Institute of Urology, Lahey Hospital and Medical Center, Burlington, Massachusetts; Department of Colon and Rectal Surgery (PWM), Lahey Hospital and Medical Center, Burlington, Massachusetts.
Institute of Urology, Lahey Hospital and Medical Center, Burlington, Massachusetts; Department of Colon and Rectal Surgery (PWM), Lahey Hospital and Medical Center, Burlington, Massachusetts.
J Urol. 2016 Sep;196(3):782-6. doi: 10.1016/j.juro.2016.03.002. Epub 2016 Mar 9.
Alternative grafts are needed for patients who are not suitable candidates for oral mucosa graft harvest or who have a paucity of oral mucosa graft available for reconstruction. Circumferential colonic mucosal grafts have demonstrated feasibility for urethral reconstruction, although sigmoid resection has been required for graft retrieval. We report the feasibility and short-term outcomes of urethral reconstruction using a rectal mucosa graft harvested by a novel, minimally invasive, transanal endoscopic microsurgical technique.
We retrospectively reviewed the records of all patients who underwent transanal endoscopic microsurgical rectal mucosa graft harvest and onlay urethroplasty since the technique was first implemented in 2013. Graft failure was defined as inability to pass a 16Fr cystoscope in the grafted urethra.
All 4 strictures were bulbopendulous with a median length of 13.5 cm (range 10 to 21). Median followup was 18 months (range 12 to 28). Stricture etiology was lichen sclerosus in 3 patients and failed hypospadias interventions in 1. Three patients had undergone at least 1 prior urethroplasty. In 1 patient stricture recurred in the graft 10 months following reconstruction. There were no colorectal complications.
To our knowledge this is the first study demonstrating urethral reconstruction using a rectal mucosa graft harvested by the transanal endoscopic microsurgical technique. Initial data revealed that this technique is feasible and safe, and minimizes graft harvest morbidity. Transanal endoscopic microsurgical harvest of a rectal mucosa graft may provide an alternative graft material for patients with long segment urethral strictures who are not candidates for oral mucosa graft harvest. Further experience and longer followup are needed to validate these findings.
对于不适合进行口腔黏膜移植采集或口腔黏膜移植供体不足的患者，需要替代移植物。环周结肠黏膜移植物已被证明可用于尿道重建，尽管需要进行乙状结肠切除术以获取移植物。我们报告了一种新的、微创的经肛门内镜显微外科技术采集直肠黏膜移植物进行尿道重建的可行性和短期结果。
我们回顾性分析了自 2013 年首次实施该技术以来所有接受经肛门内镜显微外科直肠黏膜移植物采集和覆盖式尿道成形术的患者的记录。移植物失败定义为在移植尿道中无法通过 16Fr 膀胱镜。
所有 4 例狭窄均为球部-悬垂部，中位长度为 13.5cm（范围 10-21）。中位随访时间为 18 个月（范围 12-28）。狭窄病因在 3 例患者中为硬化性苔藓，1 例为失败的尿道下裂干预。3 例患者至少进行过 1 次先前的尿道成形术。1 例患者在重建后 10 个月在移植物中再次出现狭窄。无结直肠并发症。
据我们所知，这是第一项证明使用经肛门内镜显微外科技术采集直肠黏膜移植物进行尿道重建的研究。初步数据显示，该技术具有可行性和安全性，可最大程度地减少移植物采集的发病率。经肛门内镜显微外科采集直肠黏膜移植物可能为不适合口腔黏膜移植采集且患有长段尿道狭窄的患者提供一种替代移植物材料。需要进一步的经验和更长的随访时间来验证这些发现。
