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

Abstract

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.

Keywords

• urethral stricture
• augmentation urethroplasty
• preoperative preparation
• morphological