The use of small intestinal submucosa graft for hypospadias repair: Pilot study

Abstract

ObjectiveTo evaluate the outcome of using commercially available (SIS) grafts for repairing hypospadias. Collagen-based acellular matrices, including SIS and bladder submucosa matrix, have been used to repair urethral strictures, with varying success, and patients with hypospadias and with inadequate or no genital skin need a substitute tissue for urethroplasty.Patients and methodsThis pilot study included 12 patients (mean age 8 years, range 1.5–15) with hypospadias (distal in six, mid-shaft in four and proximal in two). They underwent a repair with four layers of prefabricated SIS as an onlay graft. The outcome was assessed for cosmetic appearance, urinary stream and the postvoid residual volume. The chi-squared and Mann–Whitney U-tests were used to assess the relationship between preoperative factors and the outcome of the repair with SIS grafting.ResultsThe mean (range) follow-up was 23 (6–36) months. Nine patients ultimately voided normally, with a good cosmetic appearance and no postvoid residual urine. Six patients had a successful repair with no further intervention, whilst three had small fistulae that were treated by simple closure. In three patients the graft failed, by complete disruption or stricture. Graft infection adversely affected the outcome of SIS grafting.ConclusionsThe prefabricated SIS graft can be used as an alternative substitute for urethral reconstruction when genital skin is insufficient or lacking, as in circumcised patients or a repeat hypospadias repair. Graft infection is the chief reason for graft failure and should be prevented. Further studies with more patients are needed to confirm these preliminary results.

Use of dCELL (Decellularized Human Dermis) in Repair of Urethrocutaneous Fistulas or Glans Dehiscence

“… 28 Importantly, in cases of proximal hypospadias, where larger skin grafts are often needed to reconstruct the neourethra, the harvest of additional dermal grafts may result in considerable donor site morbidity. 29 The use of decellularized dermal matrices eliminates all concerns about donor site morbidity and has complication rates similar to those of dermal autografts anyway. 30 …”

Current Status of Tissue Engineering in the Management of Severe Hypospadias

“…A recent clinical study found that SIS grafts were successful in circumcised patients with hypospadias or undergoing repeat hypospadias repair ( 71 ) (Figure 4 ). Three of the 12 patients developed fistula, which may have been caused by the occurrence of infection, but these fistulas were easy to repair.…”

“… (A) Gross appearance of a small intestine submucosa (SIS) graft; (B) penile skin degloving through a subcoronal incision, preserving the urethral plate; (C) suturing of the SIS graft in an onlay fashion; (D) suturing of the completed onlay SIS graft; (E) splitting of the dartos flap into two halves to form the second layer of coverage for the graft; and (F) final postoperative appearance [reprinted with permission from Ref. ( 71 )]. © 2013 by Elsevier B.V. …”

Tissue engineered extracellular matrices (ECMs) in urology: Evolution and future directions

“…The anterior urethra frequently requires reconstruction to treat ischaemic strictures caused by trauma or inflammation and congenital hypospadias. 45 Substitute urethroplasty, with a skin flap or graft, is most often required in instances of strictures/defects greater >2 cm, recurrent strictures or strictures of the penile urethra. Oral mucosa, derived from buccal or lingual tissue, is the gold standard grafting biomaterial in cases where there is insufficient penile skin to utilise as a flap.…”