Dorsal onlay lingual mucosal graft urethroplasty for urethral strictures in women

Sharma, Girish Kumar; Pandey, Avantika; Bansal, Harbans; Swain, Sameer; Das, S. N.; Trivedi, Sameer; Dwivedi, US; Singh, Priyanka

doi:10.1111/j.1464-410x.2009.08951.x

Cited by 70 publications

(53 citation statements)

References 23 publications

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“…We chose to use the suprameatal approach because of the ease of incision for urethrolysis and to make access for future anti-incontinence procedure(s) less problematic [ 23 ] . This potential advantage of a dorsal approach has been noted by other authors [ 15,18 ] . In addition, Migliari et al .…”

Section: Discussionsupporting

confidence: 56%

Dorsal vaginal graft urethroplasty for female urethral stricture disease

et al. 2012

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Study Type – Therapy (case series)Level of Evidence 4What's known on the subject? and What does the study add?Female urethral stricture disease has been described for almost 200 years. The symptoms of female stricture disease may range from clinically insignificant to severe and debilitating with the exact aetiology being unclear. No strict criteria for diagnosis have been established with the diagnosis often relying on a combination of presenting symptoms and objective findings. Initial therapy for female urethral stricture disease has often rested on urethral dilatations and self‐intermittent catheterisation with surgery reserved for patients that failed conservative measures. Female urethroplasty currently is a topic of increasing attention with multiple surgical approaches described including use of both grafts (vaginal wall, buccal mucosal membrane, lingual mucosa, and labia minus) and flaps (vaginal vestibule, anterior vagina, and lateral vagina).We describe our approach to female urethroplasty using a suprameatal (dorsal) approach (described by Tsivian and Sidi) with an autologous vaginal epithelium inlay graft. The technique and modern approaches to female urethroplasty are contrasted and discussed. The success of the approach including continence rates and lack of need for long‐term self‐intermittent catheterisation is noted.OBJECTIVE To review the technique and outcomes of using a dorsal vaginal graft to perform urethroplasty for the treatment of urethral strictures in women. PATIENTS AND METHODS This is a retrospective chart review of 11 women who were treated with a dorsal vaginal graft urethroplasty by one surgeon. All women underwent preoperative evaluation that included history, physical examination, fluoro‐urodynamics and urethral calibration. After surgery interviews, physical examinations, and urinary flow and postvoid residual urine volumes (PVRs) were obtained. RESULTS In all, 11 women who had undergone dorsal vaginal graft urethroplasty were identified for review. The mean (range) age was 60.6 (39–75) years. The mean (range) follow‐up was 22.7 (6–46) months. There were no cases of new onset stress urinary incontinence. The mean PVRs before and after surgery were 187.1 mL and 75.8 mL, respectively (P= 0.003). The mean urinary flows before and after surgery were 7.3 mL/s and 21.8 mL/s, respectively (P= 0.001). No patient has required repeat surgery. Self‐reporting satisfaction scores using the Patient Global Impression of Improvement showed that four patients scored 1 (very much better), three scored 2 (much better), two patients scored 3 (a little better), and one scored 4 (no change). Only one patient scored a 5 (worse). CONCLUSION Dorsal graft urethroplasty with vaginal mucosa may be considered as a first‐line option for definitive management of female urethral stricture disease. No consensus exists for the surgical treatment of female urethral stricture disease.

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Section: Discussionsupporting

confidence: 56%

Dorsal vaginal graft urethroplasty for female urethral stricture disease

et al. 2012

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“…Le travail en double équipe, chirurgien oral et chirurgien urologue, permet de diminuer le temps d'intervention, donc d'anesthésie générale, ce qui améliore les suites opératoires. Les indications de prélèvements de muqueuse buccale vont se développer, notamment chez la femme pour le traitement des sténoses uré-trales mais aussi pour le traitement des fistules vésico-vaginales [12]. Une étude de Dublin et Stewart montre que 74 % des patients sont prêts à recommander cette procédure chirurgicale à leurs proches car la morbidité buccale est faible et le résultat urologique est satisfaisant [20].…”

Section: Resultsunclassified

“…Les complications diminuent avec le temps et restent constantes après un an de recul clinique. On retrouve donc 17 % de dysphagie à 6 mois contre 10 % à 1 an, 9 % de dysgueusie à 6 mois contre 3 % à 1 an [12]. Les équipes chinoises justifient les indications des prélèvements bilatéraux sur le bord marginal de la langue, par une faible longueur de la langue des peuples asiatiques en comparaison aux peuples européens et américains [13].…”

