Female anterior wall onlay urethroplasty with lower lip buccal mucosal graft: Importance of the laterally extended incision

Objective:To describe the outcome of female anterior wall(pubic side)onlay urethroplasty with buccal mucosal graft using laterally extended surgical dissection in patients with previously failed minimally invasive techniques.Methods:From January 2016 to April 2018,17 symptomatic patients with previously failed minimally invasive procedures were enrolled in the study.The diagnosis of urethral stricture was confirmed based on a combination of patients’symptoms,post-void residual urine,video-urodynamics,and cystoscopy.Urethroplasty with lower lip mucosal graft was performed using the modified laterally extended dissection.Patients were evaluated pre-operatively and 12-month post-operatively with the American Urological Association symptom score,post-void residual urine,and maximum flow rate.Results:Despite the previously failed minimally invasive procedures,urethroplasty with lower lip buccal graft and laterally extended dissection resulted in favorable outcomes(success rateZ94%).The mean
standard deviation of American urological association symptom score improved from pre-operative levels at the 12-month post-operative follow-up(25.82
3.97 to 10.88
5.57);so did postvoid residual urine(71.12
74.98 mL to 15.00
28.30 mL),and maximum flow rate(7.88
1.72 mL/s to 25.82
5.59 mL/s)with all statistically significant(p<0.05).Conclusion:The current study showed that female urethroplasty with buccal graft could be highly successful in experienced hands.An anterior approach could be superior to the posterior one due to higher mechanical support and lower sacculation rate.A laterally extended incision may improve visualization and better graft placement by providing wider working space.The results should be evaluated in the future studies with larger sample size.

Germline cells derived from mesenchymal stem cells, with the focus on Wharton's jelly

Previous attempts have indicated that mesenchymal stem cells (MSCs) are a valuable source and candidate and new approach for tissue engineering and reproductive medicine. MSCs have this potential to be induced and differentiated in an appropriatein vivoandin vitro condition toward various cell lineages and then they can be applied in cell therapies and clinical applications. During recent two decades, various sources have demonstrated they are a great source for MSCs, including bone marrow, the human umbilical cord as well as Wharton's jelly. Due to discarding after birth, easily accessible cells and less ethical concerns, these cells have attracted more and more scientists' attention. Infertility and reproduction diseases have provided special opportunity to examine the efficiency of MSCs in this kind of application. Based on recent investigations, MSCs embedded in Wharton's jelly tissue are more appealing for cell therapies, especially in infertility treatment purposes. So, differentiation of MSCs embedded in Wharton's jelly tissue into germ layer cells for cell-based therapy purposes is now under intensive study.