Oral mucosa grafts for urethral reconstruction

Abstract

Background: Urethral reconstruction has continued to present formidable and enormous challenges for urologic, paediatric and plastic surgeons as diverse opinions have been expressed on the quality and type of ideal substitution material. This literature review is aimed at drawing attention of surgeons to the versatile nature of oral mucosal grafts. Methods: A review of the utilization of oral mucosa in urethral reconstruction was made. Structured Medline search was performed looking at all aspects of utilization of oral mucosa including mucosal harvest, donor site morbidity and outcome. Results: The unique demands of the urethra set a high standard for autogenous graft substitutes; hence literature reports reveal that split and full thickness skin grafts from the scrotum, penis, extragenital sites (ureter, saphenous vein, appendix, colon, medial upper arm, neck, lateral chest, abdomen, bladder mucosa) and more recently oral mucosa have been used. Unlike other tissues, oral mucosa grafts are fl exible, easy to harvest and trim and have an excellent microvasculature favorable for graft-taking. Furthermore, the natural moist location of the oral mucosa in the oral environment favours its easy adaptability in the urethral passage thus giving good long-term results. However, there are reports of complications at the donor site with the commonest being anaesthesia or paraesthesia of the cheek or lips. Regional variations of the oral mucosa, length of the graft required, the decision to close or leave donor site open and harvesting technique are some of the factors suggested to account for differences in donor site morbidity. Conclusion: Oral mucosal graft is a versatile urethral substitute with excellent outcome. It is becoming the gold standard for urethral substitution.

A Retrospective Evaluation of Challenges in Urethral Stricture Management in a Tertiary Care Centre of a Poor Resource Community

“…Urethral stricture is one of the oldest and commonest urological problems treated by urologists; it has remained a major challenge till date (2). Prevalence of urethral stricture among people of poor socio-economic status is noted in our environment: four of five of our patients were either dependent, unemployed or under employed, while one of five remained untreated due to lack of fund.…”

“…Although it is one of the oldest known urological diseases, it constitutes a significant workload for urologists globally with attendant high morbidity (1, 2). Its management has continued to present a formidable and enormous challenge to urologic surgeons (3).…”

“…Poor awareness, late presentation, and persistence of rare complications have beguiled the management of urethral stricture in most African nations (2). …”

Epithelial–Mesenchymal Interactions as a Working Concept for Oral Mucosa Regeneration

“…Clinical uses for a tissue-engineered mucosa graft include not only intraoral defects, 13 such as repair of acquired or congenital oral mucosal defects, 14 but also the reconstruction of the cornea, 15 eyelids, conjunctiva, 16 esophagus, 17 trachea, 18 bladder, 19 urethra, 19 or vagina. 20 Other potential uses of tissue-engineered mucosa grafts are in vitro models to study the biology and pathology 21 and as a vehicle for delivery and expression of transduced genes.…”

Oral Mucosa Graft

“…These regional differences exist in the nature of the submucosa, the morphology of the epithelial-connective tissue boundary the composition of the lamina propria, the thickness of the epithelium and the type of keratinization (Mungadi & Ugboko, 2009). …”