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Wu Z, Chen M, Mori R. Urethral carcinoma after skin substitution urethral reconstruction. Can J Urol 2024; 31:11858-11860. [PMID: 38642465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/22/2024]
Abstract
Urethral cancer after urethral reconstruction is an under-recognized, uncommon disease associated with significant morbidity and mortality. The survival rates of patients with carcinoma of the bulbar urethra are as low as 20%-30%. Stricture recurrence and unrecognized malignant changes present prior to reconstruction are major risk factors for urethral cancer. Skin substitution urethroplasty is subjected to higher rates of recurrence, which lends to the potential for carcinogenesis. We present a case of a 59-year-old male who underwent multi-stage skin substitution urethroplasty who developed urethral carcinoma 20 years later.
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Affiliation(s)
- Zhan Wu
- Division of Urology, Geisinger, Danville, Pennsylvania, USA
| | - Mystie Chen
- Division of Urology, Geisinger, Danville, Pennsylvania, USA
| | - Ryan Mori
- Division of Urology, Geisinger, Danville, Pennsylvania, USA
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Chen S, Chen J, Zhang J, Wang K, Wei J, Weng M, Zhu L. Laparoscopic prostatectomy with complete urethral reconstruction for sexual active BPH patients. MINIM INVASIV THER 2024; 33:29-34. [PMID: 37971312 DOI: 10.1080/13645706.2023.2264390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 09/14/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To describe our technique of transvesical laparoscopic simple prostatectomy (LSP) plus complete urethral reconstruction(CUR). MATERIAL AND METHODS From May 2019 to May 2021, 28 BPH patients with prostate volumes > 80 ml and the requirement to preserve the ejaculatory function (EF) received LSP plus CUR. Baseline demographics, pathology data, perioperative and postoperative complications, and functional outcomes were assessed. Data were analyzed with the Wilcoxon test. RESULTS The median prostate volume was 106 ml. All patients successfully underwent LSP with no intraoperative complications or conversions to open surgery. The median operative time was 146 min. A total of five Clavien-Dindo Grade1-2 postoperative complications were noted, including infection, prolonged urine leakage and cardiac arrhythmia. No patient reported postoperative urgent or stress urinary incontinence. Functional outcomes at one-year follow-up demonstrated significant improvement from baseline with median IPSS and Qmax (p both < 0.001). Compared with baseline, no significant difference was observed in IIEF and MSHQ-EjD-SF at 6 and 12 months postoperatively. CONCLUSIONS Our data support transperitoneal-transvesical LSP plus CUR as a safe and effective surgical technique for treating BPH with large prostate adenoma, regardless of the volume of the median lobe, especially for patients requiring to preserve antegrade ejaculation.
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Affiliation(s)
- Shushang Chen
- Department of Urology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China
- Department of Urology, Affiliated Dongfang Hospital of Xiamen University, Fuzhou, China
| | - Jin Chen
- Department of Urology, Affiliated Dongfang Hospital of Xiamen University, Fuzhou, China
- Institute of Transplantation Medicine, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Jianping Zhang
- Department of Urology, Affiliated Dongfang Hospital of Xiamen University, Fuzhou, China
- Department of Urology, Affiliated Haixia Hospital of Huaqiao University, Quanzhou, China
| | - Kuanyin Wang
- Department of Urology, Affiliated Dongfang Hospital of Xiamen University, Fuzhou, China
- Department of Urology, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Junjie Wei
- Department of Urology, Affiliated Dongfang Hospital of Xiamen University, Fuzhou, China
| | - Mingfang Weng
- Department of Urology, Affiliated Dongfang Hospital of Xiamen University, Fuzhou, China
| | - Lingfeng Zhu
- Department of Urology, Affiliated Dongfang Hospital of Xiamen University, Fuzhou, China
- Department of Urology, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
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3
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Abbas TO, Parangusan H, Yalcin HC, Hassan M, Zakrif L, Zandi N, Pennisi CP. Trilayer composite scaffold for urethral reconstruction: in vitroevaluation of mechanical, biological, and angiogenic properties. Biomed Mater 2024; 19:025022. [PMID: 38194708 DOI: 10.1088/1748-605x/ad1c9c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/09/2024] [Indexed: 01/11/2024]
Abstract
Regeneration of damaged urethral tissue remains a major challenge in the field of lower urinary tract reconstruction. To address this issue, various synthetic and natural biodegradable biomaterials are currently being explored for the fabrication of scaffolds that promote urethral regeneration and healing. In this study, we present an approach to fabricate a trilayer hybrid scaffold comprising a central layer of poly(lactic acid) (PLA) between two layers of chitosan. The chitosan/PLA/chitosan (CPC) scaffolds were fabricated by a sequential electrospinning process and their properties were evaluated for their suitability for urethral tissue engineering. The physical and biological properties of the CPC scaffolds were evaluated in comparison to electrospun PLA scaffolds and acellular dermis (Alloderm) as controls for a synthetic and a natural scaffold, respectively. Compared to the controls, the CPC scaffolds exhibited higher elastic modulus and ultimate tensile strength, while maintaining extensibility and suture retention strength appropriate for clinical use. The CPC scaffolds displayed significant hydrophilicity, which was associated with a higher water absorption capacity of the chitosan nanofibres. The degradation products of the CPC scaffolds did not exhibit cytotoxicity and promoted wound closure by fibroblastsin vitro. In addition, CPC scaffolds showed increased growth of smooth muscle cells, an essential component for functional regeneration of urethral tissue. Furthermore, in a chicken embryo-based assay, CPC scaffolds demonstrated significantly higher angiogenic potential, indicating their ability to promote vascularisation, a crucial aspect for successful urethral reconstruction. Overall, these results suggest that CPC hybrid scaffolds containing both natural and synthetic components offer significant advantages over conventional acellular or synthetic materials alone. CPC scaffolds show promise as potential candidates for further research into the reconstruction of the urethrain vivo.
