Faculty Bibliography

Although buccal mucosa has been the preferred graft material for use in the reconstruction of anterior urethral strictures for approximately 20 years, the plastic surgery literature is lacking in studies describing and evaluating this technique. The authors sought to report their experience with the technique of buccal mucosa graft harvest for use in urethral reconstruction. The authors identified 87 consecutive patients who underwent buccal mucosal graft harvesting during a 15-year period from 1995 to 2010. All donor sites were closed primarily. Preoperatively, a specialty-specific evaluation was performed by plastic surgeons and urologists. Postoperative donor-site morbidity was followed clinically. Eighty-seven patients underwent buccal harvesting. A single buccal graft was harvested in 75 patients (86.2 percent) and bilateral grafts were harvested in 12 patients (13.8 percent). The median patient age of the patients was 42 years (range, 16 to 78 years). There were no major intraoperative or postoperative complications. Minor complications included mild discomfort, numbness, cheek swelling, and restriction of oral movement, all of which resolved by the 3-month postoperative visit. The ability to eat and drink postoperatively was diminished during only the first 24 to 48 hours in all patients. Our series provides a 1-year follow-up in a substantial cohort looking at clinical outcomes after buccal harvesting. These results confirm the safety and efficacy of buccal mucosal harvesting to provide an effective and cosmetically superior option for urethral reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

PURPOSE: We assess the ability of adenovirus mediated expression of the Escherichia coli cytosine deaminase gene in conjunction with the prodrug 5-fluorocytosine to result in radiation sensitization in the mouse prostate cancer cell line RM-1 in vitro. MATERIALS AND METHODS: To document cytotoxicity of gene therapy, RM-1 cells were exposed to escalating doses of adenovirus mediated cytosine deaminase and a fixed dose of 5-fluorocytosine or phosphate buffered saline. Viable cells as determined by exclusion of trypan blue were counted the following day. Cytosine deaminase expressing RM-1 cells were then irradiated as single cell suspensions at various doses of radiation in a cesium source (4.4 Gy. per minute) and randomized to receive 5-fluorocytosine therapy at different times in relation to the external radiation therapy. End points were determined in a clonogenic assay by counting colonies with greater than 50 cells 7 days after replating. RESULTS: Use of adenovirus mediated cytosine deaminase plus 5-fluorocytosine demonstrated viral dose dependent killing of RM-1 cells to a maximum of 85%, while either therapy alone was nontoxic. Neither adenovirus mediated cytosine deaminase infection nor 5-fluorocytosine alone influenced external radiation therapy killing. However, after controlling for death due to gene therapy alone, the combination of adenovirus mediated cytosine deaminase plus 5-fluorocytosine and external radiation therapy resulted in synergistic activity to approximately 2 logs of cell kill at low doses of radiation (p = 0.001). While altering the chronology of prodrug exposure in relation to external radiation therapy maintained synergy in all scenarios tested, starting 5-fluorocytosine 24 hours before external radiation therapy resulted in the most profound killing (p = 0.04), which indicates the importance of maintaining prodrug therapy during external radiation therapy. CONCLUSIONS: The combination of adenovirus mediated cytosine deaminase plus 5-fluorocytosine and radiation therapy resulted in radiation sensitization with clinically relevant doses of radiation suggesting a potential usefulness of this treatment in patients with prostate cancer.