2 NEW BULBAR URETHROPLASTY USING TISSUE-ENGINEERED ORAL MUCOSAL GRAFT: A PRELIMINARY CLINICAL REPORT

Vol. 189, No. 4S, Supplement, Saturday, May 4, 2013

THE JOURNAL OF UROLOGY姞

Trauma/Reconstruction: Traum & Reconstructive Surgery (1) Moderated Poster Session 1 Saturday, May 4, 2013

1:00 PM-3:00 PM

1 IDENTIFYING PATIENTS AT RISK FOR COMPLICATIONS OF URETHRAL STRICTURE: THE EFFECT OF PATIENT AGE AND STRICTURE LENGTH Keith Rourke*, Lucas Dean, Edmonton, Canada INTRODUCTION AND OBJECTIVES: Although urethral stricture can certainly diminish patient-reported quality of life, a substantial proportion of patients will experience significant complications including renal failure, urethral abscess, acute urinary retention and difficult catheterization. The objective of this study is to determine which clinical factors are associated with complications of urethral stricture specifically at the time of presentation. METHODS: A retrospective analysis of presenting symptoms was performed on a cohort of 611 patients presenting with anterior urethral stricture from July 2004 to June 2010. Complications of stricture were recorded and compared to patient age, stricture length, stricture etiology and other patient demographics. Renal failure related to the stricture, urethral abscess, acute urinary retention requiring emergent urologic intervention and difficult catheterization requiring emergent urology intervention were considered significant complications. RESULTS: Of the 611 patients, 240 patients (39%) had a complication directly related to urethral stricture including acute urinary retention (30%), difficult catheterization (14%), urethral abscess (7%), and renal failure (4%). Stricture length was predictive of complications, with 50% of those ⱖ6cm having a complication compared to 36% of those ⬍6cm (p⫽0.001). Age over the mean age of 50 was also associated with a greater likelihood of complication (44% vs. 35%, p⫽0.025). Men with stricture secondary to hypospadias had the highest complication rate of 49%, followed by iatrogenic stricture (48%), lichen sclerosis (37%), and idiopathic and trauma (36%) (p⫽0.163). Penile strictures were associated with the highest rate of complications (48%), when compared to panurethral (41%) and bulbar strictures (36%) but did not achieve statistical significance (p⫽0.075). CONCLUSIONS: For many patients urethral stricture is a morbid condition. While all patients with recurrent urethral stricture potentially benefit from urethroplasty, older patients and patients with long strictures are at highest risk of associated complications. Despite potentially lower success rates with urethroplasty these patients should be strongly encouraged to pursue definitive treatment with urethroplasty. Source of Funding: None

2 NEW BULBAR URETHROPLASTY USING TISSUE-ENGINEERED ORAL MUCOSAL GRAFT: A PRELIMINARY CLINICAL REPORT Guido Barbagli, Arezzo, Italy; Gouya Ram Liebig, Dresden, Germany; Dirk Fahlenkamp, Chemnitz, Germany; Massimo Lazzeri*, Milano, Italy INTRODUCTION AND OBJECTIVES: Here we describe the first series of a homogeneous series of patients who underwent tissueengineered oral mucosal graft urethroplasty for bulbar urethral stricture. METHODS: The patients selected for this procedure were patients with idiopathic uncomplicated bulbar urethral stricture. For the production of engineered oral graft (MukoCell®), a tiny oral mucosa biopsy was taken form the cheek of patient under local anaesthesia. The biopsy was sent to an advanced pharmaceutical clean room facility for manufacturing of cell-based medicinal products according to “Good

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Manufacturing Practice” (GMP). During three weeks, cells were isolated from the biopsy, expanded and cultured on the surface of a biocompatible collagen scaffold. The patient’s own engineered oral graft (MukoCell®) was then packed in a sterile container and sent to the Hospital. MukoCell® was implanted in the bulbar urethra as an inlay graft on the urethral plate. The bulbar urethra was closed over 16 Fr. Foley silicone catheter. Three weeks after surgery, all patients underwent a voiding urethrography. Uroflowmetry was performed every 3 months in all patients at the followup control. RESULTS: From December 2010 to May 2012, we have used this technique in 12 patients with a mean age of 43 years (range 31-75 years) with idiopathic uncomplicated bulbar urethral strictures with a mean length 4 cm (range 2-6 cm). With a mean follow-up of 10 months (range 4-21 months), 1 patient (8.4%) developed stricture recurrence requiring further urethral manipulation, and 11 patients (91.6%) showed no stricture recurrence. CONCLUSIONS: Our preliminary experience using tissue engineered oral mucosa graft in the repair of uncomplicated bulbar urethral strictures showed satisfactory preliminary results at short-term follow-up. Longer followup period is mandatory to evaluate this new approach to urethral stricture repair. Source of Funding: None

3 THE TWO- STAGED URETHRAL AND PENILE RECONSTRUCTION USING VASULARISED SCROTAL FLAP AND BUCCAL MUCOSAL GRAFT Abhishek Pandey*, Joern Beier, Cristina Raita, Hansjoerg Keller, Hof, Germany INTRODUCTION AND OBJECTIVES: The Urethroplatsy with BMG for urethral strictures can be done as a single stage procedure in most of the cases. However, complicated strictures with fully destructed urethra and penile skin because of complete scarring pose a challenge. In this prospective study we determine the success rates after the twostaged repairs. METHODS: Out of 700 (07/1994- 06/2012) consecutive urethroplasties because of urethral stricture in our tertiary referral centre 21 (3%) patients underwent a two - staged procedure. All of these 21 were included in the study. All of them were so-called Hypospadias cripple with a complete destroyed urethra a penile deviation and a complete loss of penile skin because of extended scarring. The number of previous failed operative procedures was 5.5 (5-30). The mean stricture length was 10.5 cm (4-18). At first we removed the scarred penile skin and the destructed urethra. The BMG was transplanted on the ventral aspect and an urethrostomy was performed. After 4-6 months the graft was tubularised and covered with a pedicled scrotal flap. Data for this study were prospectively recorded with the help of standardised questionnaires, self reported, postally and by evaluating uroflow and residual urine every three months in the first year and six monthly thereafter. In the case of uroflow less than 20 ml/s and/ or residual urine more than 50 ml and/ or evidence of urinary tract infection, an urethroscopy and urethrography was done. RESULTS: At a mean follow up of 37.5 months (3-85), 19/21 (90.4%) of the patients are recurrence free. In one case the scrotal flap became necrotic while in one more we noted necrosis of urethral plate. CONCLUSIONS: In case of fully destroyed urethra and a complete loss of penile skin the two- staged procedure using BMG followed by coverage by a pedicled scrotal flap is a highly effective procedure. The results are comparable with the single staged primary reconstruction, done for uncomplicated cases. Source of Funding: None