Pathomorphological restructuring of the buccal mucosa grafts during ureteroplasty (experimental and clinical study)

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BACKGROUND: Currently for the plastic surgery of extended strictures of the pyeloureteral segment and proximal ureter a grafts from the buccal mucosa is used. Histological changes in these grafts in the postoperative period have not been sufficiently studied.

AIM: is to study the histological changes in the graft from the buccal mucosa used for ureteroplasty in an experiment and in patients at different times after surgery.

MATERIALS AND METHODS: The experimental part of the study was carried out on 10 animals (rabbits). We studied histological changes in the wall of the buccal mucosa graft used for ureteroplasty. Under general anesthesia a median laparotomy was performed, the ureter was mobilized along the middle third, a defect of about 1 cm was created. Next a buccal graft of 1.5 × 1 cm was cut out, which was sutured to the ureteral defect using the onlay technique. After 6 months nephroureterectomy was performed. Three parts of the ureter were identified: the replacement zone, 3 cm sections above and below it, followed by histological examination. The clinical part of the study consisted of a histological examination of biopsy samples obtained from 5 patients during ureteroscopy by pinching graft biopsy 12 months and 24 months after buccal ureteroplasty.

RESULTS: The experimental part of the study demonstrated the possibility and effectiveness of ureteroplasty with a buccal graft, and also revealed the restructuring of squamous epithelium into transitional cell. In patients 12 and 24 months after buccal ureteroplasty similar changes in the mucous membrane of the graft were not observed, therefore, further study of the mucous membrane of the buccal graft in later postoperative periods is necessary.

CONCLUSIONS: The results of experimental and clinical studies indicate the possibility of using a graft from the buccal mucosa for plastic surgery of extensive and recurrent ureteral strictures. Unlike animals, where a restructuring of squamous to transitional cell epithelium was observed, similar morphological changes did not occur in patients after buccal ureteroplasty.

作者简介

Bakhman Guliev

City Mariinsky Hospital

编辑信件的主要联系方式.
Email: gulievbg@mail.ru
ORCID iD: 0000-0002-2359-6973
SPIN 代码: 8267-5027

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Saint Petersburg

Zhaloliddin Avazkhanov

City Mariinsky Hospital; North-Western State Medical University named after I.I. Mechnikov

Email: professor-can@mail.ru
ORCID iD: 0000-0003-3824-2681
SPIN 代码: 5012-4021
俄罗斯联邦, Saint Petersburg; Saint Petersburg

Andrey Droblenkov

Institute of Experimental Medicine; Medical and Social Institute

Email: droblenkov_a@mail.ru
ORCID iD: 0000-0001-5155-1484
SPIN 代码: 8929-8601

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Saint Petersburg; Saint Petersburg

