Is there a feasibility of pharmacotherapeutic preparation of the oral mucosa for augmentation urethroplasty?

Introduction. Augmentation urethroplasty using buccal mucosa is currently the optimal method for treating extended urethral strictures. However, this surgery is associated with a fairly high frequency of relapses and complications. One of the reasons that can determine the success or negative outcome of surgery is the morphological structure of the graft, which requires more in-depth research.

Purpose of the study. To evaluate the initial morphological state of the buccal mucosa in men and determine the feasibility of its pharmacotherapeutic preparation as a predictor of improving the quality of autograft engraftment in augmentation urethroplasty.

Materials and methods. The morphological structure of buccal mucosa fragments was studied in 20 patients with extended strictures of the spongy urethra. The objects of morphological research were intact oral mucosa before augmentation urethroplasty (1 biopsy) and mucosal fragments after 7 days of oral treatment with «Listerine» antiseptic solution (2 biopsies). The biopsy material was examined microscopically using standard staining (hematoxylin-eosin) and immunohistochemical methods.

Results. The initial histological structure of the buccal mucosa in every third patient was accompanied by inflammatory infiltration at the level of the subepithelial layer with desquamation of the epithelium. a pronounced increase and strengthening of intercellular contacts in grafts proved histologically and immunohistochemically, which was characterized by pronounced expression of antibodies throughout the thickness of the epithelial layer, after week-long handling of the oral cavity with an antiseptic. At the same time, there is a «self-organization» of the submucosal base by reducing oedema, strengthening intercellular and focal adhesion contacts, with an increase in the components of the vascular bed and the number of vascular «plumules».

Conclusion. Thus, a week-long preoperative treatment of the oral cavity allows stopping damage to the epithelium and inflammatory infiltration in the submucosal base with an improvement in its vascularization, which can be regarded as a positive factor for subsequent graft implantation.

1. Stein DM, Thum DJ, Barbagli G, Kulkarni S, Sansalone S, Pardeshi A, Gonzalez CM. A geographic analysis of male urethral stricture aetiology and location. BJU Int. 2013;112(6):830-834. DOI: 10.1111/j.1464-410X.2012.11600.x

2. Sinelnikov L.M., Protoschak V.V., Shestaev A.Y., Karpuschenko E.G., Yantsev A.A. Urethral stricture: modern state of the problem. Literature review. Experimental and clinical urology. 2016;(2):80-87. (In Russ.). eLIBRARY ID: 29899545

3. Kogan M.I., Mitusov V.V., Ametov R.E. Effect of surgical treatment of long and multifocal male urethral stricture (clinical and statistical analysis). Urology Herald. 2013;(1):46-53. (In Russ.). DOI: 10.21886/2308-6424-2013-0-1-46-53

4. Browne BM, Vanni AJ. Use of Alternative Techniques and Grafts in Urethroplasty. Urol Clin North Am. 2017;44(1):127-140. DOI: 10.1016/j.ucl.2016.08.003

5. Horiguchi A. Substitution urethroplasty using oral mucosa graft for male anterior urethral stricture disease: Current topics and reviews. Int J Urol. 2017;24(7):493-503. DOI: 10.1111/iju.13356

6. Levy ME, Elliott SP. Graft Use in Bulbar Urethroplasty. Urol Clin North Am. 2017;44(1):39-47. DOI: 10.1016/j.ucl.2016.08.009

7. Hillary CJ, Osman NI, Chapple CR. Current trends in urethral stricture management. Asian J Urol. 2014;1(1):46-54. DOI: 10.1016/j.ajur.2015.04.005

8. Barbagli G, Balo S, Montorsi F, Sansalone S, Lazzeri M. History and evolution of the use of oral mucosa for urethral reconstruction. Asian J Urol. 2017;4(2):96-101. DOI: 10.1016/j.ajur.2016.05.006

9. Kogan M.I., Dementieva I.Yu., Mitusov V.V., Glukhov V.P., Kra-sulin V.V., Sizyakin D.V., Il'yash A.V. Histopathological evaluation of the evolution of oral mucosa grafts used for augmentation urethroplasty. Urology. 2018;(5):64-68. (In Russ.). DOI: 10.18565/urology.2018.5.64-68

