Histopathological Characteristics of Buccal Mucosa Transplants in Humans after Engraftment to the Urethra: A Prospective Study

TY - JOUR

T1 - Histopathological Characteristics of Buccal Mucosa Transplants in Humans after Engraftment to the Urethra: A Prospective Study

AU - Soave, Armin

AU - Steurer, Stefan

AU - Dahlem, Roland

AU - Rink, Michael

AU - Reiss, Philipp

AU - Fisch, Margit

AU - Engel, Oliver

N1 - Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

PY - 2014/12/1

Y1 - 2014/12/1

N2 - PURPOSE: Histopathological changes in buccal mucosa transplants after engraftment to the urethra and exposure to urine remain nebulous. We investigated histopathological changes in buccal mucosa transplants integrated into the urethra in humans.MATERIALS AND METHODS: We prospectively evaluated 22 patients with recurrent urethral stricture after buccal mucosa urethroplasty between November 2012 and October 2013. All patients underwent repeat buccal mucosa urethroplasty performed by a single surgeon. Intraoperatively we harvested a sample of the integrated buccal mucosa transplant previously engrafted to the urethra, a sample of healthy urethra, a sample of freshly harvested buccal mucosa from the contralateral inner cheek and a sample of fibrotic tissue from the area of the current stricture. A dedicated uropathologist performed meticulous histopathological examination of all tissue samples using hematoxylin and eosin staining. Preoperative clinical data were also collected on all patients.RESULTS: The mean interval from previous to current buccal mucosa urethroplasty was 22.2 months (range 4.1 to 76.0). Mean stricture length at repeat urethroplasty was 52.7 mm (range 30.0 to 70.0). Histopathological characteristics of the integrated buccal mucosa transplants were completely preserved in all patients, consisting of thick sheets of stratified nonkeratinized squamous epithelium with a stratum spinosum. Transplants were not partially or entirely overgrown with urothelium.CONCLUSIONS: Buccal mucosa transplants retain their histopathological characteristics and are not overgrown with urothelium after urethral engraftment and urine exposure in humans. These findings may explain the superiority of buccal mucosa transplants on the outcome of substitution urethroplasty compared to that of other materials.

AB - PURPOSE: Histopathological changes in buccal mucosa transplants after engraftment to the urethra and exposure to urine remain nebulous. We investigated histopathological changes in buccal mucosa transplants integrated into the urethra in humans.MATERIALS AND METHODS: We prospectively evaluated 22 patients with recurrent urethral stricture after buccal mucosa urethroplasty between November 2012 and October 2013. All patients underwent repeat buccal mucosa urethroplasty performed by a single surgeon. Intraoperatively we harvested a sample of the integrated buccal mucosa transplant previously engrafted to the urethra, a sample of healthy urethra, a sample of freshly harvested buccal mucosa from the contralateral inner cheek and a sample of fibrotic tissue from the area of the current stricture. A dedicated uropathologist performed meticulous histopathological examination of all tissue samples using hematoxylin and eosin staining. Preoperative clinical data were also collected on all patients.RESULTS: The mean interval from previous to current buccal mucosa urethroplasty was 22.2 months (range 4.1 to 76.0). Mean stricture length at repeat urethroplasty was 52.7 mm (range 30.0 to 70.0). Histopathological characteristics of the integrated buccal mucosa transplants were completely preserved in all patients, consisting of thick sheets of stratified nonkeratinized squamous epithelium with a stratum spinosum. Transplants were not partially or entirely overgrown with urothelium.CONCLUSIONS: Buccal mucosa transplants retain their histopathological characteristics and are not overgrown with urothelium after urethral engraftment and urine exposure in humans. These findings may explain the superiority of buccal mucosa transplants on the outcome of substitution urethroplasty compared to that of other materials.

KW - Adult

KW - Aged

KW - Humans

KW - Middle Aged

KW - Mouth Mucosa

KW - Prospective Studies

KW - Urethra

KW - Urethral Stricture

KW - Urologic Surgical Procedures, Male

KW - Young Adult

U2 - 10.1016/j.juro.2014.06.089

DO - 10.1016/j.juro.2014.06.089

M3 - SCORING: Journal article

C2 - 24998481

VL - 192

SP - 1725

EP - 1729

JO - J UROLOGY

JF - J UROLOGY

SN - 0022-5347

IS - 6

ER -