Outcomes of Ventral Onlay Buccal Mucosal Graft Urethroplasty in Bulbomembranous Urethral Strictures Post-transurethral Resection of the Prostate.

OBJECTIVE: To evaluate the outcomes of ventral onlay buccal mucosal graft urethroplasty (VOBMGU) in bulbomembranous urethral strictures after transurethral resection of the prostate. METHODS: After approval of the institutional ethical committee, we retrospectively examined the database of patients diagnosed with post-TURP urethral stricture (PTS) and treated by VOBMGU from January 2020 to January 2022. The patients were evaluated by retrograde urethrogram and voiding cystourethrogram. Follow-up evaluation included assessment of lower urinary tract symptoms, physical examination, uroflowmetry (Q-max and International Prostate Symptom Score) 3, 6, and 12months of follow-up. RESULTS: A total of 30 patients underwent VOBMGU for bulbomembranous PTS were included. The median age of the patients was 63.5 (11.25). The median stricture length was 3.5 (1.5) cm. During follow-up, the mean Q-max significantly increased to 21.1 ± 5.5 mL/s (P < .0001), 20.1 ± 5.4 mL/s (P < .001), and 19.1 ± 5.3 mL/s (P < .003) at 3, 6, and 12months, respectively. IPSS significantly decreased to 8.93 ± 6.37 at the 12-month follow-up mark (P < .0001). Three patients developed stricture recurrence and two patients developed postoperative urinary incontinence. CONCLUSION: VOBMGU in cases of bulbomembranous urethral PTS offered excellent functional outcomes with low stricture recurrence and minimal risk of incontinence. Further prospective studies are warranted to confirm the results.

What is the role of single-stage oral mucosa graft urethroplasty in the surgical management of lichen sclerosus-related stricture disease in men? A systematic review.

PURPOSE: The benefits and harms of the available types of surgical management for lichen sclerosus-related (LS) strictures remain unclear and, thus, clear and robust clinical practice recommendations cannot be given. MATERIALS AND METHODS: To assess the role of single-stage OMGU in the management of LS strictures and explore how its benefits and harms compare with the alternative management options. Medline, Embase and Cochrane controlled trial databases (CENTRAL, CDSR) were systematically searched. Randomized (RCTs) and nonrandomized studies (NRCSs) comparing single-stage OMGU with other surgical management options for LS strictures and single-arm studies on single-stage OMGU were included. Risk of bias (RoB) was assessed. RESULTS: Of the 1912 abstracts identified, 15 studies (1 NRCS and 14 single-arm studies) were included, recruiting in total 649 patients. All studies were at high RoB. In the only NRCS available, stricture-free rate (SFR) for single-stage and staged OMGU was 88% vs 60%, respectively (p = 0.05), at a mean follow-up of 66.5 months. SFR range for single-stage OMGU in single-arm studies was 65-100% (mean/median follow-up, 12-59 months). Single-stage OMGU had low complication rates and beneficial impact on LUTS and QoL. CONCLUSIONS: The present SR highlights the methodological limitations of the available literature. In the absence of adverse local tissue conditions, and taking into consideration benefit-harm balance and surgeon's skills and expertise, single-stage OMGU can be justified in patients with LS strictures.

Hyperbaric Oxygen Therapy Improves Oral Graft Take in Hypospadias Staged Tubularized Autograft Reoperations.

PURPOSE: Increased complications following failed hypospadias repairs suggest that impaired wound healing is a contributing factor. We used perioperative hyperbaric oxygen therapy to promote wound healing determined by graft take in staged tubularized autograft reoperations using oral graft. MATERIALS AND METHODS: Hyperbaric oxygen therapy was recommended for patients with 3 or more failed hypospadias repairs, comprising 20 preoperative and 10 postoperative sessions. All patients underwent reoperative staged tubularized autograft repair using oral mucosa. Graft lengths and widths were measured at grafting and again at the second stage, from which graft area was calculated. The primary outcomes were percent graft contracture and graft failure, defined as contracture 50% or greater. Patients who received hyperbaric oxygen therapy were compared to other patients who underwent reoperative staged tubularized autograft who did not receive therapy. RESULTS: Among 57 patients 32 received hyperbaric oxygen therapy and 25 did not as they had fewer than 3 prior repairs, or were not able to receive treatment due to insurance issues or lack of local availability. Grafts were healthier in those receiving hyperbaric oxygen therapy, with significantly less percent area contracture (9% vs 26%, p=0.04) and graft failure (6% vs 28%, p=0.03) compared to those not receiving therapy, although treated patients had significantly more prior failed hypospadias repairs. CONCLUSIONS: Hyperbaric oxygen therapy improved graft take in hypospadias reoperations. This observation also calls attention to wound healing as another variable to consider in hypospadias surgery.

Prospective analysis of artificial urinary sphincter AMS 800 implantation after buccal mucosa graft urethroplasty.

