Department of Urology, Columbia University Irving Medical Center, New York, New York.
Department of Urology, Baylor College of Medicine, Houston, New York.
J Urol. 2021 Sep;206(3):655-661. doi: 10.1097/JU.0000000000001829. Epub 2021 Apr 27.
Previous studies have elucidated the unique macroscopic and histological properties of buccal mucosa that make it a viable and durable graft for urethral augmentation. However, no prior literature has directly investigated the impact of preoperative oral health on these features.
We analyzed all consenting patients who underwent buccal mucosal graft (BMG) urethroplasty at our institution from 2018 to 2020. Validated oral health surveys, the Oral Health Impact Profile (OHIP-14) and the Kayser-Jones Brief Oral Health Status Examination (BOHSE) were completed preoperatively. A staff pathologist analyzed BMG histology and quantified oral mucositis using a modified Oral Mucosa Rating Scale.
We analyzed 51 patients with a median age of 40 years (IQR 31-58). Mean BOHSE score was 1.1 and OHIP-14 score was 1.4. Median epithelial thickness was 530 μm and lamina propria thickness was 150 μm. On age-adjusted analysis, increasing BOHSE and OHIP-14 were associated with decreasing epithelial thickness (p values <0.05). Higher BOHSE scores also correlated with thinner lamina proprias (p=0.05) and increased graft stretch (p=0.03). The 2 patients with postoperative urine leaks and available graft histology had lamina propria thicknesses well below the cohort median, at 50 μm and 60 μm.
This is the first study to demonstrate that oral health conditions impact graft histology and stretch. Although much remains to be learned, our findings shed light on the potential importance of optimizing oral health prior to BMG urethroplasty, and raise the question of if preoperative mucosal biopsy could help inform surgical decision making and discussions regarding surgical success.
先前的研究已经阐明了颊黏膜独特的宏观和组织学特性，使其成为一种可行且持久的尿道增强移植物。然而，先前没有文献直接研究术前口腔健康对这些特征的影响。
我们分析了 2018 年至 2020 年在我们机构接受颊黏膜移植物（BMG）尿道成形术的所有同意患者。术前完成了经过验证的口腔健康调查，口腔健康影响量表（OHIP-14）和 Kayser-Jones 简要口腔健康状况检查（BOHSE）。一位工作人员病理学家分析了 BMG 组织学，并使用改良的口腔黏膜评分量表量化了口腔黏膜炎。
我们分析了 51 名中位年龄为 40 岁（IQR 31-58）的患者。BOHSE 评分的平均值为 1.1，OHIP-14 评分为 1.4。中位上皮厚度为 530μm，固有层厚度为 150μm。在年龄调整分析中，BOHSE 和 OHIP-14 增加与上皮厚度减少相关（p 值<0.05）。较高的 BOHSE 评分还与较薄的固有层（p=0.05）和移植物拉伸增加相关（p=0.03）。2 名术后发生尿漏且有可用移植物组织学的患者，固有层厚度明显低于队列中位数，分别为 50μm 和 60μm。
这是第一项表明口腔健康状况影响移植物组织学和拉伸的研究。尽管还有很多需要了解，但我们的发现揭示了在 BMG 尿道成形术前优化口腔健康的潜在重要性，并提出了一个问题，即术前黏膜活检是否可以帮助为手术决策提供信息，并讨论手术成功的问题。
