Buccal mucosa - a viable option for ureteroplasty

593 BUCCAL

MUCOSA

-A VIABLE

OPTION

594 SUBSTITUTION DORSAL URETHROPLASTY PENILE SKIN OR BUCCAL MUCOSA

FOR URETEROPLASTY

Montorsi F., Raber M., Scapatvxl P.

Shah S., Ranka P., Modi P., Visnagra M., Jain R

USING

FREE

E., Naspro R., Salonia A., Zanni G

, Barbagll

GRAFT G., Rigatti

San Raffaele Hospital, Urology, Milan, Italy

IKDRC, Urology, Ahmedabad,

India INTRODUCTION & OBJECTIVES: To compare outcome of recurrent bulbourethral strictures treated with free graft penile skin or buccal mucosa.

INTRODUCTION strictures

& OBJECTIVES:

by a simple procedure

interposition

MATERIAL

To cure long and multiple

without the long-tetm

or surgery of high magnitude

& METHODS:

complication

of bowel

like auto-transplantation.

Ureteric strictures

in five patients were treated

with buccal mucosa onlay grafts with an omental wrap. The underlying was tuberculosis

Ureteric

in four patients (80%) and amyloidosis

etiology

in one patient (20%).

Mean age was 45 years. Three patients (60%) had stricture in upper ureter, one patient (20%) in mid-ureter

and one patient (20%) had panureteric

stricture.

In

all patients length of stricture was greater than 5 cm.

RESULTS: patients

Ureteric

patency

(80%) have persistent

was established improvement

in all patients in renal function.

(100%).

Four

In one patient

MATERIAL & METHODS: From January 1998 to August 2001,25 patients wtth bulbar urethra strictures undetwent urethral reconstruction with preputial patch (I 7 patients) or with buccal mucosa graft (8 patients). Each patient was assessed pre-operatively by means of uroflowmetry, retrograde and dynamic cystography, urinalysis and urinary tract ultrasound; each patient also tilled m pre-operative evaluation tests, which included IPSS and IIEF. All these tests (except for cystography when normal uroflowmetry) were repeated at 3,6 I2 and 24 months follow-up. The catheter was removed after 3 weeks from operation, immediately followed by voiding urethra-cystography and uroflowmetry. Stricture recurrence and the need for further intervention were considered a failure. Chi square and McNemar tests were used to analyse the data. RESULTS: 5 patients (I with buccal mucosa-12.5%, 4 with penile skm graft patch-24%) required further treatment: two were treated with a perineostomy, 3 with internal urethrotomy. Patients mean age was 42 years (I 8-69 yrs) for buccal mucosa and 45 years (28-73 yrs) for preputial patch. All strictures were at the bulbar urethra and single, except for two that were anterior and multiple. Mean stricture length was 2.5 cm (1.5-4 cm). Complications were: lip hypoesthesia (3 patients), retraction of the ventral skin of the penis (I patient), post-voiding dribbling (2 patients). No pre-operative predictive factors for falure or success were found. 6 Preope3 I2 Catheter months months rative removal months

(20%) renal function improved initially (at 6month follow-up) but subsequently (at lyear follow-up)

the unit was non-functioning.

Follow-up

was in the range

of 1.5 year to 3.5 years.

CO_NCLUSIONS:

In selected

patients

with complicated

buccal mucosal patch graft was proved capable of maintaining urinary

drainage.

The

procedure

is technically

simple

ureteric

strictures,

patency and good and

devoid

1 121

CONCLUSIONS: The use of free graft penile skin or buccal mucosa is comparable in

of

terms of results at one-year follow-up; nevertheless urethral reconstruction with preputial patch seems to be associated with a higher percentage of stenotic recurrence and thus the need for further treatment. Three patients that required internal urethrotomy were free from recurrence at 6 months follow-up.

595

596

complications.

RESULTS OF URETHRAL RECONSTRUCTION MUCOSA TRANSPLANT IN PATIENTS PREVIOUSLY FAILED PROCEDURES

0.4 23

IIEF 127

WITH BUCCAL WITH MULTIPLE

COMPLEX

RECONSTRUCTIONS

IN PENILE CANCER

favares J.M., Lima M.V.A.. Silveira R.A.. Filho M.E.T., Fontenele F.J.. Pinheiro W., Silva L.F.G.