10. Pathak HR, Jain TP, Bhujbal SA, Meshram KR, Gadekar C, Parab S. Does site of buccal mucosa graft for bulbar urethra stricture affect outcome? A comparative analysis of ventral, dorso-lateral and dorsal buccal mucosa graft augmentation urethroplasty. Turk J Urol. 2017;43(3):350-354. DOI: 10.5152/tud.2017.30771

11. Kogan M.I., Glukhov V.P., Mitusov V.V., Krasulin V.V., Il'yash A.V. Comparative analysis of one- and two-stage augmentation urethroplasty with dorsal inlay buccal graft for extended strictures of spongious urethra. Urology. 2018;(1):84-91. (In Russ.) DOI: dx.doi.org/10.18565/urology.2018.1.84-90

12. Polyakov N.V., Keshishev N.G., Kazachenko A.V., Trofim-chuk A.D., Chernyshev I.V., Darenkov S.P., Apolikhin O.I. The effectiveness of buccal urethroplasty for urethral strictures in men. (Review). Experimental and clinical urology 2019;(4):106-113. (In Russ.) DOI: 10.29188/2222-8543-2019-11-4-106-113

13. Robine E, Rigaud J, Luyckx F, Le Clerc QC, Madec FX, Bouchot O, Branchereau J. Analyse des taux de succes des uretroplas-ties pour stenoses de l'uretre bulbaire chez l'homme adulte : revue systematique de la litterature [Analysis of success rates of uretroplasty for adult male bulbar urethral stricture: A systematic review]. Prog Urol. 2017;27(2):49-57. DOI: 10.1016/j.purol.2016.12.003

14. Liu JS, Dong C, Gonzalez CM. Risk Factors and Timing of Early Stricture Recurrence After Urethroplasty. Urology. 2016;95:202-207. DOI: 10.1016/j.urology.2016.04.033

15. Javali TD, Katti A, NagarajHK. Management of recurrent anterior urethral strictures following buccal mucosal graft-urethroplasty: A single center experience. Urol Ann. 2016;8(1):31-35. DOI: 10.4103/0974-7796.162217

16. Spilotros M, Sihra N, Malde S, Pakzad MH, Hamid R, Ockrim JL, Greenwell TJ. Buccal mucosal graft urethroplasty in men-risk factors for recurrence and complications: a third referral centre experience in anterior urethroplasty using buccal mucosal graft. Transl Androl Urol. 2017;6(3):510-516. DOI: 10.21037/tau.2017.03.69

17. Selim M, Salem S, Elsherif E, Badawy A, Elshazely M, Gawish M. Outcome of staged buccal mucosal graft for repair of long segment anterior urethral stricture. BMC Urol. 2019;19(1):38. DOI: 10.1186/s12894-019-0466-4

18. Soave A, Steurer S, Dahlem R, Rink M, Reiss P, Fisch M, Engel O. Histopathological characteristics of buccal mucosa transplants in humans after engraftment to the urethra: a prospective study. J Urol. 2014;192(6):1725-1729. DOI: 10.1016/j.juro.2014.06.089

19. Cavalcanti AG, Restrepo CF, Simoes M, Costa WS, Sampaio FJB, de Souza DB. What Is the Best Way to Prepare A Buccal Mucosa Graft for Urethroplasty? A Histology-Based Preliminary Report. Urol Int. 2018;100(4):397-401. DOI: 10.1159/000488805

20. Bhattar R, Yadav SS, Tomar V. Histopathological changes in oral mucosa in cases of failed augmented urethroplasty. Turk J Urol. 2019;45(3):206-211. DOI: 10.5152/tud.2019.67435

21. Alsarhan M, Alnofaie H, Ateeq R, Almahdy A. The Effect of Chlorhexidine and Listerine® Mouthwashes on the Tensile Strength of Selected Absorbable Sutures: An In Vitro Study.