title: Urethral Reconstruction with Rectal Mucosa Graft Onlay: A Novel, Minimally Invasive Technique.
abstract: OBJECTIVE
  Alternative grafts are needed for patients who are not suitable candidates for oral mucosa graft harvest or who have a paucity of oral mucosa graft available for reconstruction. Circumferential colonic mucosal grafts have demonstrated feasibility for urethral reconstruction, although sigmoid resection has been required for graft retrieval. We report the feasibility and short-term outcomes of urethral reconstruction using a rectal mucosa graft harvested by a novel, minimally invasive, transanal endoscopic microsurgical technique.
  
  
  METHODS
  We retrospectively reviewed the records of all patients who underwent transanal endoscopic microsurgical rectal mucosa graft harvest and onlay urethroplasty since the technique was first implemented in 2013. Graft failure was defined as inability to pass a 16Fr cystoscope in the grafted urethra.
  
  
  RESULTS
  All 4 strictures were bulbopendulous with a median length of 13.5 cm (range 10 to 21). Median followup was 18 months (range 12 to 28). Stricture etiology was lichen sclerosus in 3 patients and failed hypospadias interventions in 1. Three patients had undergone at least 1 prior urethroplasty. In 1 patient stricture recurred in the graft 10 months following reconstruction. There were no colorectal complications.
  
  
  CONCLUSIONS
  To our knowledge this is the first study demonstrating urethral reconstruction using a rectal mucosa graft harvested by the transanal endoscopic microsurgical technique. Initial data revealed that this technique is feasible and safe, and minimizes graft harvest morbidity. Transanal endoscopic microsurgical harvest of a rectal mucosa graft may provide an alternative graft material for patients with long segment urethral strictures who are not candidates for oral mucosa graft harvest. Further experience and longer followup are needed to validate these findings.
authors.affiliation: Institute of Urology, Lahey Hospital and Medical Center, Burlington, Massachusetts; Department of Colon and Rectal Surgery (PWM), Lahey Hospital and Medical Center, Burlington, Massachusetts.
authors.forename: Drew A
authors.initials: DA
authors.lastname: Palmer
authors.affiliation: Institute of Urology, Lahey Hospital and Medical Center, Burlington, Massachusetts; Department of Colon and Rectal Surgery (PWM), Lahey Hospital and Medical Center, Burlington, Massachusetts.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Marcello
authors.affiliation: Institute of Urology, Lahey Hospital and Medical Center, Burlington, Massachusetts; Department of Colon and Rectal Surgery (PWM), Lahey Hospital and Medical Center, Burlington, Massachusetts.
authors.forename: Leonard N
authors.initials: LN
authors.lastname: Zinman
authors.affiliation: Institute of Urology, Lahey Hospital and Medical Center, Burlington, Massachusetts; Department of Colon and Rectal Surgery (PWM), Lahey Hospital and Medical Center, Burlington, Massachusetts. Electronic address: alex.j.vanni@lahey.org.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Vanni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003558:Cystoscopy; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000637:transplantation*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012007:Rectum; D012189:Retrospective Studies; D013997:Time Factors; D014525:Urethral Stricture / Q000175:diagnosis / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods*; D055815:Young Adult
keywords: autografts; lichen sclerosus et atrophicus; mucous membrane; rectum; urethral stricture