Centro Chirurgico Toscano, Arezzo, Italy.
Clinic and Policlinic for Urology, University of Cologne, Cologne, Germany.
J Urol. 2018 Aug;200(2):448-456. doi: 10.1016/j.juro.2018.02.3102. Epub 2018 Mar 28.
We investigated whether tissue engineered material may be adopted using standard techniques for anterior urethroplasty.
We performed a retrospective multicenter study in patients with recurrent strictures, excluding those with failed hypospadias, lichen sclerosus, traumatic and posterior strictures. A 0.5 cm oral mucosa biopsy was taken from the patient cheek and sent to the laboratory to manufacture the graft. After 3 weeks the tissue engineered oral mucosal MukoCell® graft was sent to the hospital for urethroplasty. Four techniques were used, including ventral onlay, dorsal onlay, dorsal inlay and a combined technique. Cystourethrography was performed 1 month postoperatively. Patients underwent clinical evaluation, uroflowmetry and post-void residual urine measurement every 6 months. When the patient showed obstructive symptoms, defined as maximum urine flow less than 12 ml per second, the urethrography was repeated. Patients who underwent further treatment for recurrent stricture were classified as having treatment failure.
Of the 38 patients with a median age of 57 years who were included in study the strictures were penile in 3 (7.9%), bulbar in 29 (76.3%) and penobulbar in 6 (15.8%). Median stricture length was 5 cm and median followup was 55 months. Treatment succeeded in 32 of the 38 patients (84.2%) and failed in 15.8%. Success was achieved in 85.7% of ventral onlay, 83.3% of dorsal onlay, 80% of dorsal inlay and 100% of combined technique cases. No local or systemic adverse reactions due to the engineered material were noted.
Our findings show that a tissue engineered oral mucosa graft can be implanted using the same techniques suggested for anterior urethroplasty and native oral mucosa, and guaranteeing a similar success rate.
我们研究了组织工程材料是否可以采用标准技术用于前尿道成形术。
我们对患有复发性狭窄的患者进行了回顾性多中心研究，不包括那些患有尿道下裂失败、硬化性苔藓、创伤性和后尿道狭窄的患者。从患者的脸颊上取 0.5 厘米的口腔黏膜活检，并送到实验室制造移植物。3 周后，组织工程口腔黏膜 MukoCell®移植物被送到医院进行尿道成形术。使用了 4 种技术，包括腹侧覆盖、背侧覆盖、背侧镶嵌和联合技术。术后 1 个月行膀胱尿道造影。患者每 6 个月进行临床评估、尿流率和残余尿量测量。当患者出现梗阻症状（定义为最大尿流率小于 12 毫升/秒）时，重复进行尿道造影。因复发性狭窄而接受进一步治疗的患者被归类为治疗失败。
38 例患者年龄中位数为 57 岁，其中阴茎狭窄 3 例（7.9%），球部狭窄 29 例（76.3%），阴茎球部狭窄 6 例（15.8%）。狭窄长度中位数为 5 厘米，中位随访时间为 55 个月。38 例患者中有 32 例（84.2%）治疗成功，15.8%治疗失败。腹侧覆盖成功率为 85.7%，背侧覆盖成功率为 83.3%，背侧镶嵌成功率为 80%，联合技术成功率为 100%。未发现因工程材料引起的局部或全身不良反应。
我们的研究结果表明，组织工程口腔黏膜移植物可以采用与前尿道成形术和天然口腔黏膜相同的技术进行植入，并保证相似的成功率。