Section: Morbidité Du Prélèvement Lingualunclassified

Urétroplastie avec greffe de muqueuse buccale : techniques de prélèvements et complications. Revue de la littérature et rapport d’un cas

Toux¹,

Negra²

2017

Med Buccale Chir Buccale

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Résumé -Introduction : L'urétroplastie avec greffe de muqueuse buccale est la technique de référence pour le traitement des sténoses urétrales récidivantes. La muqueuse buccale est admise comme le gold standard des tissus de remplacements de l'urètre pathologique. La muqueuse buccale est un tissu qui répond aux exigences mécaniques de plasticité, et de résistance aux agressions chimiques de l'urine. Elle a aussi des capacités d'adaptation aux changements morphologiques du pénis. Le choix du site donneur se fait entre la muqueuse labiale, linguale et jugale. Cas clinique : Le cas clinique rapporté a été traité à l'aide de notre technique de référence, l'urétroplastie avec prélèvement jugal. Discussion : La morbidité des trois sites donneurs de la cavité buccale rapportée dans la littérature est abordée. Le prélèvement jugal engendre le moins de morbidité comparativement aux prélèvements labiaux et linguaux. Conclusion : La greffe de muqueuse buccale est admise comme le gold standard dans le traitement de la sténose urétrale par urétroplastie.Abstract -Urethroplasty with buccal mucosa graft: harvesting techniques and complications. Literature review and case report. Introduction: Urethroplasty with a buccal mucosa graft is recognized as the standard procedure for the treatment of urethral stricture. The buccal mucosa is regarded as the gold standard to replace the urethral mucosa. The oral mucosa has the qualities of plasticity and strong resistance to attack by urine. It also adapts well to morphological changes in the penis. Observation: The case reported was treated with our gold standard surgical technique, urethroplasty with oral mucosa harvested from the cheek. Commentary: After an analysis of the technique of buccal harvesting, we discuss the morbidity of the 3 donor sites used in the oral cavity. Conclusion: A graft with the buccal mucosa is currently considered as the gold standard surgical technique for urethroplasty.

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“…Prinzipiell lassen sich dabei 2 Vorgehensweisen unterscheiden, mit denen eine Erweiterung der Urethra erreicht wird: F Urethroplastik unter Verwendung eines gestielten Lappens aus Vaginalschleimhaut [8,9]; F Urethroplastik unter Verwendung eines frei transplantierten Grafts (als freies Graft wird Gewebe wie Wangenschleimhaut [10,11,12], Lingualschleimhaut [13] oder Labium minus [14,15] als Onlay verwendet).…”

Section: Therapieunclassified

“…Das Risiko lässt sich nach derzeitiger Kenntnis bei gleichwertigen funktionellen Ergebnissen durch die Verwendung von Lingualschleimhaut reduzieren [20]. Daher haben Sharma et al dieses Material auch bei Frauen verwendet [13]. In einer Serie mit 15 Patientinnen wurde eine dorsale Onlay-Plastik mit Lingualschleimhaut durchgeführt.…”

Section: Restharnfreie Miktionunclassified

Offene Harnröhrenchirurgie bei der Frau

Tritschler

Roosen

Bastian

et al. 2011

Urologe

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There are only a few disorders of the female urethra which have to be treated by open urethral surgery, urethral diverticula and urethral strictures. These diseases are rare and subsequently open surgery of the female urethra is also rare. However, these surgical techniques are an important part of the surgical armamentarium in urology, because this is the only method to preserve quality of life of patients concerned. Surgical therapy of urethral diverticula includes well-defined procedures, such as marsupialization and diverticula excision. In contrast, there is no established surgical therapy for female urethral strictures. Several suggestions to solve this problem have been made in recent years and will be presented in this article.

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Dorsal onlay lingual mucosal graft urethroplasty for urethral strictures in women

Cited by 70 publications

References 23 publications

Dorsal vaginal graft urethroplasty for female urethral stricture disease

Dorsal vaginal graft urethroplasty for female urethral stricture disease

Urétroplastie avec greffe de muqueuse buccale : techniques de prélèvements et complications. Revue de la littérature et rapport d’un cas

Offene Harnröhrenchirurgie bei der Frau

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