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MP-10.07: Antireflux Ureteral Substitution by an Isolated Ileal Segment
MODERATED POSTER SESSIONS
Introduction and Objective: To compare and assess the efficacy of the ventral/ dorsal onlay graft urethroplasty for urethral stricture therapy. Materials and Methods: We searched pertinent English literature via the databases MEDLINE, the Cochrane Library, and EMBASE Drugs and Pharmacology regarding the use of ventral/dorsal graft urethroplasty in the reconstruction of urethral defect associated with urethral stricture. Data were extracted by two reviewers independently and analysed by SPSS 13.0 software. Results: In total, 50 studies involving 1264 patients were included. Ventral onlay graft urethroplasty was used in 751 patients with a success rate of 82.6%, while dorsal onlay graft urethroplasty was used in 513 patients with a success rate of 86.9%(ventral vs. dorsal, 2⫽4.432, p⫽0.035). Oral mucosa graft has the highest success rate (88.1%) of all grafts, and the success rate of free skin graft onlay urethroplasty is associated with the location of graft placement (ventral vs. dorsal, p⫽0.016).Concerning the location of stricture, the urethroplasty for bulbar urethral stricture achieves the best result, with a success rate of 87.7%, which is also associated with the location of graft placement(ventral vs. dorsal, p⫽0.025). Conclusions: Dorsal onlay graft urethroplasty is better than ventral onlay. It is better to place the free skin graft in the dorsal placement. Bulbar urethral stricture is more suitable for graft onlay urethroplasty than penile urethral stricture. MP-10.06 Urethral Reconstruction Using Oral Keratinocyte-Seeded Bladder Acellular Matrix Grafts (BAMGs) Li C, Xu Y, Song L, Fu Q, Cui L, Yin S Department of Urology, Affiliated Sixth People’s Hospital, Shanghai Jiaotong University, Shanghai, China Introduction and Objective: To investigate the feasibility of urethral reconstruction using oral keratinocyte-seeded bladder acellular matrix grafts (BAMGs). Materials and Methods: Autologous oral keratinocytes were isolated, expanded and seeded onto BAMGs to obtain a tissueengineered mucosa. The tissue-engineered mucosa was assessed using morphology and scanning electron microscopy. In 24 male rabbits, a ventral urethral mucosal defect was created. Urethroplasty was performed with autogenic oral keratinocyteseeded BAMGs (12 rabbits; experimental group) or with BAMGs with no cell seeding (12 rabbits; control group). Retro-
grade urethrography were performed at 1, 2 and 6 months after grafting. The urethral grafts were analyzed grossly and histologically. Results: Oral keratinocytes had good biocompatibility with BAMGs. Rabbits implanted with oral keratinocyte-seeded BAMGs voided without difficulty. Retrograde urethrography revealed no sign of strictures at 1, 2 and 6 months. In the control group, the urethra of repaired defects was accompanied by strictures. Histological examination showed that grafts seeded with oral keratinocytes formed a single-layer structure by 1 month, and at 2 and 6 months the keratinocytes formed multilayers. There was an evident margin between graft oral keratinocytes and host epithelium. The oral keratinocytes of basilar layers of the grafts expressed P63 shown by immunocytochemistry. In the control group, histopathology demonstrated that no single-layer or stratified epithelium cells had developed at the sites of the repaired defects, whereas an inflammatory reaction was found in 2 rabbits. Conclusions: Oral keratinocytes had good biocompatibility with BAMGs. Urethral reconstruction with oral keratinocyte-seeded BAMGs was better than with BAMGs alone. MP-10.07 Antireflux Ureteral Substitution by an Isolated Ileal Segment Hinev A, Paunov S, Raikov R, Chankov P, Anakievski D, Dyakov S, Balev B ‘St. Marina’ University Hospital, Varna Medical University, Varna, Bulgaria Introduction and Objective: Pelvic surgery and irradiation of the pelvis are both associated with increased risk of iatrogenic damage of the ureter(s). With an aim to provide an optimal solution for the management of large defects of the distal ureter(s) we developed an antireflux technique of ileal ureteral substitution. We report herein our 5-year clinical experience with this technique. Materials and Methods: Between 2004 and 2009 the method was applied in 14 female patients (mean age 49.4 years, range 29 - 56 years) with iatrogenic injuries to the distal ureter(s) that occurred as a complication after total hysterectomy, with or without pelvic irradiation, for gynaecological malignancies. Reconstructive surgery was done, and the damaged ureter(s) was (were) replaced by an isolated ileal segment. The ureteroileal anastomosis was created in an antireflux manner by the implementation of the serous-
