Poster Session 51: Strictures and urethroplasty 1
621: Tissue-engineered buccal mucosa urethroplasty. Outcome of our first 10 patients
G. Ram-Liebig>1, 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
The open urethroplasty using buccal mucosa grafts is an established method for the treatment of urethral strictures. Due to the fact that the length of the graft at the donor site is limited, the stricture length to be reconstructed with conventional buccal mucosa is restricted. To reconstruct longer strictures, the use of tissue engineered grafts is promising. We report the outcome of our first 10 patients.
Material & Methods
Ten patients underwent an open urethroplasty using tissue engineered buccal mucosa grafts. The Age was between 31 and 75 years, the stricture length between 10 mm and 30mm. All patients underwent a urethroromia interna (UTI) between one to seven times before. Two patients had previously been treated by dilation and one underwent a transurethral resection of the prostate (TUR-P). The preoperative uroflow showed a maximum flow between 0 and 15 ml/s. After diagnostic, including mictionsurethrography, a 1 cm² piece of buccal mucosa was harvested in local anesthesia. A tissue engineered graft (MukoCell®) was produced and implanted after three weeks. An open urethroplasty was performed using the tissue engineered graft as an onlay patch in the bulbar urethra (n=9) or an inlay patch in the distal penile urethra (n=1). The transurethral catheter was removed after ten days. After three weeks an urethrography was done and the suprapubic catheter was removed. After removing the catheter an uroflowmetry was performed.
All Patients didn’t show any problems at donor site. Harvesting a piece of buccal mucosa in local anesthesia proceeded without complications, no swelling, no pain, no bleeding. The handling of the graft during operation was comfortable. The urethrography showed a watertight and wide anastomosis in 5 patients. The uroflowmetry showed a flow between 16 to 32 ml/s and no residual urine. In one patient with a long history of UTI and dilations, intraoperative bleeding occurred above the reconstructed area while inserting the transurethral catheter. Post operative, in this patient, a very short restricture occurred above of the transplant. The uroflowmetry showed a maximum flow of 5 ml/s and the urethroscopy indicated a very short stricture above of the proximal beginning of the transplant. The main region of the implanted tissue engineered mucosa was wide. In this patient we performed a urethrotomia interna.
Tissue engineered buccal mucosa grafts seem to be a useful alternative to full mucosa grafts. A longer follow up is necessary to compare tissue engineered grafts to open urethroplasty with standard buccal mucosa. The main benefit is the avoidance of potential complications at the donor site.