Histopathological changes in oral mucosa in cases of failed augmented urethroplasty

Abstract

Objective: Histopathological changes in oral (buccal or lingual) mucosa after exposure to urine are still not completely understood. We evaluated these changes in free oral mucosal graft integrated in human urethra. Material and methods: Total 19 patients with recurrent urethral stricture after oral mucosa urethroplasty (buccal 12 and lingual 7) were prospectively evaluated. Intraoperatively integrated buccal or lingual mucosal graft sample that was previously engrafted to urethra was completely excised along with healthy oral mucosa, and it was sample processed for histopathological evaluation by dedicated pathologist. Preoperative clinical data were properly collected from all the study participants. Results: The mean age of the patients was 30 years, and the mean preoperative peak flow rate was 4.2 mLis. Etiology of initial stricture was idiopathic in 13 (68.42%) patients and traumatic urethral catheterization in 6 (31.58%) patients. Mean interval from previous buccal mucosal urethroplasty to current urethroplasty was 21.9 months (range 12-46 months). On repeat urethroplasty, the mean stricture segment length was 59.2 (38-77) mm [60.08 (38-74.6) mm buccal, and 58.32 (39.6-77) mm lingual]. These integrated oral mucosal grafts maintained their histopathological characteristics in all patients except some kind of changes like submucosal fibrosis in seven (58.33%) cases of buccal and vacuolar degeneration in five (71.42%) cases of lingual mucosal urethroplasty. Conclusion: Histopathological characteristics of integrated oral (buccal and lingual) mucosal grafts were maintained even on exposure to urine except some changes like submucosal fibrosis and vacuolar degeneration. Impact of these changes require further research.