TISSUE-ENGINEERED BUCCAL MUCOSA URETHROPLASTY:
PRELIMINARY REPORT OF OUR FIRST CASES.
M.S. Aragona1, J. Ekrutt1, M. Reichert1, C. Bischoff1, K. Sayedahmed1, K. Urban1, J. Ripenhusen1, T.
Jacherzt1, R. Olianas1 G. Ram-Liebig2
1- Urologic Department, Städtische Klinikum Lüneburg, Germany;
2- University of Technology, Dept. of Anatomy, Dresden, Germany
Introduction and objective:
The buccal mucosa (BM) urethroplasty (UP) is one of the preferred treatments for long
urethral stenosis. In case of the long urethral stricture this treatment is limited from the length
of the graft that is possible to harvest. In the aim to increase the graft length not only BM of
the cheeks but also from the lower lip or the tongue can be taken. However the morbidity
increase with the extension of the harvesting.
To overcome these limitations a tissue engineered BM graft has been developed (Mukocell®).
We report on the outcome of our first 6 cases.
Methods:
From February 2012 to March 2013 7 patients underwent harvesting of BM for tissue
engineered BM UP. Only patients with no previous UP as well as stricture less then 4 cm
were selected. Lichen schlerosus was also an exclusion criterion. All patient were
preoperative evaluated with uroflowmetry, retrograde urethrography and questionnaire (IIEF,
IPSS, incontinence questionnaire). The harvesting of the graft was performed in an ambulant
setting; a small BM biopsy of about 1cm2 was taken from the right cheek. All patients went
home about 1 hour after the procedure. 3 to 4 weeks after the harvesting the tissue-engineered
graft was implanted.
In one case we could not proceed to implant because of bacterial contamination of the harvest
so that a classical BM was harvested and implanted.
2 patients underwent an inlay UP, 2 patients an UP in onlay fashion and 2 patients had a
combination of inlay and onlay. Transurethral catheter was usually removed after 3 weeks and
urethrography was performed after 6 weeks. The patient performed a voiding diary and after
assessing no significant residual the suprapubic catheter was removed. A final uroflowmetry
was also performed. Follow up was achieved with periodical telephonic interviews and in
office visits with uroflowmetry and post voidal residual ultrasound.
Results:
All 6 patients reported no problem on the donor site. Median Age was 55 Jears (32-72).
Stricture etiology was in 4 cases idiopathic and 2 cases iatrogenic. Average stricture length
was 3,58 cm (3-6cm). All the strictures were localized at the bulbar urethra.
In one case shortly after catheter removal the patient complained about strangury and a
decreased flow; a cystoscopy was performed and a small twist of the matrix was found. After
distending it the caliber of the urethra widened and patient urinate without problem. At time
of follow up all Patients refer no problem and a good uroflowmetry. No episode of urinary
tract infection or urinary retention was reported. All patient were very satisfied and would
recommend this procedure based on their experience.
Conclusions:
However in our experience the follow up is limited and no definitive conclusion or
comparison can be made with the original BM UP the using of engineered BM graft seems
feasible and safe. In our opinion it is important to continue investigating this procedure for its
potential advantages (no limitation of graft size, lower donor site morbidity).