Barbagli_EU_Genito.qxp 25/2/08 12:54 pm Page 32
Urological Surgery
is wetted with a few drops of lemon juice to stimulate best site from which to harvest substitute material for use in
the salivary glands and to be sure that the Wharton’s duct is fully open. reconstructing the urethra. The superiority of one site (cheek, lip or
During the hospital stay, the urologist and the oral surgeon visit the tongue) over another has not yet been clearly defined. The urologist
patient twice daily. The patients are asked to return to the hospital each
week for outpatient follow-up visits by the urologist and oral surgeon.
Subsequently, the patients return to the hospital once monthly for four
months for outpatient follow-up visits by the urologist and oral surgeon.
The tongue seems to represent a
reliable alternative site to the lip when
All patients are examined by the oral surgeon to determine salivatory
activity and the presence of any disturbances in food tasting, kissing,
cheek harvesting is not possible or a
speaking and swallowing.
thin graft is required.
The advantages of harvesting the graft from the tongue are:
• it is readily available from all patients; must be familiar with all of the various surgical techniques in order to
obtain an ideal graft that is suitable for whatever condition of the
• it is possible to harvest two grafts; urethra presents itself during surgery.
• the donor site scar is concealed; Oral mucosa is architecturally similar to the stratified squamous
epithelium of the penile and glanular urethra, making it exceptionally
• the harvesting procedure is quick and simple; and adaptable for urethral substitution.
15
The mouth is a formidable source of
substitute mucosal material for urethroplasty.
15
However, grafts coming
• the graft harvested from the tongue is ideal for any urethroplasty from the cheek, lip or tongue present different characteristics. They
requiring a single small, thin graft and is a good alternative to should be used according to the type of urethroplasty being performed
lip harvesting. and the characteristics of the urethral plate in relation to the stricture.
Post-operative Care The lingual mucosal graft is more similar to the graft harvested
Initially, the patient consumes a clear liquid diet and ice cream before from the lower lip than to the graft harvested from the cheek. In adult
advancing to a soft and then a regular diet. The patient ambulates on patients, we rarely use a graft from the lip as we have experienced
negative aesthetic consequences: none of our patients were satisfied
with the procedure performed using grafts from this site. Based on the
All patients are examined by the
lingual mucosal graft characteristics, the tongue will be used as an
alternative donor site to the lip in our future surgical activity. However,
oral surgeon to determine salivatory
the cheek is still an irreplaceable donor site for any kind of one-stage
activity and the presence of any
bulbar onlay graft urethroplasty or for the two-stage urethroplasty. In
these cases, abundant and resistant graft material is required to
disturbances in food tasting, kissing,
replace a diseased penile or bulbar urethra.
6–9
speaking and swallowing.
Unfortunately, some patients who underwent buccal mucosal graft
urethroplasty showed stricture recurrence and required new graft
the first post-operative day and is discharged from the hospital three procedures.
9
In these patients, urologists should consider the tongue
days after surgery. All patients remain on oral antibiotics until the as an alternative donor site. The tongue seems to represent a reliable
catheter is removed. alternative site to the lip when cheek harvesting is not possible or a
thin graft is required. The surgical technique for harvesting single or
In conclusion, surgical treatment of urethral stricture diseases is a double oral grafts from the mouth is simple, safe and reproducible by
continually evolving process. Currently, there is controversy over the any surgeon. There are no significant post-operative complications. ■
1. Markiewicz MR, Lukose MA, Margarone J, et al., The oral 6. Bracka A, Hypospadias repair: the two-stage alternative, Br J with urethral plate incision (Snodgrass) for hypospadias
mucosal graft: a systematic review, J Urol, 2007;178:387–94. Urol, 1995;76:31–41. salvage, BJU Int, 1999;83:508–9.
2. Simonato A, Gregori A, Lissiani A, et al., The tongue as an 7. Venn SN, Mundy AR, Urethroplasty for balanitis xerotica 13. Asopa HS, Garg M, Singhal GG, et al., Dorsal free graft
alternative donor site for graft urethroplasty: a pilot study, obliterans, Br J Urol, 1998;81:735–7. urethroplasty for urethral stricture by ventral sagittal
J Uro, 2006;175:589–92. 8. Depasquale I, Park AJ, Bracka A, The treatment of balanitis urethrotomy approach, Urology, 2001;58:657–9.
3. Morey A, McAninch JW, Technique of harvesting buccal mucosa xerotica obliterans, BJU Int, 2000;86:459–65. 14. Gupta NP, Ansari MS, Dogra PN, et al., Dorsal buccal mucosal
for urethral reconstruction, J Urol, 1996;155:1696–7. 9. Barbagli G, De Angelis M, Palminteri E, et al., Failed graft urethroplasty by a ventral sagittal urethrotomy and
4. Barbagli G, Palminteri E, De Stefani S, et al., Harvesting buccal hypospadias repair presenting in adults, Eur Urol, minimal-access perineal approach for anterior urethral stricture,
mucosal grafts. Keys to success, Contemp Urol, 2006;18(3): 2006;49:887–95. BJU Int, 2004;93:1287–90.
16–24. 10. Wessells H, Ventral onlay graft techniques for urethroplasty, 15. Markiewicz MR, Margarone E, Barbagli G, et al., Oral mucosa
5. Wood ND, Allen SE, Andrich DE, et al., The morbidity of buccal Urol Clin N Am, 2002;29:381–7. harvest: an overview of anatomic and biologic considerations,
mucosal graft harvest for urethroplasty and the effect of non- 11. Barbagli G, Palminteri E, Lazzeri M, Dorsal onlay techniques for EAU-EBU Update Ser (EEUS),2007;5:179–87.
closure of the graft harvest site on postoperative pain, J Urol, urethroplasty, Urol Clin N Am, 2002;29:389–95.
2004;172:580–83. 12. Hayes MC, Malone PS, The use of a dorsal buccal mucosal graft
32 EUROPEAN GENITO-URINARY DISEASE 2007
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