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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (5): 975-979. doi: 10.19723/j.issn.1671-167X.2025.05.024

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Comparison of efficacy and safety of oral mucosa grafts and acellular dermal matrix grafts in the treatment of long-segment urethral stricture

Wenyuan LENG, Duan GAO, Xiaoyu LI, Wei ZUO, Weimin HU, Zhenpeng ZHU, Chunru XU, Jian LIN*(), Xuesong LI*()   

  1. Department of Urology, Peking University First Hospital; Institute of Urology, Peking University; National Urological Cancer Center, Beijing 100034, China
  • Received:2025-02-27 Online:2025-10-18 Published:2025-06-09
  • Contact: Jian LIN, Xuesong LI
  • Supported by:
    the National Natural Science Foundation of China(82270708)

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Abstract: Objective: To investigate the differential efficacy and safety profiles of oral mucosa (OM) grafts compared with acellular dermal matrix (ADM) grafts in the surgical management of long-segment urethral strictures. Methods: A retrospective cohort study was conducted involving 27 patients who underwent graft urethroplasty for long-segment urethral strictures in Peking University First Hospital, spanning from May 2010 to September 2023. The patient cohort comprised 14 individuals who received OM grafts and 13 who underwent ADM grafts. The participants were stratified into two groups based on the type of grafts material utilized during surgery. The demographic and clinical baseline characteristics included an average age of (43.3±14.0) years in the OM group and (54.2±15.9) years in the ADM group. The mean body mass index (BMI) for the respective groups were (24.7±4.3) kg/m2 for OM and (25.4±4.8) kg/m2 for ADM. Etiological differences were noted, with idiopathic causes predominantly in the OM cohort and lichen sclerosus in the ADM cohort. Results: The surgical interventions were successfully executed for all the patients. The median stricture length was 4.5 (2.5, 9.0) cm for the OM group and 5.0 (2.0, 14.0) cm for the ADM group (P=0.555). The median operative duration was 160 (71, 221) min for the OM group and 134 (112, 274) min for the ADM group (P=0.065). The catheterization durations was 1.5 (1.0, 6.0) months for the OM group and 3.0 (1.0, 3.0) months for the ADM group. The median postoperative follow-up duration was 12.5 (1.0, 170.0) months for the OM group and 59.0 (3.0, 142.0) months for the ADM group. The surgical success rates were 50.00% in the OM group and 53.85% in the ADM group. No statistically significant differences were observed in postoperative quality of life (QoL) or international prostate symptom score (IPSS) at the final follow-up. The stricture-free survival rates did not differ significantly (HR=0.875, 95%CI: 0.507-1.511, P=0.6). In terms of safety, three patients in the OM group experienced sexual dysfunction, and two had oral complications, whereas the ADM group had one case of postoperative infection. Conclusion: The findings suggest that ADM grafts are comparable to OM grafts in terms of efficacy and safety for the treatment of long-segment urethral strictures, including complex cases attributed to lichen sclerosus. However, given the small sample size of this study, the above conclusions may have certain limitations. Larger cohort studies will be needed in the future to further validate these findings.

Key words: Urethral stricture, Urethroplasty, Acellular dermal matrix, Oral mucosa

CLC Number: 

  • R699.6

Table 1

Comparison of demographic and surgical characteristics between two groups"

Characteristics Group P value
OM ADM
Patient number 14 13
Age/years, ${\bar x}$±s 43.3±14.0 54.2±15.9 0.071
BMI/(kg/m2), ${\bar x}$±s 24.7±4.3 25.4±4.8 0.717
Smoking history, n (%) 3 (21.43) 3 (23.08) 0.946
Alcohol use history, n (%) 2 (14.29) 0 (0) 0.181
Comorbidities, n (%)
  Hypertension 2 (14.29) 1 (7.69) 0.624
  Diabetes 0 (0) 3 (23.08) 0.068
  Cardiovascular disease 2 (14.29) 0 (0) 0.181
Etiology, n (%) 0.035
  Trauma 2 (14.29) 3 (23.08)
  Lichen sclerosus 1 (7.14) 5 (38.46)
  Iatrogenic 5 (35.71) 4 (30.77)
  Idiopathic 6 (42.86) 1 (7.69)
Stricture site, n (%) 0.149
  Anterior urethra 14 (100.00) 11 (84.62)
  Posterior urethra 0 (0) 1 (7.69)
  Entire urethra 0 (0) 1 (7.69)
Stricture length/cm, median (min, max) 4.5 (2.5, 9.0) 5.0 (2.0, 14.0) 0.555
Prior surgeries, n (%) 0.652
  0 6 (42.86) 4 (30.77)
  1 1 (7.14) 4 (30.77)
  2 2 (14.29) 2 (15.38)
  3 0 (0) 2 (15.38)
  4 0 (0) 0 (0)
  ≥5 5 (35.71) 1 (7.69)
Operative duration/min, median (min, max) 160 (71, 221) 134 (112, 274) 0.065

Table 2

Comparison of clinical efficacy and safety between two surgical repair grafts across etiological subtypes"

Etiology (n) Group (n) Restricture rate, n (%) Median restricture time/months Complication (n)
Trauma (5) OM (2) 1 (50.0) 3 Oral pain (1)
ADM (3) 1 (33.3) 6
Lichen sclerosus (6) OM (1) 0 (0)
ADM (5) 3 (60.0) 6 Postoperative infection (1)
Iatrogenic (9) OM (5) 3 (60.0) 3 Dysgeusia (1)
ADM (4) 2 (50.0) 4.5
Idiopathic (7) OM (6) 3 (50.0) 3 Sexual dysfunction (3)
ADM (1) 0 (0)

Table 3

Comparative analysis of follow-up indicators between two groups"

Indicators Group P value
OM ADM
Preoperative QoL, median (min, max) 5.0 (5.0, 6.0) 6.0 (4.0, 6.0) 0.275
Preoperative IPSS, median (min, max) 20.5 (9.0, 31.0) 20.0 (15.0, 32.0) 0.800
Catheterization duration/months, median (min, max) 1.5 (1.0, 6.0) 3.0 (1.0, 3.0) 0.018
Restricture rate, n (%) 7 (50.00) 6 (46.15) 0.867
Restricture time/months, median (min, max) 2.5 (1.3, 8.0) 5.0 (1.5, 12.0) 0.163
Postoperative QoL, median (min, max) 1.0 (0, 5.0) 1.0 (0, 5.0) 0.358
Postoperative IPSS, median (min, max) 5.5 (3.0, 14.0) 7.0 (2.0, 14.0) 0.547

Figure 1

Comparison of stricture-free survival rates in two groups OM, oral mucosa; ADM, acellular dermal matrix."

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