[Reconstructive urethroplasty using porcine acellular matrix: preliminary results].
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.


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.
Mantovani
Franco
F
Department of Urology, IRCCS Ospedale Maggiore, Milano, Italy.
Trinchieri
Alberto
A
Mangiarotti
Barbara
B
Nicola
Massimiliano
M
Castelnuovo
Chiara
C
Confalonieri
Silvia
S
Pisani
Enrico
E
D000368:Aged; D000818:Animals; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000637:transplantation*; D008297:Male; D013552:Swine; D014525:Urethral Stricture / Q000601:surgery*; D013520:Urologic Surgical Procedures