UROLOGY 74 (Supplment 4A), October 2009
lined extramural tunnel technique, originally described in orthotopic bladder substitutes. To avoid mucus retention, the distal end of the isolated ileal segment was widely anastomosed with the bladder. Results: Surgery was performed with limited rate of complications. The follow-up ultrasound and radiological studies confirmed that the procedure efficiently provided a nonobstructed unidirectional flow of urine. Optimization of the renal function and restoration of the previous patient quality of life were recorded in all cases treated by the new technique. Unlike the good functional results observed, the oncological outcome was poor: the malignant disease progressed in seven patients, three of whom died with distant metastases in spite of the adjuvant treatment applied. Conversion to ileum conduit, with (1) or without (2) concomitant cystectomy was done in three patients, due to pelvic recurrences invading the bladder. Conclusions: Ureteral substitution by an isolated ileal segment via antireflux ureteroileal and reflux ileovesical anastomosis could be an option when large defects of the distal ureter are encountered. MP-10.08 Anastomotic Urethroplasty for Posterior Urethral Trauma, Surgical Steps and Results in a Multicenter International Study with 200 Patients Kulkarni S1, Barbagli G2 1 Center for Urethral Reconstructive Surgery, Pune, India; 2Center for Urethral Reconstructive Urology, Arezzo, Italy Introduction and Objective: A retrospective study of the steps and results of anastomotic urethroplasty or posterior urethral trauma. Materials and Methods: Six surgical steps are required for anastomotic urethroplasty. Step 1-Bulbar urethral mobilization, Step 2- Crural separation, Step 3- Inferior pubectomy, Step 4-Supracrural rerouting of the urethra, Step 5-Total pubectomy, Step 6-Omental wrap. In total, 200 patients were analyzed. In India, 172 patients were operated over 10 years. There were 100 patients (58%) who required inferior pubectomy and 28 patients (17%) needed inferior pubectomy. In Italy, 18 patients were operated on in 1 year. Only 4 patients (22%) patients required inferior pubectomy. Results: The success rate was 91% for primary repair and 87% for redo repair in India; whereas in Italy, the success rate was 95%. Conclusions: There is a significant differ-
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Introduction and Objective: To compare and assess the efficacy of the ventral/ dorsal onlay graft urethroplasty for urethral stricture therapy. Materials and Methods: We searched pertinent English literature via the databases MEDLINE, the Cochrane Library, and EMBASE Drugs and Pharmacology regarding the use of ventral/dorsal graft urethroplasty in the reconstruction of urethral defect associated with urethral stricture. Data were extracted by two reviewers independently and analysed by SPSS 13.0 software. Results: In total, 50 studies involving 1264 patients were included. Ventral onlay graft urethroplasty was used in 751 patients with a success rate of 82.6%, while dorsal onlay graft urethroplasty was used in 513 patients with a success rate of 86.9%(ventral vs. dorsal, 2⫽4.432, p⫽0.035). Oral mucosa graft has the highest success rate (88.1%) of all grafts, and the success rate of free skin graft onlay urethroplasty is associated with the location of graft placement (ventral vs. dorsal, p⫽0.016).Concerning the location of stricture, the urethroplasty for bulbar urethral stricture achieves the best result, with a success rate of 87.7%, which is also associated with the location of graft placement(ventral vs. dorsal, p⫽0.025). Conclusions: Dorsal onlay graft urethroplasty is better than ventral onlay. It is better to place the free skin graft in the dorsal placement. Bulbar urethral stricture is more suitable for graft onlay urethroplasty than penile urethral stricture. MP-10.06 Urethral Reconstruction Using Oral Keratinocyte-Seeded Bladder Acellular Matrix Grafts (BAMGs) Li C, Xu Y, Song L, Fu Q, Cui L, Yin S Department of Urology, Affiliated Sixth People’s Hospital, Shanghai Jiaotong University, Shanghai, China Introduction and Objective: To investigate the feasibility of urethral reconstruction using oral keratinocyte-seeded bladder acellular matrix grafts (BAMGs). Materials and Methods: Autologous oral keratinocytes were isolated, expanded and seeded onto BAMGs to obtain a tissueengineered mucosa. The tissue-engineered mucosa was assessed using morphology and scanning electron microscopy. In 24 male rabbits, a ventral urethral mucosal defect was created. Urethroplasty was performed with autogenic oral keratinocyteseeded BAMGs (12 rabbits; experimental group) or with BAMGs with no cell seeding (12 rabbits; control group). Retro-