Manseck A., Wiessner D., Oehlschlager

S., Hakenberg

O.W., Wirth M.P. IIospital Do Cancer Do Ceara, Uro-Oncologia,

Technical University,

Fortaleza, Brazil

Urology, Dresden, Germany

INTRODUCTION & OBJECTIVES: The therapy of recurrent urethral stricture and hypospadias repair in patients with multiple previous operations remains difficult. Herein we report our results with buccal mucosa urethral repair. MATERIAL & METHODS: From 1995 to June 2002, 65 men with urethral stricture and 4 patients with failure of previous hypospadias repair underwent urethral reconstruction with buccal mucosa. The number of previous operations was 1 - 18(mean 3.5). 36 patients had had previous transurethral surgery only, 16 patients had had open surgery and 17 patients had undergone open and transurethral surgery. 6 of the patients were under ongoing dilatation treatment of the urethra (in 1 case for 46 years). The length of the strictures was between 2 and 17 cm (mean 6 cm). Buccal mucosa was applied ventrally in 42 patients and dorsally in 27 patients. RESULTS: 50 patients had an uneventful follow-up of up to 6.8 years. In 14 patients (20%) recurrent stricture was seen and in 4 patients with up to 5 prior open interventions, tistula and in I patient secondary wound healing occurred. I patient with previous long term dilatation treatment of the urethra developed carcinoma of the urethra one year after surgery at a location different from the buccal mucosa transplant position. Dorsal application of buccal mucosa was successful in 85% and ventral application was successful in 67%. In patients with lor 2 (n=33), 3 or more (n=36) and 5 or more (n=16) previous procedures, recurrent strictures and/or fistula developed in 5133, 13136 and 6116 cases, respectively. CONCLUSIONS: Although the success rate of urethral reconstruction with buccal mucosa decreases considerably with increasing number of previous procedures, the success rate is still about 63% in patients with more than 4 previous urethral operations. Due to the better results of the dorsal transplant, dorsal position of buccal mucosa transplant should be preferred in patients with multiple previous failures in urethral reconstruction.

INTRODUCTION & OBJECTIVES: Cancer of the penis is a neoplasia found frequently in uro-oncological health clinics in our country. When not treated approprtately it causes death in all cases. The main prognostic factor of the disease is the presence or absence of nodal metastases in the groin. The surgical control of these metastases is the most important factor in the improvement of the patients’ survival. The surgical treatment offered for the patients with cancer of the penis results in psycho-social implications and it is necessary, besides the knowledge of the tumoral biology and of the natural history of the disease, when selecting one of the multiple surgical options to attempt to minimize the psychological impact without reducing the oncological results, MATERIAL & METHODS: In the period between October 1999 until September 2002, 16 complex surgical reconstructions were done in our institution in the treatment of penile cancer. Only 02 patients presented with initial lesions and simple procedures were accomplished as partial glandectomia and reconstructions with a preputial flap. In the majority of the cases the patients presented with loco-regionally advanced disease and we used in 10 patient reconstructions with musculofascial cutaneous flap with the muscle tensor fasciae latae with bilateral reconstruction in 02 patients. In 02 cases of advanced disease we used reconstructions with vertical rectus abdominis musculocutaneous and gracilis musculocutaneous flap. 13 patients accomplished external radiotherapy in the postoperative period. RESULTS: The more frequent early complications were formation of prolongated seroma (07 cases), infection of the flap (04 cases) and partial necrosis of the flap (02 cases). We had one death in the early postoperative period for lung thromboembolism. The late follow-up revealed persistent linfedema in 06 cases, local tumoural recidiva in 03 cases, distant metastasis in a vertebral body in 0 I case and death for pelvic recurrence in 0 1 case. CONCLUSIONS: The aggressive surgical reconstructions offers oncologics and aesthetic patients with advanced penile cancer. European

Urology

Supplements

treatment with complex results quite satisfactory in

2 (2003) No. 1, pp. 151