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RECONSTRUCTIVE
UROLOGY
Reconstructive
urethroplasty using porcine acellular matrix: preliminary results
[Article in Italian]
Mantovani F, Trinchieri A, Mangiarotti B, Nicola M, Castelnuovo C, Confalonieri
S, Pisani E.
Department of Urology, IRCCS Ospedale Maggiore, Milano, Italy.
Arch Ital Urol Androl. 2002;74:127-8
- Objective:
The use of “porcine acellular matrix”, obtained from small
intestine submucosa, could simplify the repair of long urethral strictures,
whereas single stage techniques can be carried out only by means of
grafts, as buccal mucosa; or flaps, as prepucial skin. To our knowledge
we report the first use of porcine intestine submucosa in urethroplastic
surgery.
- Materials
and Methods:
From May 2001 to December 2001, five urethral reconstructions were completed
using “porcine acellular matrix”. Four male patients had urethral
strictures longer than 10 cm. After circumcision and penile degloving,
we extended the surgical approach to the perineum-scrotal region by
a midline longitudinal incision. The urethra was exposed, dissected
from corpora cavernosa, then rotated of 180 degrees and on this side
longitudinally incised throughout all the stenotic length. Urethroplasty
was accomplished with matrix tissue modelled according to the length
of the stenosis and grafted by a 5-0 polyglycolic acid running suture.
The enlarged urethra was then derotated, laying the graft dorsally,
closed to corpora cavernosa, to prevent pouching. A further graft was
accomplished in a female patient with a 3 cm long urethral stricture.
All urethroplasties were stented for 14 days. No complication developed.
- Results:
After 1 month urethral patency was satisfactory compared with preoperatory
images and the urinary flow was normal. After 2 months the urethra was
endoscopically verified: it was easy to appreciate the homogeneous transformation
of the graft into the native tissue. At 6-month follow-up radiological
and urodynamic outcome is still satisfactory in all patients.
- Conclusions:
According to our preliminary experience “porcine acellular matrix”
is a promising approach for the repair of long urethral strictures.
Its safety and effectiveness encourage us to treat more cases in male
and female patients.
- Editorial
Comment
The authors are probably the first to report on porcine acellular matrix
for male patients with long urethral strictures.
There are several critical points, which should be mentioned. One of
them is why alternative methods such as penile skin or buccal mucosa
had not been used in these patients. This brings up another question
regarding ethical committee approval: How do you obtain informed consent
in these patients where alternatives exist?
Nevertheless this paper has been published and provides now for the
first time a clinical experience with acellular matrix as a substitute
for the male urethra. We have to await now how this porcine material
will react in the human host in the long term. Will it be replaced by
human collagenous tissue? We still don‘t know if this replaced
tissue has some elasticity or whether the material will be encapsulated
by fibrous tissue. This may then possibly lead to late reactions, both
locally and systemically at a much later date. Furthermore porcine acellular
matrix still contains DNA and viral transmissions are a possibility.
Altogether further long term observations are mandatory before any larger
series with this material should be initiated.
Dr.
Arnulf Stenzl
Professor and Chairman of Urology
Eberhard-Karls-University Tuebingen
Tuebingen, Germany
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