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

Esperto, Francesco; Verla, Wesley; Ploumidis, Achilles; Barratt, Rachel; Rocca, Roberto La; Lumen, Nicolaas; Yuan, Yuhong; Campos-Juanatey, Félix; Greenwell, Tamsin; Martins, Francisco E.; Osman, Nadir I.; Riechardt, Silke; Waterloos, Marjan; Dimitropoulos, Konstantinos

doi:10.1007/s00345-021-03803-5

Cited by 8 publications

(5 citation statements)

References 39 publications

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“…Four patients (8.3%) have undergone endoscopic urethrotomy. Median patient's age was 37 [interquartile range (IQR) [30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] years in LS group and 54 (IQR 20-84) years in idiopathic group. Stricture length was 8 (IQR 5-8) cm in LS group and 3 (IQR 2.5-4) cm in idiopathic group.…”

Section: Resultsmentioning

confidence: 99%

“…In this sense, Kulkarni et On the other hand, it prevents the cosmetic and functional deterioration inherent in two-stage surgery (45). A recent systematic review showed that stricture free-rate in patients with LS underwent urethroplasty was 88% vs. 60% for single-stage and staged urethroplasty respectively (46). The recently published EAU-Guidelines on urethral stricture concluded that single-stage BMG urethroplasty provides patency rates between 65 and 100% and is not inferior to staged BMG urethroplasty (47).…”

Section: Discussionmentioning

confidence: 99%

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Does aetiology of urethral stricture influence the survival of the buccal mucosa graft?—comparative study in patients with penile urethral stricture due to lichen sclerosus vs. idiopathic group

Hevia¹,

Fraile²,

Sanz³

et al. 2022

Transl Androl Urol

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Background: Lichen sclerosus (LS) is one of causes of male urethral stricture, mainly penile or anterior urethra, and frequently associated with phimosis. This disease involves penile skin and surrounding tissues, which might affect long-term graft survival after a substitution urethroplasty. The aim of this study is to assess LS impact on urethral grafts, comparing outcomes in the LS group versus idiopathic urethral stricture.Methods: Retrospective descriptive analysis of male patients who underwent urethroplasty with buccal mucosa graft (BMG) at our academic institution during the last decade [2008][2009][2010][2011][2012][2013][2014][2015][2016][2017][2018][2019][2020][2021]. Patients were allocated to LS group or idiopathic group depending on the aetiology of urethral stricture. The LS was confirmed by histology. Data collected included patient baseline characteristics, stricture description, perioperative parameters, surgical technique and outcomes. Kaplan-Meier survival analysis was performed to assess graft survival in both groups, as univariate and multivariate analysis were performed trying to identify independent risk factors for graft survival. Primary outcome was treatment success, defined as the no need for further treatments.Results: Forty-eight male patients underwent substitution urethroplasty, 11 in LS group and 37 in idiopathic group. Baseline characteristics between both groups were different mainly in terms of age and stricture features (length), with larger strictures in LS group (6.8 vs. 3.5 cm). All grafts were procured from buccal mucosa, while no differences in grafts survival were observed between both groups (40.3 vs. months).Mean of patient global impression of improvement (PGI-I) score was 2.1 in LS group vs.2.4 in idiopathic group. Age, aetiology and smoking habit seems to be independent risk factors for graft survival, but not in multivariate analysis.Conclusions: Patients with LS have longer strictures than idiopathic group. No differences were found in graft survival between both groups and independent risk factor for graft survival were not identified.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Does aetiology of urethral stricture influence the survival of the buccal mucosa graft?—comparative study in patients with penile urethral stricture due to lichen sclerosus vs. idiopathic group

Hevia¹,

Fraile²,

Sanz³

et al. 2022

Transl Androl Urol

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“…LS strictures tend to be progressive and recalcitrant in nature with urethroplasty success rates reaching a ceiling of around 70% to 80% in most scenarios. 25,26 In the long term LS strictures may be progressive despite urethroplasty with recurrences regularly identified over 10 years after surgery. 27 These data support LS as an established risk factor for long-term stricture recurrence after urethroplasty.…”

Section: Discussionmentioning

confidence: 99%

Affirming Long-Term Outcomes After Contemporary Urethroplasty: The Adverse Impact of Increasing Stricture Length, Lichen Sclerosus, Radiation, and Infectious Strictures