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Affiliation(s)
- Tariq O Abbas
- Regenerative Medicine Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Pediatric Surgery Department, Hamad General Hospital, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
- Urology Division, Urology Department, Sidra Medicine, Doha, Qatar
| | | | - Huseyin C Yalcin
- Biomedical Research Centre, Qatar University, Doha, Qatar
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Mohamed Hassan
- Centre for Advanced Materials, Qatar University, Doha, Qatar
| | - Lubna Zakrif
- Biomedical Research Centre, Qatar University, Doha, Qatar
| | - Nooshin Zandi
- Regenerative Medicine Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Cristian P Pennisi
- Regenerative Medicine Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Wang L, Wang K, Yang M, Yang X, Li D, Liu M, Niu C, Zhao W, Li W, Fu Q, Zhang K. Urethral Microenvironment Adapted Sodium Alginate/Gelatin/Reduced Graphene Oxide Biomimetic Patch Improves Scarless Urethral Regeneration. Adv Sci (Weinh) 2024; 11:e2302574. [PMID: 37973550 PMCID: PMC10787096 DOI: 10.1002/advs.202302574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 09/17/2023] [Indexed: 11/19/2023]
Abstract
The nasty urine microenvironment (UME) is an inherent obstacle that hinders urethral repair due to fibrosis and swelling of the oftentimes adopted hydrogel-based biomaterials. Here, using reduced graphene oxide (rGO) along with double-freeze-drying to strengthen a 3D-printed patch is reported to realize scarless urethral repair. The sodium alginate/gelatin/reduced graphene oxide (SA/Gel/rGO) biomaterial features tunable stiffness, degradation profile, and anti-fibrosis performance. Interestingly, the 3D-printed alginate-containing composite scaffold is able to respond to Ca2+ present in the urine, leading to enhanced structural stability and strength as well as inhibiting swelling. The investigations present that the swelling behaviors, mechanical properties, and anti-fibrosis efficacy of the SA/Gel/rGO patch can be modulated by varying the concentration of rGO. In particular, rGO in optimal concentration shows excellent cell viability, migration, and proliferation. In-depth mechanistic studies reveal that the activation of cell proliferation and angiogenesis-related proteins, along with inhibition of fibrosis-related gene expressions, play an important role in scarless repair by the 3D-printed SA/Gel/rGO patch via promoting urothelium growth, accelerating angiogenesis, and minimizing fibrosis in vivo. The proposed strategy has the potential of resolving the dilemma of necessary biomaterial stiffness and unwanted fibrosis in urethral repair.
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Affiliation(s)
- Liyang Wang
- The Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, 200233, P. R. China
- School of Materials Science and Engineering, Shanghai University of Engineering Science, Shanghai, 201620, P. R. China
| | - Kai Wang
- Clinical Research Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200233, P. R. China
| | - Ming Yang
- The Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, 200233, P. R. China
- Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200000, P. R. China
| | - Xi Yang
- Novaprint Therapeutics Suzhou Co., Ltd, Suzhou, 215000, P. R. China
| | - Danyang Li
- The Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, 200233, P. R. China
- School of Materials Science and Engineering, Shanghai University of Engineering Science, Shanghai, 201620, P. R. China
| | - Meng Liu
- The Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, 200233, P. R. China
- Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200000, P. R. China
| | - Changmei Niu
- Novaprint Therapeutics Suzhou Co., Ltd, Suzhou, 215000, P. R. China
| | - Weixin Zhao
- Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC, 27155, USA
| | - Wenyao Li
- School of Materials Science and Engineering, Shanghai University of Engineering Science, Shanghai, 201620, P. R. China
| | - Qiang Fu
- The Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, 200233, P. R. China
- Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200000, P. R. China
| | - Kaile Zhang
- The Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, 200233, P. R. China
- Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200000, P. R. China
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Białek Ł, Rydzińska M, Vetterlein MW, Dobruch J, Skrzypczyk MA. A Systematic Review on Postoperative Antibiotic Prophylaxis after Pediatric and Adult Male Urethral Reconstruction. J Clin Med 2023; 12:6162. [PMID: 37834807 PMCID: PMC10573465 DOI: 10.3390/jcm12196162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/17/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
In the era of antibiotic overuse and increasing antibiotic resistance, there is a gap in evidence regarding antibiotic stewardship, and in particular, perioperative antibiotic prophylaxis after urethral reconstruction. The aim of this systematic review was to evaluate the effectiveness and relevance of postoperative antibiotic prophylaxis after male pediatric and adult urethral reconstruction. An online search of MEDLINE database via PubMed was performed. The systematic review was registered in PROSPERO (CRD42022348555) and was conducted according to the PRISMA guidelines and AMSTAR 2 checklist. A narrative synthesis of included studies was performed. After the screening of 1176 publications, six studies regarding antibiotic prophylaxis after hypospadias reconstruction and two studies regarding antibiotic prophylaxis after urethroplasty in adults were eligible to be included in the systematic review. All but one of the studies on hypospadias repair showed no benefit from postoperative antibiotic prophylaxis. The level of evidence on postoperative antibiotic prophylaxis after urethroplasty in adults is low. Neither of the two studies included in the review showed a benefit from antibiotic use. Postoperative prophylaxis after hypospadias repair is not effective in preventing urinary tract infections and wound infections. It seems that the use of postoperative prophylaxis after urethroplasty in adults is also not beneficial, but there is a high need for high-quality scientific data.
