Objective: Urethral stricture is a highly prevalent disease and has a continued rising incidence. The global burden of disease keeps rising as there are significant rates of recurrence with the existing management options with the need for additional repeat procedures. Moreover, the existing treatment options are associated with significant morbidity in the patient. Long segment urethral strictures are most commonly managed by augmentation urethroplasty. We explored the potential for the application of an acellular tissue engineered bovine pericardial patch in augmentation urethroplasty in a series of our patients suffering from urethral stricture disease. The decreased morbidity due to the avoidance of harvest of buccal mucosa, decreased operative time and satisfactory postoperative results make it a promising option for augmentation urethroplasty. Methods: Nine patients with long segment anterior urethral strictures (involving penile and/or bulbar urethra and stricture length >4 cm) were included in the study after proper informed consent was obtained. Acellular tissue engineered indigenous bovine pericardial patch was used for urethroplasty using dorsal onlay technique. Results: A total of nine patients underwent tissue engineered indigenous pericardial patch urethroplasty for long segment urethral strictures, mostly catheter injury induced or associated with balanitis xerotica obliterans. Median follow-up was 8 months (range: 2-12 months). Out of nine patients, eight (88.9%) were classified as success and one (11.1%) was classified as failure. Conclusion: Our study brings a product of tissue engineering, already being used in the cardiovascular surgery domain, into the urological surgery operating room with satisfactory results achieved using standard operating techniques of one stage urethroplasty.
Tapan K. Mandal,Shashanka Dhanuka,Sunirmal Choudhury, et al. Tissue engineered indigenous pericardial patch urethroplasty: A promising solution to a nagging problem[J]. Asian Journal of Urology,
2020, 7(1): 56-60.
Preoperative retrograde urethrogram and voiding cystourethrogram. (A) Control film; (B) Retrograde urethrogram; (C) Cystogram of full bladder; (D) Voiding cystourethrogram; (E) Voiding cystourethrogram of invert mode image; (F) Post void image.
Intraoperative images. (A) Stricture urethral plate; (B) Bovine pericardial patch; (C) Pericardial patch placed dorsally; (D) Quilting of patch to underlying corpora cavernosa; (E) Another row of quilting of patch; (F) Tubularization of urethra.
Patients
N
Success, n (%)
Failure, n (%)
Overall
9
8 (88.9)
1 (11.1)
Stricture site
Penile
2
2 (100)
0 (0)
Peno-bulbar
7
6 (85.7)
1 (14.3)
Stricture length
5-7 cm
2
2 (100)
0 (0)
>7-10 cm
3
3 (100)
0 (0)
>10-13 cm
2
2 (100)
0 (0)
>13 cm
2
1 (50)
1 (50)
Native urethral plate
5 mm
4
4 (100)
0 (0)
6 mm
5
4 (80)
1 (20)
Stricture characteristics.
Patients Serial No.
Preoperative Qmax on uroflowmetry (mL/s)
Postoperative Qmax on uroflowmetry (mL/s)
8th day
3 months
6 months
1
3
20
20
19
2
4
24
25
22
3
3
14
10
15
4
6
30
24
24
5
5
24
23
24
6
4
28
23
22
7
7
14
15
15
8
6
26
25
22
9
6
20
19
19
Maximal flow on uroflowmetry.
[1]
Chapple C, Andrich D, Atala A, Barbagli G, Cavalcanti A, Kulkarni S , et al. SIU/ICUD consultation on urethral strictures: the management of anterior urethral stricture disease using substitution urethroplasty. Urology 2014; 83(Suppl. 3):S31-47.
[2]
Moon SJ, Kim DH, Jo JK, Chung JH, Lee JY, Park SY , et al. Bladder reconstruction using bovine pericardium in a case of enterovesical fistula. Korean J Urol 2011; 52:150-3.
[3]
Chee JY, Durai P, Wu MWF, Tiong HY . Bladder repair following iatrogenic cystotomy in irradiated small capacity bladders. Singapore Med J 2015; 56:e49-52. https://doi.org/10.11622/smedj.2015052.
[4]
Li X, Guo Y, Ziegler KR, Model LS, Eghbalieh SD, Brenes RA , et al. Current usage and future directions for the bovine pericardial patch. Ann Vasc Surg 2011; 25:561-8.
[5]
Vesely I, Mako WJ . Comparison of the compressive buckling of porcine aortic valve cusps and bovine pericardium. J Heart Valve Dis 1998; 7:34-9.
[6]
Cheng L, Li S, Wang Z, Huang B, Lin J . A brief review on anterior urethral strictures. Asian J Urol 2018; 5:88-93.