU Int 2020; 126:684-693. [PMID: 32512634 DOI: 10.1111/bju.15131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To describe patient-reported outcome measures (PROMs) after buccal mucosa graft (BMG) urethroplasty. MATERIALS AND METHODS We prospectively collected PROMs in patients who underwent BMG urethroplasty for bulbar urethral strictures between October 2009 and February 2017. Preoperatively and at the first, second and third postoperative follow-up visits, patients completed five PROM questionnaires: the International Prostate Symptom Score (IPSS); the IPSS Quality of Life questionnaire; the Urogenital Distress Inventory Short-Form questionnaire (UDI-6); the International Index of Erectile Function (IIEF)-5 questionnaire, combined with IIEF-Q9 and IIEF-Q10 for assessing ejaculatory and orgasmic functions; and the International Consultation on Incontinence Questionnaire Lower Urinary Tract Symptoms Quality of Life (ICIQ-LUTS-QOL) questionnaire. In addition to using these questionnaires, we evaluated maximum urinary flow rate (Qmax ), post-void residual urine volume and total voided urine volume at each follow-up visit. Buccal pain and discomfort were assessed using a visual analogue scale (VAS). Comparison of questionnaire scores was performed using a paired Wilcoxon rank-sum test. Treatment failure was defined as any need for urinary diversion or urethral instrumentation after surgery. RESULTS A total of 97 patients met the inclusion criteria. The first postoperative follow-up visit was at a median of 2.1 months (n = 97/97), and the second and third visits were after a median of 7.8 (n = 82/97) and 17.0 months (n = 70/97), respectively. Significant improvements compared to baseline were observed in IPSS, and IPSS-QOL, UDI-6 and ICIQ-LUTS-QOL scores at the first follow-up, and remained improved during the follow-up period (P ≤ 0.001). Patients with mild to no baseline erectile dysfunction experienced a significant decline in erectile function at the first follow-up (median [interquartile range {IQR}] preoperative IIEF-5 score 23.0 [21.0-25.0] vs median [IQR] IIEF-5 score at first follow-up 19.5 [16.0-23.8]; P ≤ 0.001). This decline fully recovered during further follow-up (median [IQR] IIEF-5 score at third follow-up 24.0 [20.5-25.0]; P = 0.86). No significant changes in median orgasmic and ejaculatory function were noted. The first postoperative median (IQR) VAS score was 3.0 (2.0-4.45), and a significant improvement in local pain and discomfort was observed during the follow-up (median [IQR] VAS at third follow-up: 0.0 [0.0-1.0]; P ≤ 0.001). Nine patients (9/97; 9.3%) had treatment failure. Stratifying recurrence based on a difference of <10 mL/s vs ≥10 mL/s between preoperative and postoperative Qmax could not demonstrate a significant difference (P = 0.06). CONCLUSION Significant improvements in voiding symptoms and quality of life after surgery were reported. Patients with good baseline erections recovered erectile function during follow-up, although a significant decrease in erectile function was observed at the first follow-up. This study highlights the importance of PROMs in urethral reconstructive surgery, emphasizing that success should not be defined only by stricture-free survival.
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Affiliation(s)
- Pieter D'hulst
- Department of Reconstructive Urology, University Hospitals Leuven, Leuven, Belgium
| | - Tim Muilwijk
- Department of Reconstructive Urology, University Hospitals Leuven, Leuven, Belgium
| | - Kathy Vander Eeckt
- Department of Reconstructive Urology, University Hospitals Leuven, Leuven, Belgium
| | - Frank Van der Aa
- Department of Reconstructive Urology, University Hospitals Leuven, Leuven, Belgium
| | - Steven Joniau
- Department of Reconstructive Urology, University Hospitals Leuven, Leuven, Belgium
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