With MukoCell®, there now exists a treatment option for urethral reconstruction that uses the patient’s own cells as a transplant, a truly gentle alternative to conventional transplantation solutions. The replacement tissue is cultured from the patient’s own cells, incorporated into the surrounding tissue within a short amount of time and develops into new, fully functional urethral tissue. To harvest the seed transplant, a small piece of the patient’s buccal mucosa is removed under local anesthesia (see figure).
Small biopsy instead of large-scale removal of oral mucosa
The use of an autologous transplant has significant advantages for the patient because taking a biopsy is for the most part pain-free and without complications. The conventional extraction of native buccal mucosa and any of the complications that may follow (such as pain, bleeding, paresthesias, contractures, deformities of the mouth, difficulty with eating, drinking and speaking, permanent salivation, etc.) are avoided. Taking only a few cells from the buccal mucosa also reduces the length of the surgery and the time under anesthesia, thus simplifying the surgical technique. The costs for transplant use and patient care remain unchanged.
Urethral reconstruction with native oral mucosal tissue is a recognized method for treating urethral strictures, with an acceptable failure rate of approximately 30%. However, this usually involves extraction of a large segments of buccal mucosa (see figure) as well as related complications such as, for example, pain, bleeding or scarring accompanied by potential consequences for the patients’ facial expressions, eating and drinking as well as the mobility of the lower lip. Current statistics confirm long-term complications following the removal of buccal mucosa tissue in 18% to 30% of patients. Not least of all, any removal of native oral mucosa from a patient must be limited merely because of the nature of the procedure.
The high rate of long-term complications for the patient’s mouth area makes an urethral reconstruction with native buccal mucosa also a poor method for treating urethral strictures.
disadvanatages of an urethral reconstrucion with buccal mucosa
Urethrotomy is the most common treatment option for a narrowing of the urethra. In Germany alone, approximately 45,000 such surgeries are done each year. However, many patients undergo the procedure more than once. It is a quick surgery that is cheaper per procedure compared to other treatment options. Yet, the 12-month failure rate is 70% and with repeated urethrotomies, the patients’ chances for a cure can even drop as low as 0%. The probability of recurrence of the stricture increases with each repetition of the treatment [Steenkamp et al 1997, Santucci 2009]. A patient must, therefore, undergo multiple interventions (sometimes two to three times per year) over the course of his lifetime.
This is the reason why urethrotomy / transurethral incision, which is only an intermediate solution, is not considered as an appropriate method for treating urethral strictures.