Sergey Vinnichuk

North-Western State Medical University named after I.I. Mechnikov

Email: s.a.vinnichuk@gmail.com
ORCID iD: 0000-0002-9590-6678
SPIN 代码: 6448-9110

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg

Oibek Abdurakhmanov

City Mariinsky Hospital

Email: ovshen_19@mail.ru
ORCID iD: 0009-0002-0350-3538
俄罗斯联邦, Saint Petersburg

参考

  1. Güneş M, Altok M, Özmen Ö, et al. A novel experimental method for penile augmentation urethroplasty with a combination of buccal mucosa and amniotic membrane in a rabbit model. Urology. 2017;102:240–246. doi: 10.1016/j.urology.2016.10.061
  2. Mattos RM, Araújo SR, Quitzan JG, et al. Can a graft be placed over a flap in complex hypospadias surgery? An experimental study in rabbits. Int Braz J Urol. 2016;42(6):1228–1236. doi: 10.1590/S1677-5538.IBJU.2016.0168
  3. Oliva P, Delcelo R, Bacelar H, et al. The buccal mucosa fenestrated graft for Bracka first stage urethroplasty: experimental study in rabbits. Int Braz J Urol. 2012;38(6):825–832. doi: 10.1590/1677-553820133806825
  4. Souza GF, Calado AA, Delcelo R, et al. Histopathological evaluation of urethroplasty with dorsal buccal mucosa: an experimental study in rabbits. Int Braz J Urol. 2008;34(3):345–351; discussion 351–354. doi: 10.1590/s1677-55382008000300012
  5. Hu X, Xu Y, Song L, Zhang H. Combined buccal and lingual mucosa grafts for urethroplasty: an experimental study in dogs. J Surg Res. 2011;169(1):162–167. doi: 10.1016/j.jss.2009.10.032
  6. Loran OB, Veliev EI, Kotov SV, Belomyttsev SV. Choice of an optimal free graft for replacement urethroplasty in extensive urethral strictures. Urologiia. 2011;(4):11–16. (In Russ.)
  7. Somerville JJ, Naude JH. Segmental ureteric replacement: an animal study using a free non-pedicled graft. Urol Res. 1984;12(2): 115–119. doi: 10.1007/bf00257176
  8. Guliev BG, Komyakov BK, Avazkhanov ZP, Korol EI. Laparoscopic buccal plasty of the pyeloureteral segment and proximal ureter. Urology reports (St. Petersburg). 2023;13(1):43–51. doi: 10.17816/uroved321558
  9. Cheng S, Fan S, Wang J, et al. Laparoscopic and robotic ureteroplasty using onlay flap or graft for the management of long proximal or middle ureteral strictures: our experience and strategy. Int Urol Nephrol. 2021;53;(3):479–488. doi: 10.1007/s11255-020-02679-5
  10. Lee Z, Lee M, Koster H, et al. Collaborative of reconstructive robotic ureteral surgery (CORRUS). A multi-institutional experience with robotic ureteroplasty with buccal mucosa graft: an updated analysis of intermediate-term outcomes. Urology. 2021;147:306–310. doi: 10.1016/j.urology.2020.08.003
  11. Fan S, Yin L, Yang K, et al. Posteriorly augmented anastomotic ureteroplasty with lingual mucosal onlay grafts for long proximal ureteral strictures: 10 cases of experience. J Endourol. 2021;35(2):192–199. doi: 10.1089/end.2020.0686
  12. Yang K, Fan S, Wang J, et al. Robotic-assisted lingual mucosal graft ureteroplasty for the repair of complex ureteral strictures: technique description and the medium-term outcome. Eur Urol. 2022;81(5):533–540. doi: 10.1016/j.eururo.2022.01.007
  13. Liang C, Wang J, Hai B, et al. Lingual mucosal graft ureteroplasty for long proximal ureteral stricture: 6 years of experience with 41 cases. Eur Urol. 2022;82;(2):193–200. doi: 10.1016/j.eururo.2022.05.006
  14. Guliev BG, Komyakov B, Avazkhanov Z, et al. Laparoscopic ventral onlay ureteroplasty with buccal mucosa graft for complex proximal ureteral stricture. Int Braz J Urol. 2023;49(5):619–627. doi: 10.1590/S1677-5538.IBJU.2023.0170

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2. Fig. 1. Isolation of the middle third of the ureter, formation of a defect measuring 1.0 cm

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3. Fig. 2. A flap is cut out from the buccal mucosa and cleared of underlying tissue

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4. Fig. 3. The flap is sewn to the ureteral defect

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5. Fig. 4. Removed kidney with ureter

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6. Fig. 5. Results of histological examination of the area of buccal plastic surgery of the rabbit ureter. The replacement of the squamous epithelium of the buccal mucosa with transitional cell epithelium is determined. Explanations in the text. Hematoxylin and eosin staining. Magnification ×40 (а), ×400 (b, c, d)

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7. Fig. 6. Frontal section of the rabbit ureter above the buccal plasty area. Hematoxylin and eosin staining. Magnification ×40 (а), ×400 (b)

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8. Fig. 7. Oblique longitudinal section of the rabbit ureter below the buccal plasty. Hematoxylin and eosin staining. Magnification ×40 (а), ×400 (b)

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9. Fig. 8. Mucosa of a patient’s buccal graft after buccal ureteroplasty. Hematoxylin and eosin staining. Magnification ×40

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