1-Stage Urethral Reconstruction Using Colonic Mucosa Graft for the Treatment of a Long Complex Urethral Stricture

Abstract

This initial experience in 16 patients indicates that colonic mucosa graft urethroplasty is a feasible procedure for long, complex anterior urethral strictures. The technique may be considered for urethral reconstruction when more conventional procedures have failed.

Evolution in Tissue Engineering for the Lower Urinary Tract

“…A dog model has been studied and it was also used for human urethral reconstruction with relatively good results. The principal complications at the harvest site were not described but at the reconstruction site: meatal stenosis, bulbar or bulbomembranous urethral stenosis and proximal anastomotic site stricture were observed with low complication rate (Xu et al 2004, Xu et al 2009, Xu et al 2003.…”

The Treatment of Panurethral Strictures

“…Such strictures were traditionally managed with 2-stage repairs using scrotal skin (1,2). However, as the field of urethral reconstruction developed, there was a move towards 1-stage repair using free grafts made of skin, pedicle-based flaps or combined approaches (3)(4)(5)(6)(7)(8)(9). Numerous substitution urethroplasty techniques have been described and there were, however, no universally accepted graft material for either primary urethral substitution or technique of reconstruction after multiple failed attempts.…”

“…Numerous substitution urethroplasty techniques have been described and there were, however, no universally accepted graft material for either primary urethral substitution or technique of reconstruction after multiple failed attempts. (3)(4)(5)(6)(7)(8)(9). The penile skin flap provided a versatile mechanism for achieving excellent results in the single-stage repair of complex anterior urethral strictures.…”

“…Berglund et al (5) reported a series of 18 patients with a mean stricture length of 15.1 cm using combined buccal mucosal graft and genital skin flap for reconstruction of extensive anterior urethral strictures. For those patients in whom no adequate donor skin was available for grafting because of multiple penile surgeries or diseased skin existing, mucosal grafts urethroplasty may be appropriate (7,8). Several experimental studies and clinical experiences have contributed to the development and evolution of substitute urethroplasty in surgical treatment of penile and bulbar urethral strictures.…”

“…Several experimental studies and clinical experiences have contributed to the development and evolution of substitute urethroplasty in surgical treatment of penile and bulbar urethral strictures. In 2002 and 2003, we described the results of a pilot study on the use of the colonic mucosa as a novel substitute for urethral reconstruction in 10 dogs before performing the operation in 16 patients with severe lengthy urethral stricture (7,12,13). In 2009, we reported a series of 35 patients with a mean stricture length of 15.1 cm and mean followup 53.6 months (range 26 to 94) using colonic mucosal graft for reconstruction of extensive urethral strictures (14).…”