Outcomes of adult urethroplasty with commercially available acellular matrix

Abstract

Background: Reconstruction for complex urethral strictures may necessitate grafting. Buccal mucosal graft (BMG) harvest involves additional morbidity, making 'off-the-shelf' options attractive. Multiple extracellular matrices (ECMs) have been used with varying degrees of success. We reviewed our experience with MatriStem (ACell, Inc., Columbia, MD, USA) to assess safety and clinical/histologic outcomes. Methods: All patients undergoing acellular matrix-based reconstruction were included. Data regarding indications for surgery, patient demographics, subsequent procedures, clinical outcomes, and histologic analysis, when present, were collected. Results: Eight patients undergoing urethral reconstruction with ECM were identified. All repairs were performed as staged procedures. Grafting was performed with either MatriStem alone or MatriStem and concomitant BMG. Seven patients (88%) underwent prior endoscopic intervention and five patients (71%) had failed to respond to one or multiple prior urethroplasties. Length of involved segments ranged from 2.5 to 15 cm. ECM graft placement was feasible and demonstrated excellent graft take. Among patients undergoing second-stage repairs (four of eight, 50%), 50% remained patent without the need for subsequent dilation. Conclusions: Use of acellular matrix grafts in urethral reconstruction appears safe and feasible. Acellular matrix performs similarly to BMG with respect to graft take and contraction following staged repair. Further study is warranted.

Bioscaffold-Induced Brain Tissue Regeneration

“…ECM scaffolds are widely used in peripheral soft tissue repair, including bladder (Santucci and Barber, 2005; Pearlman et al, 2018), dermis (Tchanque-Fossuo et al, 2017; Jeon and Kim, 2018), muscle (Sicari et al, 2014; Zhao and Bass, 2018), heart (Badylak et al, 2006; Khalil et al, 2018), and peripheral nerve (Nectow et al, 2012; Prest et al, 2018). These biomaterials can be sourced from different organs, such as the UBM (Freytes et al, 2008; Crapo et al, 2012, 2014; Dziki et al, 2017; Faust et al, 2017), umbilical cord (Koci et al, 2017), peripheral nervous system (Prest et al, 2018), spinal cord (Tukmachev et al, 2016), as well as the brain (Crapo et al, 2012; Medberry et al, 2013; Faust et al, 2017).…”

Single-Layer Acellular Porcine Bladder Matrix as Graft in Corporoplasty for Ventral Curvature in Pediatric Proximal Hypospadias Repair: An Initial Experience

“…Although the specific form, thickness and size of the wound matrix was not described, the authors demonstrated similar graft take and contraction rates following staged repair when compared to buccal mucosal graft. 11 Case series involving use of ACell MatriStem UBM for female urethral reconstructions and closures of vesicovaginal fistulae have also been reported. 12 , 13 A pinned search with MeSH terms in PubMed demonstrates no published reports using Cytal in the pediatric urological literature.…”

Partial decellularization eliminates immunogenicity in tracheal allografts

“…Decellularization is a proven method of creating non‐immunogenic scaffolds via regenerative medicine, with several United States Food and Drug Administration approved applications 2–5 . When applied to the trachea, complete decellularization has formed scaffolds capable of supporting functional neotissue formation in vitro, but in vivo performance is limited by the loss of mechanical properties 6–12 .…”

“…and Drug Administration approved applications. [2][3][4][5] When applied to the trachea, complete decellularization has formed scaffolds capable of supporting functional neotissue formation in vitro, but in vivo performance is limited by the loss of mechanical properties. [6][7][8][9][10][11][12] Tracheal cartilage provides the primary structural support for the organ and efforts to decellularize chondrocytes from the dense extracellular matrix result in a loss of graft patency.…”