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| Overcoming scarring in the urethra: Challenges for tissue engineering |
Simsek Abdulmuttalipab,Aldamanhori Reema,R.Chapple Christophera,MacNeil Sheilab( )
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a Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
b Department of Materials Science & Engineering, Kroto Research Institute, University of Sheffield,Sheffield, UK |
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Abstract Urethral stricture disease is increasingly common occurring in about 1% of males over the age of 55. The stricture tissue is rich in myofibroblasts and multi-nucleated giant cells which are thought to be related to stricture formation and collagen synthesis. An increase in collagen is associated with the loss of the normal vasculature of the normal urethra. The actual incidence differs based on worldwide populations, geography, and income. The stricture aetiology, location, length and patient's age and comorbidity are important in deciding the course of treatment. In this review we aim to summarise the existing knowledge of the aetiology of urethral strictures, review current treatment regimens, and present the challenges of using tissue-engineered buccal mucosa (TEBM) to repair scarring of the urethra. In asking this question we are also mindful that recurrent fibrosis occurs in other tissues—how can we learn from these other pathologies?
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Received: 09 November 2016
Published: 09 June 2018
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| Penile, % | Bulbar, % | | Iatrogenic | 40 | 35 | | Idiopathic | 15 | 40 | | Inflammatory | 40 | 10 | | Traumatic | 5 | 15 |
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Iatrogenic stricture aetiology (%) by location [13].
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Algorithm of anterior urethral stricture treatment (A) and bulbar urethral stricture treatment (B) [4].
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| Factors | Risk ratio (range) | | Diseases | | Smoking | 1.8 (1.0-3.1) | | Diabetes mellitus | 2.0 (0.8-4.9) | | Chronic obstructive pulmonary disease | 1.3 (0.4-4.4) | | Connective tissue disease | 1.3 (0.3-4.7) | | Coronary artery disease | 1.0 (0.4-2.5) | | Stricture aetiology | | Trauma | 2.6 (0.98-6.9) | | Iatrogenic | 3.4 (1.2-10) | | Infectious | 7.3 (2.3-23.7) | | Lichen sclerosus | 5.9 (2.1-16.5) | | Radiation | 3.3 (0.8-14) | | Location | | Anterior | 0.49 (0.2-1.2) | | Posterior | 0.67 (0.3-1.7) | | Panurethral | 1.4 (0.38-5) | | Prior treatment | | Urethroplast | 6.9 (2.1-22.6) | | Urethrotomy | 0.8 (0.2-2.8) | | Dilation | 0.7 (0.3-1.4) | | Hypospadias | 1.6 (0.7-3.9) | | Stricture length >5 cm | 2.3 (1.2-4.5) | | Age | 0.99 (0.98-1.01) |
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