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Publication – Video Session 2 – EAU 2012 – Video Session 2: Pelvic and urethral reconstruction

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V8: Presentation of a potential appropriate method for bulbar urethroplasty with tissue-engineered oral mucosa graft (MukoCell®)

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G. Ram-Liebig1, D. Fahlenkamp2, G. Romano3, U. Balsmeyer2, R. Funk4, G. Barbagli3

(1) MukoCell GmbH, Dresden, Germany
(2) Zeisigwald Clinics Bethanien, Clinic for Urology, Chemnitz, Germany
(3) Center for Reconstructive Urethral Surgery, Arezzo, Italy
(4) University of Technology, Dept. of Anatomy, Dresden, Germany

Introduction & Objectives

Tissue-engineeringcanhelp to overcome problems, associated with tissue limitations for urologicalreconstruction. MukoCell® is a tissue-engineered oral mucosal graft forurethroplasty. We describe a potential appropriate method for bulbarurethroplasty with MukoCell®.

Material & Methods

Fourpatientswith a mean age of 55 years underwent urethroplasty with MukoCell®. Thefollow-up time was 2-9 months. For the production of MukoCell®, a tiny oralmucosa biopsy was taken from the patient and sent to an advanced pharmaceuticalclean room facility for manufacturing of cell-based medicinal productsaccording to „Good Manufacturing Practice“ (GMP). During three weeks,cells were isolated from the biopsy, expanded and cultured on the surface of abiocompatible scaffold. Patient’s own MukoCell® was then packed in a sterilecontainer and sent to the hospital, where it was implanted into the patient,undergoing urethral reconstruction surgery. For this purpose, perinealincision was made. The bulbar urethra was fully exposed and opened along itsventral surface. The urethral plate was longitudinally incised to obtain a widewindow. Mukocell®was layered on the created window and tailored according to the size of thewindow. MukoCell® was then sutured and quilted deeply into the urethral platewindow. The bulbar urethra was closed over 16 ChFoley silicone catheter. Radiologic and uroflowmtericanalysis were performed in the follow-up time.

Results

After the biopsy harvesting, patients did not have any complains at the oral site.The urethroplasty with MukoCell® was performed without any intraoperative orpostoperative complications. Postoperative cystourethrographicanalysis showed wide urethral caliber without leakage or restricture.Uroflowmetricstudy showed adequate flow rate, residual urine was not observed. DuringFollow-up time of up to 9 months, no restricturewas observed.

Conclusions

Urethralreconstruction with tissue engineered oral mucosa (MukoCell®) is feasible andcan be successfully performed with the operative technique, proposed in ourstudy. The placement of tissue-engineered material between two nativeepithelial strips may induce the incorporation of MukoCell® into the adjacenttissue and hence accelerate the process of generation of the implanted graft. MukoCell® may present a new and attractive alternative to native oral mucosafor urethral reconstructions in the future.

Aditional information: Official EAU 2012 Website

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