Calvo,

Fender,

Hoy

et al. 2024

Journal of Urology

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Purpose: There is a paucity of reported long-term outcomes after contemporary urethroplasty. Our objective is to determine the long-term success of modern urethroplasty and identify factors associated with stricture recurrence in this context. Materials and Methods: Patients undergoing urethroplasty from July 2003 to May 2013 with at least 100 months of follow-up were identified. Long-term outcomes including stricture recurrence and patient satisfaction were evaluated by review of regional/provincial electronic records and telephone interview. Urethroplasty failure was defined as a recurrent stricture (<16F) confirmed on cystoscopy. Cox regression was used to evaluate variables associated with longterm stricture recurrence. Results: A total of 733 patients were identified with 100 months follow-up. Median patient age was 45 years, stricture length was 4.7 cm, and 85.8% failed prior endoscopic treatment. At a median follow-up of 12.3 years, 89 recurrences were observed. Cumulative incidence of stricture recurrence was 6%, 10%, and 12% after 1, 5, and 10 years, respectively. From a patient-reported perspective, 89% of patients reported being satisfied with the outcome of surgery. On multivariable analyses, increasing stricture length (HR 1.1, 95% CI 1.05-1.15; P < .001) and stricture etiology (P < .001), in particular lichen sclerosus (HR 4.46, radiation (HR 4.25,, and infectious strictures (HR 5.27, 95% CI 2.03-13.7), were independently associated with stricture recurrence. Conclusions: This study affirms the widely held belief that modern urethroplasty provides high long-term patency and patient-reported satisfaction. Patients with longer strictures as well as those with lichen sclerosus, radiation, and infectious etiologies have a higher hazard of stricture recurrence in the long term.

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“…Although Humby was credited with the first description of oral mucosa during an urethroplasty in 1941 [ 10 ], it was not until 1992, when Bürguer and Dessanti published their studies, which popularized oral tissues for urological reconstruction [ 3 , 11 ]. Following studies on BMG reported long-term urethral patency rates between 75.6% and 92% [ 12 , 13 , 14 , 15 , 16 ], even in panurethral strictures [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Histological Comparison of Buccal and Lingual Mucosa Grafts for Urethroplasty: Do They Share Tissue Structures and Vascular Supply?

Campos-Juanatey

Etxebarria

Hermosa

et al. 2022

JCM

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Comparable outcomes were published using a buccal mucosa graft (BMG) from the cheek and a lingual mucosa graft (LMG) from the sublingual area, for urethral augmentation or substitution. To date, no histological comparison between both grafts has been conducted. We histologically assessed BMG and LMG harvested during urethral surgeries, aiming to compare graft properties and vascular support. We conducted a prospective single cohort study, including oral mucosa urethroplasty patients. During surgery, graft dimensions and donor sites were collected, and a 0.5 × 0.5 cm sample was obtained from the prepared graft. Formalin-fixed paraffin-embedded samples were sliced at 4 micrometres (µm) and hematoxylin-eosin stained. Using a telepathology tool, all slides were digitalized and measured from 10× to 40× magnification. In each graft, global and individual layers thicknesses were assessed, including vascular density and area. Descriptive and comparative (parametrical and non-parametrical) statistical analysis occurred. We collected 57 grafts during 33 urethroplasties, with 30 BMG and 22 LMG, finally, included. The mean age was 56.6 (SD 15.2) years, and the mean graft length was 5.8 (SD 1.7) cm and the width was 1.7 (SD 0.4) cm. The median graft thickness was 1598.9 (IQR 1200–2100) µm, the mean epithelium layer was 510.2 (SD 223.7) µm, the median submucosa was 654 (IQR 378–943) µm. the median muscular was 477.6 (IQR 286–772) µm, the median vascular area was 5% (IQR 5–10), and the median adipose tissue area was 5% (IQR 0–20). LMG were significantly longer and narrower than BMG. Total graft thickness was similar between LMG and BMG, but the epithelium and submucosa layers were significantly thinner in LMG. The muscular layer was significantly thicker in LMG. Vascular density and vascular areas were not significantly different between both types of grafts. LMG showed significantly less adipose tissue compared with BMG. Our findings show LMG and BMG for urethroplasty surgeries share the same thickness and blood supply, despite having significantly different graft sizes as well as mucosal and submucosal layers thickness.

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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

Cited by 8 publications

References 39 publications

Does aetiology of urethral stricture influence the survival of the buccal mucosa graft?—comparative study in patients with penile urethral stricture due to lichen sclerosus vs. idiopathic group

Does aetiology of urethral stricture influence the survival of the buccal mucosa graft?—comparative study in patients with penile urethral stricture due to lichen sclerosus vs. idiopathic group

Affirming Long-Term Outcomes After Contemporary Urethroplasty: The Adverse Impact of Increasing Stricture Length, Lichen Sclerosus, Radiation, and Infectious Strictures

Histological Comparison of Buccal and Lingual Mucosa Grafts for Urethroplasty: Do They Share Tissue Structures and Vascular Supply?

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