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Affiliation(s)
- Łukasz Białek
- Department of Urology, Centre for Postgraduate Medical Education, 01-813 Warsaw, Poland
| | - Marta Rydzińska
- Department of Urology, Centre for Postgraduate Medical Education, 01-813 Warsaw, Poland
| | - Malte W. Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Jakub Dobruch
- Department of Urology, Centre for Postgraduate Medical Education, 01-813 Warsaw, Poland
| | - Michał A. Skrzypczyk
- Department of Urology, Centre for Postgraduate Medical Education, 01-813 Warsaw, Poland
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Huang LP, Liu Y, Li QJ, Zhang WQ, Wu CY, Zhao LM, Xie HQ. A Modified Small Intestinal Submucosa Patch with Multifunction to Promote Scarless Repair and Reinvigoration of Urethra. Adv Healthc Mater 2023; 12:e2300519. [PMID: 37062917 DOI: 10.1002/adhm.202300519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/28/2023] [Indexed: 04/18/2023]
Abstract
To reconstruct and restore the functions of the male urethra is a challenging task for urologists. The acellular matrix graft currently used in the clinics is mono-functional and may cause a series of complications including stricture, fibrosis, and stone formation. As a result, such graft materials cannot meet the increasing demand for multifunctionality in the field of urethral tissue engineering. In this context, a multifunctional urethral patch is designed for the repair of urethral defects by mixing protocatechualdehyde (PCA) with small intestinal submucosa (SIS) under an alkalin condition to allow cross linking. As shown, the PCA/SIS patch possesses excellent biocompatibility, antioxidant activity, and anti-inflammatory property. More importantly, this patch can remarkably promote the adhesion, proliferation, and directional extension of rabbit bladder epithelial mucous cells (R-EMCs) as well as rabbit bladder smooth muscle cells (R-SMCs), and upregulate the expression of cytokeratin in the EMCs and contractile protein in the SMCs in vitro. In vivo experiments also confirm that the PCA/SIS patch can significantly enhance scarless repair of urethral defects in rabbits by facilitating smooth muscle regeneration, reducing excessive collagen deposition, and accelerating re-epithelialization and neovascularization. Taken together, the newly developed multifunctional PCA/SIS patch provides a promising candidate for urethral regeneration.
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Affiliation(s)
- Li-Ping Huang
- Department of Orthopedics Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Yuan Liu
- Department of Orthopedics Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Qian-Jin Li
- Department of Orthopedics Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Wen-Qian Zhang
- Department of Orthopedics Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Chen-Yu Wu
- Department of Orthopedics Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Long-Mei Zhao
- Department of Orthopedics Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Hui-Qi Xie
- Department of Orthopedics Surgery and Orthopedic Research Institute, Laboratory of Stem Cell and Tissue Engineering, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
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7
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Tao C, Jin X, Zhang H. Dorsal oral mucosa graft urethroplasty for female urethral stricture reconstruction: A narrative review. Front Surg 2023; 10:1146429. [PMID: 37025264 PMCID: PMC10072323 DOI: 10.3389/fsurg.2023.1146429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
Female urethral stricture is currently a challenging situation. In general, urethra dilatation can be selected for treatment, but the complications and high recurrence rate urge doctors to consider other treatments. Recently, dorsal oral mucosa graft urethroplasty is concerned by more and more surgeons, but there are not enough reports so far. A comprehensive search of dorsal oral mucosa graft urethroplasty was performed. According to the existing literature, there are applications of buccal mucosa and lingual mucosa, and compared with other kinds of grafts, the success rate is higher. However, there is a lack of multicenter, large sample and long follow-up studies. And there is still no enough comparative study between different types of oral mucosa. In summary, dorsal oral mucosa graft urethroplasty is an effective option for the management of female urethral stricture. More multicenter and large sample studies with long-term follow-up data are needed.
