DOI: http://dx.doi.org/10.18203/2349-2902.isj20201546

Practice of the use of oral mucosa graft urethroplasty among Nigerian urologists

Ngwobia P. Agwu, Ahmed M. Umar

Abstract


Background: Urethral stricture is an ancient disease that has plagued men. Management of this disease has been evolving due to advances in technology and better understanding of the pathogenesis. Use of oral mucosal grafts for substitution urethroplasty has been gaining world-wide acceptance and application by urologists. This article examines the of application of this urethral substitute among Nigerian urologists.

Methods: This was a questionnaire-based study administered to urologists during the annual general meeting and scientific conference.

Results: Forty two respondents completed the questionnaire and comprised of 41 (97.6%) males and 1 (2.4%) female. There were 24 (57.1%) consultants, senior registrars and others 4 (9.6%). Thirty three (78.6%) of the respondents had practised for less than 10 years. Region of practice in Nigeria were 13 (31%) in South-west, 5 (11.9%) in South-East, 3 (7.1%) in South -South, 9 (21.4%) in North-West, 10 (23.8%) in North-central and 2 (4.8%) in North-East. Annual volume of urethroplasty was less than 10 in 19 (45.2%) and only 3 (7.1%) performed more than 30 urethroplasties. Place of practice was mainly in the University Teaching Hospital 33 (78.6%). Oral mucosa grafts (OMGs) used either alone or in combination with penile flaps was used by 30 (71.4%) respondents while 11 (26.2%) used only penile skin flaps. Up to 10 (23.8%) of the respondents indicated desire to undergo training on the use of OMG for urethral reconstruction.

Conclusions: Use of OMG is accepted by Nigerian urologists, however application is limited by low annual urethroplasty volume and lack of training.


Keywords


Practice, Oral mucosa grafts, Urethroplasty

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References


Jordan G, Chapple C, Heynes C. Urethral strictures. An International Consultation on Urethral strictures, Available at: https://www.siu-urology.org/ themes/web/assets/files/ICUD/pdf/urethral_strictures_2010.pdf. Accessed on October 16 2010.

Blandy JP. Urethral Stricture. Postgraduate Med J. 1980;56:383-418.

Das S. Urology in ancient India. Indian J Urol. 2007;23:2-5.

Hampson LA, McAninch JW, and Breyer BN. Male urethral strictures and their management. Nat Rev Urol. 2014;11:43-50.

Vanni AJ. New frontiers in urethral reconstruction: Injectables and alternative grafts. Transl Androl Urol. 20015;4(1): 84-91.

Cheng L, Li S, Wang Z, Huang B, Lin J. A brief review on anterior urethral strictures. Asian J Urol. 2018;5:88-93.

Hillary CJ, Osman NI, Chaple CR. Current trends in urethral stricture management. Asian J Urol. 2014;1(1):46-54.

Stein MJ and De Souza RA. Anterior urethral Stricture Review. Transl Androl Urol. 2013;2(1):32-8.

Mungadi IA, Mbibu HN. Current concepts in the management of anterior urethral stricture. Nigerian J Surgical Res. 200;8:103-10.

Pal DK, Kumar S, Ghosh B. Direct visual internal urethrotomy: Is it a durable treatment option. Urol Ann. 2017;9:18-22.

Das SK, Jana D, Gosh B, Pal DK. A comparative study between the outcomes of visual internal urethrotomy for short segment anterior urethral strictures done under spinal anaesthesia and local anaesthesia. Turk J Urol. 2019;45:33-46.

Al-Dabbagh A, Dahla ZF. The role of internal optical urethrotomy in treatment of male urethral stricturea. Open J Urol. 2018;8:327-35.

Al-Taweel W, Seyam R. Visual internal urethrotomy for adult male urethral stricture has poor long-term results. Adv Urol 2005;2015:656459.

Akyüz M, Tokuç E, Özsoy E, Koca O, Kanberoğlu H, Öztürk M, et al. Characteristics of the urethroplasty and our approach- Experience in patients with urethral stricture. Turk J Urol. 2019;45(4):307-11.

Suh J-G, Choi WS, Paick J-S, Kim SW. Surgical outcome of excision and end-to-end anastomosis for bulbar urethral strictures. Korean J Urol. 2013;54:442-7.

Jeong HJ. Perineum-based pediculated scrotal flap for reconstructive urethral surgery. Int Neuro Urol J. 2012;16:96-9.