grade urethrography were performed at 1, 2 and 6 months after grafting. The urethral grafts were analyzed grossly and histologically. Results: Oral keratinocytes had good biocompatibility with BAMGs. Rabbits implanted with oral keratinocyte-seeded BAMGs voided without difficulty. Retrograde urethrography revealed no sign of strictures at 1, 2 and 6 months. In the control group, the urethra of repaired defects was accompanied by strictures. Histological examination showed that grafts seeded with oral keratinocytes formed a single-layer structure by 1 month, and at 2 and 6 months the keratinocytes formed multilayers. There was an evident margin between graft oral keratinocytes and host epithelium. The oral keratinocytes of basilar layers of the grafts expressed P63 shown by immunocytochemistry. In the control group, histopathology demonstrated that no single-layer or stratified epithelium cells had developed at the sites of the repaired defects, whereas an inflammatory reaction was found in 2 rabbits. Conclusions: Oral keratinocytes had good biocompatibility with BAMGs. Urethral reconstruction with oral keratinocyte-seeded BAMGs was better than with BAMGs alone. MP-10.07 Antireflux Ureteral Substitution by an Isolated Ileal Segment Hinev A, Paunov S, Raikov R, Chankov P, Anakievski D, Dyakov S, Balev B ‘St. Marina’ University Hospital, Varna Medical University, Varna, Bulgaria Introduction and Objective: Pelvic surgery and irradiation of the pelvis are both associated with increased risk of iatrogenic damage of the ureter(s). With an aim to provide an optimal solution for the management of large defects of the distal ureter(s) we developed an antireflux technique of ileal ureteral substitution. We report herein our 5-year clinical experience with this technique. Materials and Methods: Between 2004 and 2009 the method was applied in 14 female patients (mean age 49.4 years, range 29 - 56 years) with iatrogenic injuries to the distal ureter(s) that occurred as a complication after total hysterectomy, with or without pelvic irradiation, for gynaecological malignancies. Reconstructive surgery was done, and the damaged ureter(s) was (were) replaced by an isolated ileal segment. The ureteroileal anastomosis was created in an antireflux manner by the implementation of the serous-
UROLOGY 74 (Supplment 4A), October 2009
lined extramural tunnel technique, originally described in orthotopic bladder substitutes. To avoid mucus retention, the distal end of the isolated ileal segment was widely anastomosed with the bladder. Results: Surgery was performed with limited rate of complications. The follow-up ultrasound and radiological studies confirmed that the procedure efficiently provided a nonobstructed unidirectional flow of urine. Optimization of the renal function and restoration of the previous patient quality of life were recorded in all cases treated by the new technique. Unlike the good functional results observed, the oncological outcome was poor: the malignant disease progressed in seven patients, three of whom died with distant metastases in spite of the adjuvant treatment applied. Conversion to ileum conduit, with (1) or without (2) concomitant cystectomy was done in three patients, due to pelvic recurrences invading the bladder. Conclusions: Ureteral substitution by an isolated ileal segment via antireflux ureteroileal and reflux ileovesical anastomosis could be an option when large defects of the distal ureter are encountered. MP-10.08 Anastomotic Urethroplasty for Posterior Urethral Trauma, Surgical Steps and Results in a Multicenter International Study with 200 Patients Kulkarni S1, Barbagli G2 1 Center for Urethral Reconstructive Surgery, Pune, India; 2Center for Urethral Reconstructive Urology, Arezzo, Italy Introduction and Objective: A retrospective study of the steps and results of anastomotic urethroplasty or posterior urethral trauma. Materials and Methods: Six surgical steps are required for anastomotic urethroplasty. Step 1-Bulbar urethral mobilization, Step 2- Crural separation, Step 3- Inferior pubectomy, Step 4-Supracrural rerouting of the urethra, Step 5-Total pubectomy, Step 6-Omental wrap. In total, 200 patients were analyzed. In India, 172 patients were operated over 10 years. There were 100 patients (58%) who required inferior pubectomy and 28 patients (17%) needed inferior pubectomy. In Italy, 18 patients were operated on in 1 year. Only 4 patients (22%) patients required inferior pubectomy. Results: The success rate was 91% for primary repair and 87% for redo repair in India; whereas in Italy, the success rate was 95%. Conclusions: There is a significant differ-
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