Urethral Stricture in Children: Treatment by Urethroplasty with Bladder Mucosa Graft

Monfort, G; Bretheau, D; Benedetto, Vincenzo Di; Bankolé, R

doi:10.1016/s0022-5347(17)36950-1

Cited by 28 publications

(12 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[14] Similarly, Monfort et al, managed strictures in pediatric patients and noted a comparable success rate of 90% for bladder mucosa and oral mucosa. [15] After these initial publications, 1994 onwards several clinical accounts have been published on the use of oral mucosa, especially for small populations of patients. [16,17] The first large heterogeneous patient sample (n ϭ 18) was presented by Duchett et al, where after 27 months of follow-up, 17% of the patients required corrective surgery.…”

Section: Historical Perspectivementioning

confidence: 99%

Oral mucosa grafts for urethral reconstruction

Mungadi

Ugboko

2009

Ann Afr Med

View full text Add to dashboard Cite

Background: Urethral reconstruction has continued to present formidable and enormous challenges for urologic, paediatric and plastic surgeons as diverse opinions have been expressed on the quality and type of ideal substitution material. This literature review is aimed at drawing attention of surgeons to the versatile nature of oral mucosal grafts. Methods: A review of the utilization of oral mucosa in urethral reconstruction was made. Structured Medline search was performed looking at all aspects of utilization of oral mucosa including mucosal harvest, donor site morbidity and outcome. Results: The unique demands of the urethra set a high standard for autogenous graft substitutes; hence literature reports reveal that split and full thickness skin grafts from the scrotum, penis, extragenital sites (ureter, saphenous vein, appendix, colon, medial upper arm, neck, lateral chest, abdomen, bladder mucosa) and more recently oral mucosa have been used. Unlike other tissues, oral mucosa grafts are fl exible, easy to harvest and trim and have an excellent microvasculature favorable for graft-taking. Furthermore, the natural moist location of the oral mucosa in the oral environment favours its easy adaptability in the urethral passage thus giving good long-term results. However, there are reports of complications at the donor site with the commonest being anaesthesia or paraesthesia of the cheek or lips. Regional variations of the oral mucosa, length of the graft required, the decision to close or leave donor site open and harvesting technique are some of the factors suggested to account for differences in donor site morbidity. Conclusion: Oral mucosal graft is a versatile urethral substitute with excellent outcome. It is becoming the gold standard for urethral substitution.

show abstract

Section: Historical Perspectivementioning

confidence: 99%

Oral mucosa grafts for urethral reconstruction

Mungadi

Ugboko

2009

Ann Afr Med

View full text Add to dashboard Cite

show abstract

“…End-to-end anastomosis is frequently used to repair short, non complex urethral defects wherein organ continuity is surgically restored by aligning and joining normal tissue segments [8]. In circumstances in which there is a lack of patient urethral tissue, extragenital skin flaps [9], [10], buccal mucosa [11], bladder mucosa [12], [13], and tunica vaginalis [14] have been utilized clinically as autologous tissue grafts for urethroplasty procedures. In addition to the risk of donor site morbidity, the long-term success of these implants is often suboptimal due to significant complications such as fistula formation [15], recurrent strictures [16], hair growth [17], stone formation [18], diverticula [19], and meatal stenosis [20].…”

Section: Introductionmentioning

confidence: 99%

Acellular Bi-Layer Silk Fibroin Scaffolds Support Tissue Regeneration in a Rabbit Model of Onlay Urethroplasty

Chung

Franck

et al. 2014

PLoS ONE

View full text Add to dashboard Cite

Acellular scaffolds derived from Bombyx mori silk fibroin were investigated for their ability to support functional tissue regeneration in a rabbit model of urethra repair. A bi-layer silk fibroin matrix was fabricated by a solvent-casting/salt leaching process in combination with silk fibroin film casting to generate porous foams buttressed by homogeneous silk fibroin films. Ventral onlay urethroplasty was performed with silk fibroin grafts (Group 1, N = 4) (Width×Length, 1×2 cm2) in adult male rabbits for 3 m of implantation. Parallel control groups consisted of animals receiving small intestinal submucosa (SIS) implants (Group 2, N = 4) or urethrotomy alone (Group 3, N = 3). Animals in all groups exhibited 100% survival prior to scheduled euthanasia and achieved voluntary voiding following 7 d of initial catheterization. Retrograde urethrography of each implant group at 3 m post-op revealed wide urethral calibers and preservation of organ continuity similar to pre-operative and urethrotomy controls with no evidence of contrast extravasation, strictures, fistulas, or stone formation. Histological (hematoxylin and eosin and Masson's trichrome), immunohistochemical, and histomorphometric analyses demonstrated that both silk fibroin and SIS scaffolds promoted similar extents of smooth muscle and epithelial tissue regeneration throughout the original defect sites with prominent contractile protein (α-smooth muscle actin and SM22α) and cytokeratin expression, respectively. De novo innervation and vascularization were also evident in all regenerated tissues indicated by synaptophysin-positive neuronal cells and vessels lined with CD31 expressing endothelial cells. Following 3 m post-op, minimal acute inflammatory reactions were elicited by silk fibroin scaffolds characterized by the presence of eosinophil granulocytes while SIS matrices promoted chronic inflammatory responses indicated by mobilization of mononuclear cell infiltrates. The results of this study demonstrate that bi-layer silk fibroin scaffolds represent promising biomaterials for onlay urethroplasty, capable of promoting similar degrees of tissue regeneration in comparison to conventional SIS scaffolds, but with reduced immunogenicity.

show abstract

“…Bladder mucosa may be used for long segment urethral stricture reparation, since it is easy to obtain long segments of bladder mucosa. Furthermore, bladder mucosa has similar characteristics to urethral epithelium (2,5–7,13). Although complications, including meatal stenosis, prolapse and shrinkage of bladder mucosa, may occur, a high success rate could be achieved by selecting suitable cases (6,7).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

View full text Add to dashboard Cite

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.

show abstract

Urethral Stricture in Children: Treatment by Urethroplasty with Bladder Mucosa Graft

Cited by 28 publications

References 20 publications

Oral mucosa grafts for urethral reconstruction

Oral mucosa grafts for urethral reconstruction

Acellular Bi-Layer Silk Fibroin Scaffolds Support Tissue Regeneration in a Rabbit Model of Onlay Urethroplasty

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

Contact Info

Product

Resources

About