A randomized prospective trial of primary versus AlloDerm closure of buccal mucosal graft harvest site for substitution urethroplasty.

OBJECTIVES: To present a prospective, randomized trial comparing primary and AlloDerm closure of the oral harvest site. The use of buccal mucosa grafts for substitution urethroplasty is an established and durable technique. The optimal management of the buccal mucosa grafts harvest site for the intraoral defect has yet to be determined. METHODS: Between February 2003 and September 2006, a total of 20 men undergoing buccal mucosal urethroplasty were randomly assigned to either primary (n = 10) or AlloDerm closure (n = 10) of the oral harvest site. All patients were clinically examined postoperatively and each completed a 10-point analog pain score and descriptive questionnaire postoperatively, at 3 weeks, and at 3, 6, and 12 months. RESULTS: A 100% of patients completed the study at 12 months follow-up. Oral pain dissipated acutely after 3 weeks. No significant differences in either neurosensory or mouth tightness symptoms were noted, except increased incidence of cheek swelling at 3 weeks in the AlloDerm group. CONCLUSIONS: AlloDerm proved to be an effective means of closing the harvest site, but offered no significant advantages when compared with primary closure. AlloDerm closure was associated with increased morbidity in mouth tightness symptoms, cheek swelling, and discomfort while chewing food; only increased incidence of cheek swelling at 3 weeks was found to be significant. Despite its excellent molecular properties and nonimmunogenic nature, the role of AlloDerm graft use in closing the buccal mucosal harvest site appears to be an unnecessary step. Primary closure was extremely well tolerated in both short- and long-term follow-up, with minimal sequelae at 12 months.

Preliminary report on use of AlloDerm for closure of intraoral defects after buccal mucosal harvest.

The ideal method for managing the intraoral defect after harvesting buccal mucosa for urethral reconstruction has not been clearly established. We describe a novel technique using AlloDerm to cover the harvest site, providing a simple means for a potentially less painful tension-free closure.

Efficacy of high-energy transurethral microwave thermotherapy in alleviating medically refractory urinary retention due to benign prostatic hyperplasia.

OBJECTIVES: To determine the efficacy of high-energy transurethral microwave thermotherapy (HE-TUMT) in treating patients with medically refractory complete urinary retention secondary to benign prostatic hyperplasia (BPH). METHODS: Between April 2000 and July 2003, 39 patients in urinary retention due to BPH were treated with HE-TUMT. A Foley catheter was reinserted after HE-TUMT and removed at 3 weeks for a voiding trial. Patients unable to void were recatheterized, and voiding trials were repeated at 2-week intervals. Patients were evaluated according to history and physical examination, prostate-specific antigen level, prostate volume, cystourethroscopy, International Prostate Symptom Score, quality of life score, peak uroflow, and postvoid residual. Success was defined as the ability to urinate after HE-TUMT without the need for further intervention. RESULTS: The mean (+/- SD) patient age was 72 +/- 9.3 years. Mean follow-up period was 18 +/- 10.2 months. Twenty patients (51%) were characterized as American Society of Anesthesiologists class III or higher. The mean prostate volume was 75.2 +/- 57.6 cm3. The mean length of time that patients were dependent on indwelling Foley catheters before HE-TUMT was 9.6 +/- 14.2 weeks. Thirty-two patients were able to void after HE-TUMT, for an overall success rate of 82%. Patients voiding successfully after HE-TUMT had a mean of 1.6 +/- 0.8 voiding trials and required catheters after HE-TUMT for a mean period of 4.1 +/- 2 weeks. Only 6 (15%) of the patients who were voiding were able to stop their medication for BPH. CONCLUSIONS: We found an encouraging success rate with HE-TUMT in relieving urinary retention in patients with BPH, including those with large prostate volumes. It is an acceptable option for patients who are considered high risk for surgery. Several patients required multiple voiding trials before spontaneous urination, which suggests that improvements in bladder outlet obstruction might require a prolonged period after HE-TUMT. Finally, many patients might require continued use of medications after HE-TUMT.

Ventral onlay buccal mucosal grafts for anterior urethral strictures: long-term followup.

PURPOSE: We present our long-term experience with buccal mucosal grafts, placed ventrally, for the treatment of anterior urethral strictures. MATERIALS AND METHODS: A total of 23 patients with anterior urethral strictures underwent urethral reconstruction using buccal mucosa as a ventral onlay graft, with 18 grafts placed in the bulbar and 5 in the penile urethra. All operations were performed in 1 stage by a single surgeon (NAA). Mean graft length was 4.9 cm (range 3 to 12). International Prostate Symptom Score and uroflowmetry were obtained preoperatively, at 3, 6 and 12 months postoperatively, and annually thereafter. Urethral imaging was obtained preoperatively, at catheter removal and selectively thereafter. RESULTS: Patients were followed for a mean of 50 months (range 17 to 94). Etiology of the strictures was instrumentation (in 9), idiopathic (in 9), prior hypospadias repair (in 2), urethritis (in 2) and trauma (in 1). Of the 23 patients 21 (91%) were previously treated for urethral stricture with a total of 59 procedures (mean 2.8 procedures per patient). Success, defined as normal voiding without any need for subsequent urethral manipulation, was achieved in 20 of 23 patients (87%). A distal anastomotic stricture developed in the remaining 3 patients, each managed with 1 internal urethrotomy. One of these patients continues to require monthly self-dilations. There were no fistulas or clinically perceptible graft sacculations. CONCLUSIONS: With long-term followup our series confirms the durability of ventrally placed buccal mucosal grafts for the treatment of anterior urethral strictures. This proven procedure results in a high success rate with few complications.