Urethral Reconstruction with Rectal Mucosa Graft Onlay: A Novel, Minimally Invasive Technique

Palmer, Drew; Marcello, Peter W.; Zinman, Leonard; Vanni, Alex J.

doi:10.1016/j.juro.2016.03.002

Cited by 27 publications

(19 citation statements)

References 16 publications

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“…Follow-up results in the current study suggest that the approach is feasible and safe. Short-term successful outcomes have also been described previously (4,6,12). In order to avoid the potential complications following conventional open surgery for bladder mucosa graft harvest, patients in the current study underwent a minimally invasive approach of transurethral endoscopic sub-mucosal dissection via water-jet to harvest the bladder mucosa.…”

Section: Discussionsupporting

confidence: 62%

“…Xu et al (11) reported a feasible procedure for complex urethral strictures using circumferential colonic mucosa grafts, which achieved a high success rate of 86%. Palmer et al (12) reported a feasible, safe and low morbidity technique for harvesting rectal mucosa graft for urethral reconstruction via a transanal endoscopic microsurgical technique. However, this technique carries a risk of colonic perforation and requires an experienced surgeon, as well as absence of bowel disease in the patient, which limit the extensive use of rectal mucosa grafts among many institutions.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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The aim of the current study was to describe a novel approach of urethral reconstruction through minimally invasive harvesting of the bladder graft via endoscopic sub-mucosal dissection of water-jet. The records of two patients were reviewed, who underwent transurethral endoscopic surgical bladder mucosa graft harvest by water-jet and urethral reconstruction with informed consent. Case 1 was a 35-year-old male with anterior urethral stricture; case 2 was a 22-year-old male with secondary anterior urethral stricture and hypospadias following a failed hypospadias surgery. The two male patients successfully underwent urethral reconstruction using bladder mucosa graft harvested via endoscopic assisted by water-jet; no perforation, cysthemorrhagia or any other postoperative bladder-related complication was observed. Voiding cystourethrogram of case 1 indicated that the reconstructed urethra was unobstructed, and no recrudescence was observed within 4 months of follow-up. In case 2, dysuria had disappeared completely within 1 month of follow-up, and the urethra plate was successfully reconstructed by first-stage. To the best of our knowledge, this is the first report to demonstrate urethral reconstruction using a bladder mucosa graft harvested by transurethral endoscopic sub-mucosal dissection, assisted by water-jet. Transurethral endoscopic surgery may provide a minimally invasive approach instead of the traditional open surgery for harvesting bladder mucosa graft. Urethral reconstruction conducted with bladder mucosa graft harvested via endoscopic sub-mucosal dissection assisted by water-jet is a feasible and safe method, and the short-term follow-up results are encouraging.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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“…More than 200 different reconstructive methods for urethral stricture disease or congenital absence have been described, with a variety of donor tissues, such as free skin grafts [1], bladder mucosa [2], buccal mucosa [3], and lingual mucosa [4], proving successful for urethral reconstruction. However, in many cases, an adequate amount of donor tissue is not available [5].…”

Section: Introductionmentioning

confidence: 99%

Urethral reconstruction with autologous urine-derived stem cells seeded in three-dimensional porous small intestinal submucosa in a rabbit model

Liu

et al. 2017

Stem Cell Res Ther

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BackgroundUrethral reconstruction is one of the great surgical challenges for urologists. A cell-based tissue-engineered urethra may be an alternative for patients who have complicated long strictures and need urethral reconstruction. Here, we demonstrated the feasibility of using autologous urine-derived stem cells (USCs) seeded on small intestinal submucosa (SIS) to repair a urethral defect in a rabbit model.MethodsAutologous USCs were obtained and characterized, and their capacity to differentiate into urothelial cells (UCs) and smooth muscle cells (SMCs) was tested. Then, USCs were labeled with PKH67, seeded on SIS, and transplanted to repair a urethral defect. The urethral defect model was surgically established in New Zealand white male rabbits. A ventral urethral gap was created, and the urethral mucosa was completely removed, with a mean rabbit penile urethra length of 2 cm. The urethral mucosal defect was repaired with a SIS scaffold (control group: SIS with no USCs; experimental group: autologous USC-seeded SIS; n = 12 for each group). A series of tests, including a retrograde urethrogram, histological analysis, and immunofluorescence, was undertaken 2, 3, 4, and 12 weeks after the operation to evaluate the effect of the autologous USCs on urethral reconstruction.ResultsAutologous USCs could be easily collected and induced to differentiate into UCs and SMCs. In addition, the urethral caliber, speed of urothelial regeneration, content of smooth muscle, and vessel density were significantly improved in the group with autologous USC-seeded SIS. Moreover, inflammatory cell infiltration and fibrosis were found in the control group with only SIS, but not in the experimental autologous USC-seeded SIS group. Furthermore, immunofluorescence staining demonstrated that the transplanted USCs differentiated into UCs and SMCs in vivo.ConclusionsAutologous USCs can be used as an alternative cell source for cell-based tissue engineering for urethral reconstruction.

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“…Xu et al first reported using tubularized colonic mucosa in 2003 for the repair of recurrent urethral strictures (3,4). Most recently Palmer et al reported on endoscopic rectal mucosal graft harvest with subsequent rectal mucosal graft substitution urethroplasties with promising early results (5). …”

Section: Introductionmentioning

confidence: 99%

“…Additionally, histologic studies of colonic mucosa exposed previously to urine demonstrated the ability of the colonic mucosa to adapt as a non-secreting urothelium (2). In Palmer et al ’s early report of using rectal mucosal substitution grafts, patients selected for the study were those with long urethral strictures, primarily secondary to lichen sclerosus, with median stricture length of 13.5 cm (5). In the current study we chose to evaluate the use of rectal mucosal substitution grafts in patients with prior buccal mucosal grafts (BMGs) or head and neck radiation, thus precluding use of a BMG, to evaluate its use in a setting wherein buccal mucosa is not a graft option.…”

Section: Introductionmentioning

confidence: 99%

Use of rectal mucosal grafts in substitution urethroplasty: an early series

Monn

Waters

Mellon

2018

Transl. Androl. Urol

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BackgroundTo evaluate the feasibility of use of rectal mucosal grafts for augmentation urethroplasty.MethodsA series of five patients who underwent rectal mucosal graft urethroplasty for urethral stricture disease were identified. Descriptive statistics were used to describe these patients. Primary endpoints were recurrence of stricture and perioperative morbidity.ResultsFive patients underwent rectal mucosal graft augmentation urethroplasty. Four had a history of prior buccal mucosal graft (BMG) urethroplasty and one had a history of head and neck cancer. Rectal mucosa was noted to be thinner and required more tailoring than buccal mucosa. All patients had patent urethras at time of postoperative retrograde urethrogram. A small diverticulum was noted in one patient with no further sequelae. No complications from rectal mucosal graft harvest were noted. All patients with prior buccal grafting subjectively preferred the rectal graft due to fewer side effects. Subjectively, patients with prior buccal grafts preferred the post-operative recovery following rectal mucosal graft urethroplasty.ConclusionsRectal mucosal graft augmentation urethroplasty is a safe alternative in patients with contraindications to buccal grafting with limited morbidity.

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Urethral Reconstruction with Rectal Mucosa Graft Onlay: A Novel, Minimally Invasive Technique

Cited by 27 publications

References 16 publications

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

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

Urethral reconstruction with autologous urine-derived stem cells seeded in three-dimensional porous small intestinal submucosa in a rabbit model

Use of rectal mucosal grafts in substitution urethroplasty: an early series

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