Free bladder mucosa graft harvested by water‑jet: A novel, minimally invasive technique for urethral reconstruction

Wang, Zhixian; Zeng, Xiaoyong; Chen, Ruibao; Wang, Tao; Hu, Jia; Wang, Shaogang; Liu, Jihong

doi:10.3892/etm.2018.6469

Cited by 7 publications

(7 citation statements)

References 14 publications

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“…Urethroplasty is of long-term effectiveness and is being increasingly performed in developed countries (9). In China, the oral mucosa, foreskin flaps, bladder mucosa, colonic mucosa, and other tissue flaps have been used for urethroplasty (11,12), while the main flaps used are foreskin flaps and scrotal flaps in our hospital. Additionally, treatments for simple MUS are also turning to endoscopic minimally invasive treatment or even urethroplasty.…”

Section: Discussionmentioning

confidence: 99%

The Changing Trend in Clinical Characteristics and Outcomes of Male Patients With Urethral Stricture Over the Past 10 Years in China

Ding

Peng

et al. 2021

Front. Public Health

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Background: Male urethral stricture is a disease with a high incidence rate. With social-economic development in the developing countries, the trend of etiology and treatment of male urethral stricture changed was speculated.Methods: The clinical data of the male patients with urethral stricture from 2000 to 2019 were analyzed. The subjects were divided into Group A (2000–2009) and Group B (2010–2019) according to treatment time. The pooled analysis of the data extracted from pieces of literature was also performed.Results: About 540 patients were included in the present study, including 235 patients in Group A and 305 patients in Group B. In recent 10 years, trauma has still been the main cause of urethral stricture. Iatrogenic injury, especially transurethral operation, increases significantly, while male urethral stricture secondary to radiotherapy and infection decrease. Urethroplasty increases and the reoperation rate decreases in treating simple urethral stricture, and flap urethroplasty also increases in treating complex urethral stricture. The results of a pooled analysis of data from 11 centers in Mainland China are partially consistent with it. Complications, such as urethral fistula, false canal, ejaculation disorder, and penile curvature, decrease significantly.Conclusions: The main causes of urethral stricture in the recent 10 years are still trauma and iatrogenic injuries, and the etiology of urethral stricture is related to socioeconomic development. With the increase of intracavitary minimally invasive treatment and flap urethroplasty, the curative effect is increasing, while iatrogenic urethral stricture cannot be ignored.

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Section: Discussionmentioning

confidence: 99%

The Changing Trend in Clinical Characteristics and Outcomes of Male Patients With Urethral Stricture Over the Past 10 Years in China

Ding

Peng

et al. 2021

Front. Public Health

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“…Wang Z et al ( 11 ), however, using an important technical innovation for the collection of bladder mucosa, published their interesting study results. The innovation consisted of the endoscopic dissection of the vesical submucosa using a jet of water applied through equipment called a hybrid knife system.…”

Section: Discussionmentioning

confidence: 99%

“…In 2018, Wang Z et al described transurethral harvesting of bladder mucosa graft in 2 patients using the Hybrid Knife system, which uses a jet of water to aid the process. Short-term follow-up did not reveal any bladder complications ( 11 ).…”

Section: Introductionmentioning

confidence: 94%

Preliminary results of a new surgical technique: bladder mucosal graft harvested with holmium:YAG (HO:YAG) laser. A new option in bulbar replacement urethroplasty?