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Affiliation(s)
- Chunqin Tao
- Department of Burns and Plastic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoxiang Jin
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hengshu Zhang
- Department of Burns and Plastic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Correspondence: Hengshu Zhang
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Yilmaz H, Avci IE, Cinar NB, Akdas EM, Unal M, Baynal EA, Kara O, Teke K. Urethral rupture concomitant with penile fracture does not adversely affect functional outcomes. Urologia 2022:3915603221141171. [PMID: 36515568 DOI: 10.1177/03915603221141171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The aim of this study was to identify possible risk factors for urethral rupture and to evaluate the effect of urethral rupture repair on long-term functional outcomes and complications. MATERIALS AND METHODS The medical records of consecutive penile fracture patients were retrospectively reviewed. Penile fracture patients with and without urethral rupture were compared according to demographics, clinical and intraoperative findings. Comparisons of postoperative functional results of the groups were performed using the 5-item version of the International Index of Erectile Function (IIEF-5) and the International Prostate Symptom Score (IPSS). Finally, among them, long-term penile complications including penile curvature, painful erection, palpable nodule, and paresthesia were assessed. RESULTS Fifty-three patients participated. Patients with urethral rupture (n = 8) were older (44.50 ± 10.69, 36.58 ± 10.33 years, p = 0.052). There was no significant difference in fracture etiology (p = 0.64). Urethral bleeding was present only in patients with urethral rupture (p < 0.001). Although no bilateral corpus cavernosum rupture was encountered in penile fracture patients without urethral rupture, this rate was significantly higher in those with urethral rupture at a rate of 62.5% (p < 0.001). The time from surgical repair to sexual activity was similar in both groups (p = 0.66). There was no significant difference in IPSS and IIEF-5 scores, the presence of erectile dysfunction and complication rates (p > 0.05). CONCLUSIONS Older age is a possible risk factor for a concomitant urethral rupture with penile fracture and it seems to be associated with urethral bleeding and bilateral corpus cavernosum involvement. Additionally, urethral rupture repair neither adversely affected functional outcomes nor increased penile complication rates.
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Affiliation(s)
- Hasan Yilmaz
- Department of Urology, Kocaeli University, School of Medicine, Kocaeli, Turkey
| | - Ibrahim Erkut Avci
- Department of Urology, Kocaeli University, School of Medicine, Kocaeli, Turkey
| | - Naci Burak Cinar
- Department of Urology, Kocaeli University, School of Medicine, Kocaeli, Turkey
| | - Enes Malik Akdas
- Department of Urology, Kocaeli University, School of Medicine, Kocaeli, Turkey
| | - Muhlis Unal
- Department of Urology, Kocaeli University, School of Medicine, Kocaeli, Turkey
| | | | - Onder Kara
- Department of Urology, Kocaeli University, School of Medicine, Kocaeli, Turkey
| | - Kerem Teke
- Department of Urology, Kocaeli University, School of Medicine, Kocaeli, Turkey
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Horiguchi A, Shinchi M, Ojima K, Hirano Y, Ito K, Azuma R. Surgical and Patient-Reported Outcomes of Delayed Anastomotic Urethroplasty for Male Pelvic Fracture Urethral Injury at a Japanese Referral Center. J Clin Med 2022; 11:jcm11051225. [PMID: 35268315 PMCID: PMC8911321 DOI: 10.3390/jcm11051225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 12/28/2022] Open
Abstract
We aimed to assess the surgical and patient-reported outcomes of delayed anastomotic urethroplasty (DAU) for pelvic fracture urethral injury (PFUI). We included 211 male patients who underwent DAU for PFUI. DAU success was considered when the urethral lumen was sufficiently large for the passage of a flexible cystoscope, without additional treatment required. The patients completed the lower urinary tract symptoms (LUTS)-related quality of life (QOL) questionnaire (scores: 0, not at all; 1, a little; 2, somewhat; 3, a lot), EuroQol-5 dimensions (EQ-5D), and EQ-5D visual analog scale (EQ-VAS). Postoperative overall satisfaction was evaluated using the following responses: “very satisfied,” “satisfied,” “unsatisfied,” or “very unsatisfied.” DAU was successful in 95.3% cases, with a median postoperative follow-up duration of 48 months. Multivariate logistic regression analysis revealed that “greater blood loss” was an independent predictor of failed urethroplasty. Questionnaire responses were obtained from 80.1% patients. The mean LUTS-related QOL, EQ-5D score and EQ-VAS improved significantly from 2.8, 0.63 and 54.4 at baseline to 0.9, 0.81 and 76.6 postoperatively (p < 0.0001 for all parameters). Moreover, 35.5% and 59.2% of the patients responded being “satisfied” and “very satisfied,” respectively, with their DAU outcomes. DAU not only had a high surgical success rate, but also a significant beneficial effect on both LUTS-related QOL and overall health-related QOL.
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Affiliation(s)
- Akio Horiguchi
- Department of Urology, National Defense Medical College, Saitama 359-8513, Japan; (M.S.); (K.O.); (Y.H.); (K.I.)
- Correspondence: ; Tel.: +81-4-2995-1676
| | - Masayuki Shinchi
- Department of Urology, National Defense Medical College, Saitama 359-8513, Japan; (M.S.); (K.O.); (Y.H.); (K.I.)
| | - Kenichiro Ojima
- Department of Urology, National Defense Medical College, Saitama 359-8513, Japan; (M.S.); (K.O.); (Y.H.); (K.I.)
| | - Yusuke Hirano
- Department of Urology, National Defense Medical College, Saitama 359-8513, Japan; (M.S.); (K.O.); (Y.H.); (K.I.)
| | - Keiichi Ito
- Department of Urology, National Defense Medical College, Saitama 359-8513, Japan; (M.S.); (K.O.); (Y.H.); (K.I.)