OBJECTIVES: To analyze functional outcomes and complication rates of artificial urinary sphincter (AUS) implantation in patients who had undergone buccal mucosa graft urethroplasty (BMGU) beforehand. PATIENTS AND METHODS: This prospectively maintained single-center database comprises data from 236 patients from 2009 to 2015 who underwent AUS implantation. A total of 17 patients after BMGU were available for analysis. Primary endpoints consisted of continence and complication rates. Continence was defined as no use of safety pads, social continence as < 2 pads per day. Stricture recurrence was defined as a decrease in uroflowmetry, a maximum flow rate < 10 ml/s or residual urine volume (> 100 ml). Kaplan-Meier analysis determined explantation-free survival. RESULTS: Median follow-up was 24 months (interquartile range [IQR] 6-31 months). Indication for AUS implantation was severe urinary incontinence with a history of radical prostatectomy (RRP) in 8 (47.1%), trauma in 1 (5.9%) and TUR-P in 8 (47.1%) patients. Pelvic irradiation was reported in 13 (76.5%) cases. The median length of buccal mucosa graft for urethroplasty was 4 cm (3-5 cm). A double cuff was implanted in 14 patients (82.4%), 3 patients received a single cuff. Complete and social continence was achieved in 76.5% and 100% of the patients, respectively. There was no significant difference in complications and explantation-free survival (log-rank, p = 0.191) between patients who had undergone BMGU before AUS compared to patients with no history of BMGU. CONCLUSIONS: According to the prospective follow-up data in a homogenous cohort, AUS implantation seems to be a viable, safe and effective therapeutic strategy for incontinence treatment despite previous BMGU.

Buccal epithelium Expanded and Encapsulated in Scaffold-Hybrid Approach to Urethral Stricture (BEES-HAUS) procedure: A novel cell therapy-based pilot study.

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.

Effects of Laser Photobiomodulation and Ozone Therapy on Palatal Epithelial Wound Healing and Patient Morbidity.

OBJECTIVE: The aim of this study was to compare the effects of laser photobiomodulation (PBM) and topical ozone therapy on the reepithelialization of palatal donor site wounds through clinical assessment and computer-aided image analysis and to assess the patient morbidity following free gingival graft (FGG) surgeries. MATERIAL AND METHODS: Thirty-six patients requiring FGG were randomly allocated into three groups: laser group (n = 12), ozone group (n = 12), and control group (n = 12). Epithelialization was evaluated by applying 3% hydrogen peroxide (H2O2) to the wound area and also measured by using digital image analysis (ImageJ). Bland-Altman plots were used for assessing agreement between H2O2 and ImageJ measurements. Parameters in relation to patient morbidity were assessed by using visual analog scale (VAS) on the first 3, 7, 14, and 30 days postoperatively. RESULTS: At day 14, statistically significant smaller wounds were observed with digital image analysis in the ozone group as compared with the control group (p = 0.034). However, intergroup comparison of the remaining wound area evaluated by the clinician using the H2O2 method did not reveal any significant differences (p > 0.05). Nonetheless, according to Bland-Altman analysis, the lower and upper limits showed a moderate agreement between the two measurement methods. The mean VAS sores exhibiting postoperative discomfort was observed to be significantly higher in the control group compared with the laser group (p = 0.002) and ozone group (p < 0.001) at day 7. CONCLUSIONS: Adjunctive ozone therapy could have a significantly beneficial effect on the acceleration of palatal wound healing following FGG procedures. Both PBM and ozone treatment modalities reduced postoperative discomfort as compared with spontaneous healing.

Evaluation of low-level laser therapy in rabbit oral mucosa after soft tissue graft application: A pilot study.

The aim of the present study was to assess the histopathological effects of low-level laser therapy (LLLT) on healing of the oral mucosa after soft tissue graft operations. The alterations at the end of healing in normal and LLLT-applied oral mucosa were studied in two healthy adult New Zealand white rabbits by taking specimens for light microscopic inspection. There was no adverse event reported in the study and no post-operative complications, such as swelling, bleeding, or edema, were observed in the rabbits. Complete wound healing was faster in the LLLT-applied rabbit. Compared to the normal rabbit oral mucosa, thickening of the stratum corneum (hyperkeratosis) was found in the epithelia of the rabbits. A significant increase in the epithelial thickness was found in the samples of rabbits, suggesting increased scar tissue following the wound repair. Additionally, many mitotic figures were present in the epithelia of the LLLT-applied rabbit, indicating epithelial cell hyperplasia. Long and irregular connective tissue protrusions projecting into the undersurface of the epithelium and mononuclear cell infiltrations were noted in the rabbits. The results suggest that LLLT used for soft tissue operations provides better and faster wound healing and that LLLT enhances epithelization.

Comparative study between porcine small intestinal submucosa and buccal mucosa in a partial urethra substitution in rabbits.

