Porcine Small Intestinal Submucosa Graft For Repair Of Anterior Urethral Strictures

Main Category: Urology / Nephrology
Article Date: 20 Aug 2007 - 0:00 PDT

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UroToday.com- Substitution urethroplasty using free grafts or pedicled skin flaps is the alternative to anastomotic urethroplasty for strictures that are too long for this proven technique. These known substitution techniques are not without donor-site morbidity or sacculations that can lead to delayed post-void dribble. Synthetic materials have been tried in the past without great results.

In a recent study by Richard Fiala and colleagues from Olomouc Czech Republic the midterm performance of the SIS graft in anterior urethral reconstruction was evaluated. The review is published in the June 2007 issue of European Urology.

Fifty patients aged 45-73 years (mean 63 years) with anterior urethral strictures underwent urethroplasty using a porcine SIS collagen-based matrix for urethral reconstruction. Stricture location was in the bulbar urethra in 10 patients, the bulbo-penile area in 31 cases, and the distal penile urethra in 9 patients. All patients received a four-layered SIS patch graft in a ventral onlay fashion. Failure was defined as a stricture on urethrogram.

Analysis of results revealed that after a mean follow-up of 31.2 months the clinical, radiological, and cosmetic findings were excellent in 40 (80%) patients. Strictures recurred in one of 10 bulbar repairs, 5 of 31 bulbopenile repairs, and four of nine penile stricture repairs. These all occurred in the first 6 months post-operatively. Successes appeared long-lasting.

As with most substitution urethroplasties bulbar repairs performed the best owing to the robust vascularity of this area which is more likely to support a free graft such as SIS. As expected, the further distal the repair became the poorer the results. The SIS graft appears to be an option for substitution urethroplasty in the bulbar urethra although the success rate does not equal the short-term and likely long-term results of the buccal mucosa graft.

Fiala R, Vidlar A, Vrtal R, Belej K, Student V

Eur Urol. 51(6):1702-8, June 2007
doi:10.1016/j.eururo.2007.01.099

Reported by UroToday.com Contributing Editor Michael J. Metro, M.D

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