Güneş Mustafa, Altok Muammer, Özmen Özlem, Umul Mehmet, Güneş Alime, Baş Ercan, Özyildiz Zafer, Sönmez Tolga Taha, Orhan Hikmet
Department of Urology, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey.
Department of Urology, Faculty of Medicine, Süleyman Demirel University, Isparta, Turkey.
Urology. 2017 Apr;102:240-246. doi: 10.1016/j.urology.2016.10.061. Epub 2016 Dec 19.
To investigate the results of penile urethral reconstruction using amniotic membrane (AM) and buccal mucosa (BM) grafts, and the simultaneous use of both in a rabbit model.
A total of 28 male rabbits were divided into 4 groups according to grafting style: group 1 (AM), group 2 (BM), group 3 (BM + AM), and group 4 (sham). A standardized urethral defect was created in the 3 initial groups. The sham group underwent only a ventral vertical urethral incision and primary re-suturation. AM grafts were used in group 1, and BM grafts were used in groups 2 and 3. AM grafts were affixed to the BM grafts in group 3 as a covering tissue. Urethrography and endoscopy were performed after the 1st and 2nd months of grafting. The penises were subjected to histopathologic and immunohistochemical assessment for fibroblast growth factor and vascular endothelial growth factor expression.
Dehiscence and fistula developed in group 1, whereas 2 fistulas were observed in group 2. No complications developed in group 3. Epithelization at urethras was observed at 4 weeks in all groups, but transformation to urothelial epithelialization occurred at 8 weeks. Marked amelioration and epithelial transformation were observed in group 3. The most prominent fibroblast growth factor expression was observed in group 3. Vascular endothelial growth factor expression was completely negative in group 3 at 8 weeks, indicating complete healing.
The simultaneous use of AM and BM for ventral onlay penile urethroplasty provides better tissue healing and lower complication rates in comparison to BM alone. Further animal studies or clinical applications are needed.
在兔模型中研究使用羊膜（AM）和颊黏膜（BM）移植物进行阴茎尿道重建的结果，以及两者同时使用的情况。
根据移植方式将28只雄性兔分为4组：第1组（AM）、第2组（BM）、第3组（BM + AM）和第4组（假手术组）。在最初的3组中制造标准化尿道缺损。假手术组仅进行腹侧垂直尿道切开和一期重新缝合。第1组使用AM移植物，第2组和第3组使用BM移植物。第3组将AM移植物作为覆盖组织固定在BM移植物上。移植后第1个月和第2个月进行尿道造影和内镜检查。对阴茎进行组织病理学和免疫组织化学评估，以检测成纤维细胞生长因子和血管内皮生长因子的表达。
第1组出现裂开和瘘管，而第2组观察到2个瘘管。第3组未出现并发症。所有组在4周时均观察到尿道上皮化，但在8周时转变为尿路上皮化生。第3组观察到明显改善和上皮化生。第3组成纤维细胞生长因子表达最为显著。第3组在8周时血管内皮生长因子表达完全阴性，表明完全愈合。
与单独使用BM相比，同时使用AM和BM进行腹侧覆盖阴茎尿道成形术可提供更好的组织愈合和更低的并发症发生率。需要进一步的动物研究或临床应用。
