Choudhury Sunirmal, Khare Eeshansh, Pal Dilip Kumar
Department of Urology, Institute of Postgraduate Medical Education and Research (IPGME-R), Kolkata, India.
Turk J Urol. 2022 May;48(3):222-228. doi: 10.5152/tud.2022.22018.
Buccal mucosal graft is the best autologous material for substitution urethroplasty. However, in cases where buccal mucosa is unavailable, a non-autologous tissue like acellular tissue-engineered pericar- dial patch can be very helpful. Our study is a small approach regarding the success and durability of acellular tissue-engineered pericardial patch as a substitution tissue in urethroplasty.
A total of 22 patients underwent acellular tissue-engineered pericardial patch substi- tution urethroplasty using dorsolateral onlay technique for long segment urethral stricture, for a period of twoyears. Observations and comparison were made in terms of postoperative change in maximum urinary flowrate (Qmax), resolution of obstructive lower urinary tract symptoms, improvement in retrograde urethrogram and complications encountered, with buccal mucosal graft urethroplasty as a historical control.
Out of these 22 patients, 18 patients had successful outcomes considering maximum flow rate (Qmax)> 10 mL/s on uroflowmetry, resolved obstructive lower urinary tract symptoms, and normal postoperativeretrograde urethrogram, whereas four patients were considered a failure because of Qmax <10 mL/s, unre- solved obstructed lower urinary tract symptoms and recurrence of urethral stricture on retrograde urethro-gram and development of urethrocutaneous fistula.
Acellular tissue-engineered pericardial patch substitution urethroplasty can be a useful alternative to autologous tissue substitution, especially where the buccal mucosal graft is unavailable for urethroplasty.
颊黏膜移植物是替代尿道成形术的最佳自体材料。然而，在无法获取颊黏膜的情况下，非自体组织如脱细胞组织工程心包补片可能会非常有帮助。我们的研究是关于脱细胞组织工程心包补片作为尿道成形术替代组织的成功率和耐久性的一项小型研究。
共有22例患者采用背外侧覆盖技术，使用脱细胞组织工程心包补片进行替代尿道成形术治疗长段尿道狭窄，为期两年。以颊黏膜移植物尿道成形术作为历史对照，观察并比较术后最大尿流率（Qmax）的变化、下尿路梗阻症状的缓解情况、逆行尿道造影的改善情况以及所遇到的并发症。
在这22例患者中，18例患者取得了成功，即尿流率测定时最大尿流率（Qmax）>10 mL/s，下尿路梗阻症状缓解，术后逆行尿道造影正常；而4例患者被认为治疗失败，原因是Qmax<10 mL/s，下尿路梗阻症状未缓解，逆行尿道造影显示尿道狭窄复发以及出现尿道皮肤瘘。
脱细胞组织工程心包补片替代尿道成形术可以成为自体组织替代的一种有用的替代方法，尤其是在无法获取颊黏膜移植物进行尿道成形术的情况下。