PURPOSE: Several urethral conditions may require tissue substitution. One collagen-base biomaterial that recently emerged as an option is small intestinal submucosa (SIS). The aim of this study was to compare the results of SIS and buccal mucosa for urethral substitution in rabbits. MATERIALS AND METHODS: Thirty-six North Folk male rabbits were randomized into three groups. In all animals, a 10 × 5 mm urethral segment was excised, and the urethral defect was repaired using a one-layer SIS patch (group I [GI]); four-layer SIS (group II [GII]); or buccal mucosa (group III [GIII]). Urethrography was performed preoperatively and after 12 weeks. After sacrifice, graft retraction was objectively measured using Scion Image(®) computer analysis and by calculation of ellipse area. The grade of fibrosis, inflammatory reaction, vascular/epithelial regeneration, and collagen III/I ratio were analyzed by hematoxylin/eosin and Picrosirius red staining. RESULTS: Urethrography confirmed a wide urethral caliber without any signs of strictures after surgery. Urethral fistulae was diagnosed in 8.3% of cases (1 animal each group). Average graft shrinkage was 55.2% in GI; 44.2% in GII; and 57.2% in GIII (p<0.05). The intensity of chronic inflammation, fibrosis, epithelium regeneration, and neovascularization was similar in all groups (p>0.05). Collagen III/I ratio was higher in GII (GI: 119.6; GII: 257.2 and GIII: 115.0); p<0.01. CONCLUSIONS: The four-layer SIS is more advantageous than the one-layer SIS and buccal mucosa for urethral substitution in rabbits.

[The silicone palatal plaque: an effective bandage after harvesting autogenous hard palate mucosa]. / La plaque palatine en silicone, un pansement efficace après prélèvement d'une greffe muco-palatine.

INTRODUCTION: Autogenous hard palate mucosa is recognized in eyelid surgery for reconstruction of the posterior lamella. Complications such as pain or donor site hemorrhage are due to surgical technique and can reduce the indications for this graft. METHOD: We describe the autogenous hard palate mucosa graft technique and the production of a silicone plaque for the palate. RESULTS: For the three patients studied, the autogenous hard palate mucosal graft was effective in reconstructing the lower eyelid posterior lamella with good functional and aesthetic results. The silicone palatal plaque controlled palatal hemorrhage and pain and accelerated palatal mucosa healing. CONCLUSION: The silicone palatal plaque is an advantageous adjuvant for autogenous hard palate mucosa.

Vocal function following vertical hemilaryngectomy: comparison of four reconstruction techniques in the canine.

The goals of laryngeal reconstruction have been prevention of aspiration, production of a functional voice, and maintenance of an adequate airway for decannulation. A number of procedures for partial laryngeal reconstruction have accomplished these objectives. However, few studies have attempted to compare patients' vocal characteristics following different reconstruction procedures. In this study, an in vivo canine model was used to compare acoustic and aerodynamic measures of vocal function for the following vertical hemilaryngectomy reconstruction techniques: 1) a superiorly based sternohyoid muscle flap, 2) a modified epiglottic laryngoplasty, 3) a new procedure using a layered vascularized buccal mucosal flap and a transversely oriented sternohyoid muscle flap, and 4) hemilaryngeal transplantation combined with arytenoid adduction. Hemitransplantation provided the most efficient phonation of the four techniques. The vascularized buccal mucosa flap produced the best phonation of the autologous tissue techniques examined. Both vascularized buccal mucosa flap and hemilaryngeal transplantation subjects demonstrated a mucosal wave on stroboscopy. The results indicate that vocal function will improve as the layered structure of the vocal fold is more accurately replicated in a reconstructed hemilarynx. Endoscopic findings and whole organ sections are presented.

Chemically separated connective tissue grafts: clinical application and histological evaluation.

Subepithelial palatal connective tissue grafts, separated from the epithelium either chemically (n = 5) or surgically (n = 2) were inserted in patients presenting with gingival recession. Biopsies at the grafted tissue and a portion of non-keratinized mucosa were taken 12 months later. Histology showed keratinization of the newly formed epithelium, and interestingly a deep projection of epithelium into the connective tissue in almost all biopsies, sometimes with an enlargement and a cyst-like space. We conclude that chemical separation of epithelium and connective tissue is clinically feasible for connective tissue grafts and that the subepithelial connective tissue grafting technique should be modified to avoid this projection of epithelium.

Posterior lamellar eyelid reconstruction with a hard palate mucosal graft.

A graft of hard palate mucosa is a satisfactory substitute for the posterior lamella of tarsus and conjunctiva in eyelid reconstruction. The graft may be harvested after administration of local anesthesia in adults, provides structural support as well as a mucosal surface, and contracts minimally. The palatal donor site heals with a minimum of postoperative care. Results in four eyelids with severe cicatricial entropion were satisfactory. The only observed complication was apparent partial keratinization of one graft in a patient with Stevens-Johnson syndrome.