Goel A, Kumar M, Singh M. Orandi flap for penile urethralstricture: Polishing the gold standard. Can Assoc J. 2015;9:160-3.

Wang X, Zeng X, Chen R, Wang T, Hu J, Wang S, et al. Free bladder mucosa graft harvested by water jet: A novel minimally invasive technique for urethral reconstruction. Exp Therap Med. 2018;16:2251-6.

Xu Y-M, Qiao Y, Sa Y-L, Zhang J, Fu Q, Song L-J. urethral reconstruction using colonic mucosa graft for complex strictures. J Urol. 2009;182:1040-3.

Mathur RK, Sharma AK and Odiya S. Tunica albuginea urethroplasty for anterior stricture: A urethroscopic analysis. Int Urol. 2009;16:751-5.

Foiquinos RC, Calddo AA, Janio R, Griz A, Macedo Jr A, Ortiz V. The tunica vaginalis dorsal graft urethroplasty: Initial experience. Int Braz J Urol. 2007;33:523-31.

Rao SN, Khattar N, Akhtar A, Goel H, Varshney A, Sood R. Everted saphenous vein graft for long anterior urethral strictures in men with tobacco-exposed oral mucosa: A prospective non-randomized study. Indian J Urol. 2019;35:134-40.

Liu Y, Zhuang L, Ye W, Ping P, Wu M. One stage dorsal inlay oral mucosa graft urethroplasty for urethral stricture. Bb MC Urol. 2014;14:35.

Selim M, Salem S, El Sherif E, Badawy A, Elshazely M, Gawish M. Outcome of staged buccal mucosa graft for repair of long segment anterior urethral stricture. BMC Urol. 2019;19:38.

Markiewivz MR, Lukose MA, Margorone III JE, Barbagli G, Miller KS, Chuang SK. Oral Mucosa Graft: Systematic review. J Urol. 2007;165:1131-4.

Bhargava S and Chaple CR. Is buccal mucosa graft urethroplasty the new gold standard? BJU Int. 2004;93:1191-3.

Eshiobo I, Ehizomen E, Omosege F, Onuorah V. Buccal mucosal graft urethroplasty for proximal bulbar stricture: A revist of the surgical technique and analysis of eleven consecutive cases. Niger Med J. 2016;57:266-71.

Ajape AA, Kuranga SA, Olanipekun HB, Mohammed TO. A novel slit-integration method of graft urethroplasty in prevention of recurrence: short term results of a pilot study. Investig Clin Urol. 2019;60:319-25.

Thomas K, Satzman A, Hebert K, Montgomery M. Work-Life Integration of female urologists. Urology Pract. 2018;5:143-9.

Stringer L, Morris H, Li Gan AM, Sener A. Assessing gender trends in Canadian urology. Can Urol Assoc J. 2019;13(12):3937.

Anderson K, Tennankore K, Cox A. Trends in the training of female urology residents in Canada. Can Urol Assoc J. 2018;12(3);105-11.

Oranusi CK, Nwofor AME, Orakwe JC. Urethroplasty Practices among Reconstructive Urologists in Nigeria. Niger J Surg. 2015;21:146-50.

Almannie RM, Alshahabibi AI. Management of urethral stricture: A nation-wide survey of urologists in the Kingdom of Saudi Arabia. Urol Ann. 2018;10:363-8.

Anger JT, Buckley JC, Santucci RA, Elliot SP, Saigal CS et al. Trends in stricture management among male Medicare beneficiaries: Underuse of urethroplasty? Urology 2011;77:481-5.

Ahmed A, Kalayi GD. Urethroplasty at Ahmadu Bello University Zaria. East Afr Med J. 1997;74(4):225-57.

Oguike T C, Onuora V C and Obarisigbon E. The Changing Pattern Of Urethral Stricture Disease In Midwestern Nigeria. J Biomed Sci. 2006;5(2):50-4.

Mungadi IA and Ugboko VI. Oral Mucosa grafts for urethral reconstruction. Annals African Med. 2009;8:203-9.

Ismaila A, Mungadi, Agwu NP. Oral Mucosa Graft, Skin Grafts - Indications, Applications and Current Research, Marcia Spear, IntechOpen, Available at: https://www.intechopen.com/books/skin-grafts-indications-applications-and-current-research/oral-mucosa-graft. Accessed on 3 June 2019.

Kulkarni SB, Barbgali G, Sansalone S and Joshi PM. Harvesting oral Mucosal Grafts for one-stage anterior urethroplasty. Indian J Urol 2014;30(1):117-21.