et al. 2023

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Objective: To describe the technique of transurethral harvesting of bladder mucosal graft using the Holmium:YAG (Ho-YAG) laser and describe the preliminary results from 7 cases where this graft was used for urethroplasty. Materials and Methods: We performed a single-stage dorsal onlay urethroplasty using bladder mucosal graft in 7 patients with anterior urethral stricture. Transurethral harvesting was performed with the Ho-YAG laser. We performed a prospective and descriptive analysis with uroflowmetry performed at 30, 90 and 180 days after surgery and applied the PROM translated into Portuguese before and 6 months after urethroplasty. Results: Seven patients were included, 2 (28.5%) with penile urethral stricture, and 5 (71.5%) with bulbar urethral stricture. Mean stricture length was 50mm (range 35-60mm). Stricture etiology was trauma in 3 (42.9%) patients, iatrogenic in 1 (14.3%) patient, and idiopathic in 3 (42.9%) patients. Two patients (28.6%) had previously undergone ventral buccal mucosa urethroplasty. Mean bladder mucosal graft length was 52.86mm (± 13.801), and mean harvest time was 46.43min (± 14.639). Dorsal onlay urethroplasty using bladder mucosa was successfully completed in 5 patients (71.4%). Two patients (28.6%) couldn't have the procedure completed using bladder mucosa, one due to thermal damage of the graft during harvesting, and one due to insufficient graft length. In both cases the procedure was completed using buccal mucosa. Two patients (28.6%) experienced minor hematuria between the twelfth and eighteenth postoperative day, but neither required hospitalization and/or additional procedures. All patients achieved normalization of peak flow, and this was maintained throughout the follow-up period. Mean peak flow was 17.8 ml/s (± 3.271) at 30 days, 20.6 ml/s (± 5.413) at 90 days, and 19.6 ml/s (± 8.019) 180 days. Mean IPSS score decreased from 19.3 to 5.4. Similar improvements were also seen in the ICIQ-MLUTS Score (a mean drop from 3.8 to 2.0) and Peeling's Voiding Picture Score (a mean drop from 4.0 to 2.2). Quality of Life improved post urethroplasty, with increases in EQ-5D (from 0.6371 to 0.7285) and EQ-VAS (from 58.0 to 84.0). Conclusion: Transurethral harvesting of bladder mucosa using the Holmium laser (Ho-YAG) is feasible and reproducible. Our preliminary experience suggests that bladder mucosa grafts achieve comparable results to other grafts when used for dorsal onlay urethroplasty. Further research is needed to confirm these results.

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“…Bladder mucosa has many favorable properties including inherent tolerance of urine exposure and large graft segment harvest without significant harvest site morbidity. 73 , 74 However, it classically requires open surgical harvest and suffers from higher-than-average complication rates, making it a last resort typically reserved for severe proximal hypospadias and other major congenital malformations. 67 , 75 Colonic and rectal mucosa, harvested after either sigmoid resection or transanal endoscopic mucosal resection, offers another excellent graft choice for long, complex USD that has failed previous management attempts with long-term success rates comparable to other graft sources at ~85%.…”

Section: Alternative Graft Optionsmentioning

confidence: 99%

Recurrent Anterior Urethral Stricture: Challenges and Solutions

Mershon¹,

Baradaran²

2021

RRU

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Recurrent male anterior urethral stricture disease is a complex surgical challenge that should be managed by reconstructive urologists with experience in stricture management. Diagnosis of recurrence requires both anatomic narrowing and patient symptoms identified on validated questionnaires, with limited role for intervention in asymptomatic treatment "failures". Endoscopic management has a very specific role in recurrence, and the choice of technique for urethroplasty depends on pre-operative urethrography and cystoscopy. Surgical success depends on addressing patient concerns, complete stricture excision, tissue quality optimization, and the use of multi-stage repair when indicated. Augmentation with genital skin flaps and/or grafts is often required, with buccal mucosa as the ideal graft source if local tissue is compromised. Salvage options including urinary diversion and perineal urethrostomy must also be considered in debilitated patients with severe disease or repeated treatment failures. Unique patient populations including patients with hypospadias and lichen sclerosis are among the highest risk for repeated recurrence and require special care in surgical technique, graft selection, and post-operative management.

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Free bladder mucosa graft harvested by water‑jet: A novel, minimally invasive technique for urethral reconstruction

Cited by 7 publications

References 14 publications

The Changing Trend in Clinical Characteristics and Outcomes of Male Patients With Urethral Stricture Over the Past 10 Years in China

The Changing Trend in Clinical Characteristics and Outcomes of Male Patients With Urethral Stricture Over the Past 10 Years in China

Preliminary results of a new surgical technique: bladder mucosal graft harvested with holmium:YAG (HO:YAG) laser. A new option in bulbar replacement urethroplasty?

Recurrent Anterior Urethral Stricture: Challenges and Solutions

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