| | - Ryuichi Azuma
- Department of Plastic Surgery, National Defense Medical College, Saitama 359-8513, Japan;
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10
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Horiguchi A, Edo H, Shinchi M, Ojima K, Hirano Y, Ito K, Shinmoto H. Role of magnetic resonance imaging in the management of male pelvic fracture urethral injury. Int J Urol 2022; 29:919-929. [PMID: 34986514 DOI: 10.1111/iju.14779] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 12/14/2021] [Indexed: 12/15/2022]
Abstract
The management of male pelvic fracture urethral injury remains a urological challenge. Pelvic fracture urethral injury can be associated with sequelae, such as urethral gap, erectile dysfunction and urinary incontinence. Delayed anastomotic urethroplasty, the gold standard treatment for urethral gaps caused by pelvic fracture urethral injuries, is technically demanding, and reconstructive urologists should preoperatively obtain as much detailed anatomical information as possible. A combination of antegrade and retrograde urethrography is the fundamental preoperative evaluation, but it cannot accurately assess the urethral gap length, the degree of lateral prostatic displacement, the anatomical relationship of the urethra with its surrounding structures (such as the rectum and dorsal venous complex) or periurethral problems (such as minor fistulae or cavitation). To make up for these limitations of urethrography, magnetic resonance imaging has emerged as a non-invasive, multiplanar and high-resolution modality for the evaluation of pelvic fracture urethral injury. Magnetic resonance imaging has excellent soft-tissue contrast, and can clearly show the urethra and periurethral tissues without the effects of radiation, thus enabling clinicians to anticipate the required ancillary techniques for delayed anastomotic urethroplasty and to predict functional outcomes, such as erectile function and urinary continence, after delayed anastomotic urethroplasty. This review discusses the role of magnetic resonance imaging in the evaluation of pelvic fracture urethral injury and its impact on patient management.
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Affiliation(s)
- Akio Horiguchi
- Departments of, Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hiromi Edo
- Department of, Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Masayuki Shinchi
- Departments of, Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Kenichiro Ojima
- Departments of, Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yusuke Hirano
- Departments of, Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Keiichi Ito
- Departments of, Urology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hiroshi Shinmoto
- Department of, Radiology, National Defense Medical College, Tokorozawa, Saitama, Japan
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11
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Arunachalam P, Sen S, Sam CJ, Backer A. Pathology and Surgical Management of Urinary Retention Manifesting After Anorectal Malformation Surgery. J Indian Assoc Pediatr Surg 2022; 27:147-152. [PMID: 35937107 PMCID: PMC9350636 DOI: 10.4103/jiaps.jiaps_348_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/20/2021] [Accepted: 02/11/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Associated congenital anomalies, operative structural injury, and postoperative neurovesical dysfunction combine to cause urinary retention in children with a history of surgery for anorectal malformation (ARM). Aim To study the presentation and management of urinary retention in patients with a history of ARM surgery. Methodology Retrospective study. Results and Discussion Twenty-five children presented with urinary retention with a history of ARM surgery performed elsewhere. There were 17 males (high - 14, intermediate - 2, and low - 1) and 8 females (cloaca). Sixteen children had an abnormal spine. Eight children had urethral injury (total transection - 3) and three had a large residual rectal stump. 41/48 renal units were dilated and 27 refluxing. Seventeen children had abnormal estimated glomerular filtration rate and five had undergone urinary diversion. Management Definitive surgical management was individualized, the most pertinent consideration being whether normal voiding would be feasible or whether a continent low pressure urinary reservoir with clean intermittent catheterization (CIC) would be a safer option. Operative management included excision of the rectal stump (3), urethral reconstruction (2), bladder augmentation (17), Mitrofanoff port (22), bladder neck closure (2), and antireflux surgery (13). Follow-up estimated glomerular filtration rate had improved/normalized in all but two patients. HUN resolved/improved in all and 25/27 refluxing units ceased refluxing. All are socially continent with ten voiding normally and the rest on CIC. Conclusion Urinary retention after ARM surgery is multifactorial and requires prompt recognition and possibly urinary diversion. Final reconstruction aims at achieving continence with safe upper tracts. Urethral voiding is possible in the selected cases.
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Affiliation(s)
- Pavai Arunachalam
- Department of Pediatric Surgery, PSGIMS and R and PSG Hospitals, Coimbatore, Tamil Nadu, India
| | - Sudipta Sen
- Department of Pediatric Surgery, PSGIMS and R and PSG Hospitals, Coimbatore, Tamil Nadu, India
| | - Cenita J. Sam
- Department of Pediatric Surgery, PSGIMS and R and PSG Hospitals, Coimbatore, Tamil Nadu, India
| | - Abu Backer
- Nambiyappan Hospitals, Tirunelveli, Tamil Nadu, India,Address for correspondence: Dr. Abu Backer, Nambiyappan Hospitals, Tirunelveli, Tamil Nadu, India. E-mail:
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12
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Hofer MD, Cooley LF, Elmasri A, Martins FE. Revisiting One-Stage Urethroplasties for Distal Urethral Strictures. J Clin Med 2021; 10:jcm10245905. [PMID: 34945200 PMCID: PMC8708882 DOI: 10.3390/jcm10245905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/07/2021] [Accepted: 12/12/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Reconstructive approaches for distal urethral strictures range from simple meatotomy to utilizing grafts or flaps depending on the etiology, length and location. We describe a contemporary cohort of distal urethral strictures and report a surgical technique termed distal one-stage urethroplasty developed to address the majority of distal urethral strictures encountered. Methods: Thirty-four patients were included. The mean age was 56.7 years (range 15.7–84.9 years), the mean stricture length was 1.1 cm (0.5–1.5) and the mean follow-up was 42.5 months (28–61.3). Results: The vast majority of distal strictures (27/34 (79.4%)) were treated with our hybrid one-stage approach combining a distal urethral reconstruction with excision of the scar tissue without the need to use grafts or flaps. The average stricture length was 0.68 cm and average operative time was 24.43 min. Post-operative spraying was reported in a minority of patients (4/27 (14.8%)). The length of stricture and surgery were significantly longer in those 7/34 (20.6%) patients in whom grafts or flaps were used (2.88 cm and 154.8 min, respectively, p < 0.001 for both when compared to the hybrid one-stage approach). We noted 6/34 (17.6%) recurrences of distal urethral strictures, all of which were treated successfully with graft and flap repairs. Conclusions: The vast majority of distal urethral strictures are amenable to a distal one-stage urethroplasty, avoiding the use of grafts and/or flaps while achieving reasonable outcomes. This limited approach, at least initially, is associated with shorter operative time and time of catheter placement and avoids morbidity associated with graft or flap harvesting. Spraying of urine is seldomly encountered and comparable to other approaches addressing distal urethral strictures.
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Affiliation(s)
| | - Lauren Folgosa Cooley
- Department of Urology, Northwestern University, Chicago, IL 60611, USA; (L.F.C.); (A.E.)
| | - Ayman Elmasri
- Department of Urology, Northwestern University, Chicago, IL 60611, USA; (L.F.C.); (A.E.)
| | - Francisco E. Martins
- Department of Urology, School of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal;
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13
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Pastorek D, Culenova M, Csobonyeiova M, Skuciova V, Danisovic L, Ziaran S. Tissue Engineering of the Urethra: From Bench to Bedside. Biomedicines 2021; 9:1917. [PMID: 34944733 DOI: 10.3390/biomedicines9121917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022] Open
Abstract
Tissue engineering (TE) is a promising approach for repair/substitution of damaged tissues and organs. Urethral strictures are common and serious health conditions that impair quality of life and may lead to serious organ damage. The search for ideal materials for urethral repair has led to interest of scientists and surgeons in urethral TE. Over the last decades, a significant amount of preclinical studies and considerable progress have been observed. In contrast, urethral TE has made slow progress in clinical practice so far. To address this, we conducted a systematic review of the literature on clinical applications of TE constructs for urethral repair in the last three decades. In summary, the TE approach is promising and effective, but many issues remain that need to be addressed for broader adoption of TE in urethral repair. Better design of trials, better cooperation of research groups and centralization could lead to reduction of costs and slowly proceed to commercialization and routine use of TE products for urethral reconstruction.
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14
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Horch RE, Ludolph I, Arkudas A, Cai A. Personalized Reconstruction of Genital Defects in Complicated Wounds with Vertical Rectus Abdominis Myocutaneous Flaps including Urethral Neo-Orifice. J Pers Med 2021; 11:1076. [PMID: 34834428 DOI: 10.3390/jpm11111076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/18/2021] [Accepted: 10/22/2021] [Indexed: 12/04/2022] Open
Abstract
Non-healing extensive wounds in the perineal region can lead to severe soft tissue infections and disastrous complications, which are not manageable with conservative measures. Specifically in recurrent or advanced pelvic malignancies, irradiation often leads to extensive scarring and wound breakdown, resulting in significant soft tissue defects during surgical tumor excision. Among several surgical options to reconstruct the perineum, the transpelvic vertical rectus abdominis myocutaneous (VRAM) flap has proven to be one of the most reliable methods. Specific modifications of this flap allow an individualized procedure depending on the patient’s needs. We modified this technique to include the urethral orifice into the skin paddle of VRAM flaps in three patients as a novel option to circumvent urinary diversion and maintain an acceptable quality of life.
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15
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Hamamoto K, Horiguchi A, Shinchi M, Ojima K, Hirano Y, Takahashi E, Kimura F, Ito K, Azuma R. Impact of urethroplasty on overactive bladder symptoms in patients with anterior urethral strictures. Int J Urol 2021; 29:50-56. [PMID: 34605092 DOI: 10.1111/iju.14713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/12/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the incidence of overactive bladder in men with anterior urethral stricture and to evaluate the impact of urethroplasty on its improvement. METHODS A total of 104 men with anterior urethral stricture who underwent urethroplasty between 2016 and 2020 completed a validated urethral stricture surgery patient-reported outcome measure comprising six lower urinary tract symptoms questions on voiding symptoms and overactive bladder symptom score before and 3, 6, and 12 months after urethroplasty. Patients with an urgency score of ≥2 for overactive bladder symptom score question 3, and a total overactive bladder symptom score of ≥3 were considered to have overactive bladder. An improvement in overactive bladder was defined as a decrease in the total overactive bladder symptom score by at least three points. RESULTS Thirty-nine patients (37.5%) were considered to have overactive bladder, and improvement in overactive bladder after urethroplasty was found in 30 (76.9%). Maximum flow rate on uroflowmetry, postvoid residual urine volume, lower urinary tract symptoms total score, and total overactive bladder symptom score were all significantly improved after urethroplasty (P < 0.0001 for all variables). There was a positive correlation between changes in lower urinary tract symptoms total score and total overactive bladder symptom score (Spearman's correlation 0.48, P < 0.0001). Multivariate logistic regression analysis showed that greater change in lower urinary tract symptoms score was an independent predictor of improvement in overactive bladder (odds ratio 1.30, 95% confidence interval 1.06-1.59; P = 0.002). CONCLUSIONS Overactive bladder is prevalent in patients with anterior urethral stricture, and can be effectively improved after urethroplasty. Improvement of voiding symptoms are key for improving overactive bladder symptoms.
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Affiliation(s)
- Koetsu Hamamoto
- Department of Urology, National Defense Medical College, Saitama, Japan
| | - Akio Horiguchi
- Department of Urology, National Defense Medical College, Saitama, Japan
| | - Masayuki Shinchi
- Department of Urology, National Defense Medical College, Saitama, Japan.,Department of Urology, National Hospital Organization, Nishisaitama-Chuo Hospital, Saitama, Japan
| | - Kenichiro Ojima
- Department of Urology, National Defense Medical College, Saitama, Japan
| | - Yusuke Hirano
- Department of Urology, National Defense Medical College, Saitama, Japan
| | - Eiji Takahashi
- Department of Urology, National Hospital Organization, Nishisaitama-Chuo Hospital, Saitama, Japan
| | - Fumihiro Kimura
- Department of Urology, National Hospital Organization, Nishisaitama-Chuo Hospital, Saitama, Japan
| | - Keiichi Ito
- Department of Urology, National Defense Medical College, Saitama, Japan
| | - Ryuichi Azuma
- Department of Plastic Surgery, National Defense Medical College, Saitama, Japan
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16
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Cavallo JA, Vanni AJ, Dy GW, Stair S, Shakir NA, Canes D, Zhao LC. Clinical Outcomes of a Combined Robotic, Transabdominal, and Open Transperineal Approach for Anastomotic Posterior Urethroplasty. J Endourol 2021; 35:1372-1377. [PMID: 33820448 DOI: 10.1089/end.2020.0973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Robotic pelvic surgery is being increasingly utilized for reconstruction proximal to the genitourinary diaphragm. We describe a combined robotic, transabdominal, and open transperineal approach for complex anastomotic posterior urethroplasty. Materials and Methods: We performed a multi-institutional retrospective study of patients who underwent anastomotic posterior urethroplasty by a combined robotic, transabdominal, and open transperineal approach between January 2012 and December 2018. Patient demographics; preoperative, intraoperative, and postoperative clinical data; and complications were reviewed. Urethroplasty success, de novo stress urinary incontinence (SUI), and de novo erectile dysfunction (ED) were evaluated. Results: Twelve patients were identified with a mean follow-up of 596 (range 73-1618) days. Mean patient age was 65.9 (range 53.4-76.8). Reconstruction required corporal splitting, prostatectomy, and gracilis muscle flap use in one (8.3%), eight (66.7%), and four (33.3%) patients, respectively. Postoperative urinary leak, thromboembolic event, and wound abscess occurred in one (8.3%), one (8.3%), and two (16.7%) patients, respectively. Stenosis recurrence occurred in two patients (16.7%) at a mean 187.5 (20-355) postoperative days. De novo ED and de novo SUI were reported in two (16.7%) and four (33.3%) patients, respectively. Nine patients (75.0%) underwent placement of an artificial urinary sphincter at a mean interval of 359.2 (111-1456) days after the index procedure, with no subsequent erosion. Conclusions: Complex posterior urethroplasty by a combined robotic, transabdominal and open transperineal approach is associated with success and complications rates that are comparable to open techniques and may allow for adjunctive procedures such as prostatectomy. This technique allows for the reconstruction of posterior urethral stenoses that would otherwise have been managed conservatively or with urinary diversion.
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Affiliation(s)
- Jaime A Cavallo
- Department of Urology, Yale University School of Medicine, New Haven, Connecticut, USA.,Veterans Affairs Connecticut Healthcare System, West Haven and Newington, Connecticut, USA
| | - Alex J Vanni
- Department of Urology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Geolani W Dy
- Department of Urology, Oregon Health & Science University, Portland, Oregon, USA
| | - Sabrina Stair
- Department of Urology, New York University Langone Health, New York, New York, USA
| | - Nabeel A Shakir
- Department of Urology, New York University Langone Health, New York, New York, USA
| | - David Canes
- Department of Urology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Lee C Zhao
- Department of Urology, New York University Langone Health, New York, New York, USA
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17
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Rashidbenam Z, Jasman MH, Tan GH, Goh EH, Fam XI, Ho CCK, Zainuddin ZM, Rajan R, Rani RA, Nor FM, Shuhaili MA, Kosai NR, Imran FH, Ng MH. Fabrication of Adipose-Derived Stem Cell-Based Self-Assembled Scaffold under Hypoxia and Mechanical Stimulation for Urethral Tissue Engineering. Int J Mol Sci 2021; 22:ijms22073350. [PMID: 33805910 PMCID: PMC8036589 DOI: 10.3390/ijms22073350] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/28/2021] [Accepted: 03/03/2021] [Indexed: 12/13/2022] Open
Abstract
Long urethral strictures are often treated with autologous genital skin and buccal mucosa grafts; however, risk of hair ingrowth and donor site morbidity, restrict their application. To overcome this, we introduced a tissue-engineered human urethra comprising adipose-derived stem cell (ASC)-based self-assembled scaffold, human urothelial cells (UCs) and smooth muscle cells (SMCs). ASCs were cultured with ascorbic acid to stimulate extracellular matrix (ECM) production. The scaffold (ECM) was stained with collagen type-I antibody and the thickness was measured under a confocal microscope. Results showed that the thickest scaffold (28.06 ± 0.59 μm) was achieved with 3 × 104 cells/cm2 seeding density, 100 μg/mL ascorbic acid concentration under hypoxic and dynamic culture condition. The biocompatibility assessment showed that UCs and SMCs seeded on the scaffold could proliferate and maintain the expression of their markers (CK7, CK20, UPIa, and UPII) and (α-SMA, MHC and Smootheline), respectively, after 14 days of in vitro culture. ECM gene expression analysis showed that the ASC and dermal fibroblast-based scaffolds (control) were comparable. The ASC-based scaffold can be handled and removed from the plate. This suggests that multiple layers of scaffold can be stacked to form the urothelium (seeded with UCs), submucosal layer (ASCs only), and smooth muscle layer (seeded with SMCs) and has the potential to be developed into a fully functional human urethra for urethral reconstructive surgeries.
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Affiliation(s)
- Zahra Rashidbenam
- Centre for Tissue Engineering and Regenerative Medicine, Universiti Kebangsaan Malaysia Medical Centre, 12th Floor, Clinical Block, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia;
| | - Mohd Hafidzul Jasman
- Clinical Skills Learning and Simulation Unit, Department of Medical Education, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia;
| | - Guan Hee Tan
- Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, 8th Floor, Clinical Block, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia; (G.H.T.); (E.H.G.); (X.I.F.); (Z.M.Z.)
| | - Eng Hong Goh
- Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, 8th Floor, Clinical Block, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia; (G.H.T.); (E.H.G.); (X.I.F.); (Z.M.Z.)
| | - Xeng Inn Fam
- Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, 8th Floor, Clinical Block, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia; (G.H.T.); (E.H.G.); (X.I.F.); (Z.M.Z.)
| | - Christopher Chee Kong Ho
- School of Medicine, Taylor’s University, No. 1 Jalan Taylor’s, Subang Jaya 47500, Selangor Darul Ehsan, Malaysia;
| | - Zulkifli Md Zainuddin
- Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, 8th Floor, Clinical Block, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia; (G.H.T.); (E.H.G.); (X.I.F.); (Z.M.Z.)
| | - Reynu Rajan
- Minimally Invasive Upper Gastrointestinal and Bariatric Surgery Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, 8th Floor, Clinical Block, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia; (R.R.); (M.A.S.); (N.R.K.)
| | - Rizal Abdul Rani
- Arthoplasty Unit, Department of Orthopaedics and Traumatology Surgery, Universiti Kebangsaan Malaysia Medical Centre, 9th Floor, Clinical Block, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia;
| | - Fatimah Mohd Nor
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Clinical Block, 8th Floor, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia; (F.M.N.); (F.H.I.)
| | - Mohamad Aznan Shuhaili
- Minimally Invasive Upper Gastrointestinal and Bariatric Surgery Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, 8th Floor, Clinical Block, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia; (R.R.); (M.A.S.); (N.R.K.)
| | - Nik Ritza Kosai
- Minimally Invasive Upper Gastrointestinal and Bariatric Surgery Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, 8th Floor, Clinical Block, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia; (R.R.); (M.A.S.); (N.R.K.)
| | - Farrah Hani Imran
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Universiti Kebangsaan Malaysia Medical Centre, Clinical Block, 8th Floor, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia; (F.M.N.); (F.H.I.)
| | - Min Hwei Ng
- Centre for Tissue Engineering and Regenerative Medicine, Universiti Kebangsaan Malaysia Medical Centre, 12th Floor, Clinical Block, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur 56000, Malaysia;
- Correspondence: ; Tel.: +6012-313-9179
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18
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Liu Y, Zhao Q, Yang F, Wang M, Xing N. "Sandwich" Technique of Total Urethral Reconstruction in the Laparoscopic Radical Prostatectomy: A Prospective Study. Cancer Manag Res 2021; 13:2341-2347. [PMID: 33732026 PMCID: PMC7959195 DOI: 10.2147/cmar.s299367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/08/2021] [Indexed: 11/23/2022] Open
Abstract
Background Early incontinence that has great impact on the quality-of-life is one usual drawback after laparoscopic radical prostatectomy (LRP). This prospective study aims at further documenting the improved effect of the “Sandwich” urethra reconstruction technique on continence at the early stage after LRP. Methods During the period from October 2017 to December 2018, 130 patients undergoing LRP in our institution were recruited into this prospective study. Sixty-six patients in Group A received LRP with the “Sandwich” technique of urethra reconstruction, while the remaining 64 patients in Group B did not adopt this reconstruction technique. The basic clinical data, perioperative related data, urinary continence, and urodynamic tests were analyzed and evaluated. Results There is no statistical difference in patients’ basic clinical data, perioperative related data except urethral reconstruction time, which was 23.49±4.72 minutes in Group A and 20.16±5.75 minutes in Group B (P<0.001). The continence rates in Group A at 2, 4, 8, and 12 weeks were 54.55%, 83.33%, 93.94%, and 96.97%, respectively. The continence rates in Group B were 10.94%, 14.06%, 37.50%, and 71.88%, respectively. The continence rate of Group A was significantly higher after surgery compared with Group B (P<0.001). Maximum flow rates before and after the “Sandwich” procedure for 12 months were 13.2±2.8 m/s and 15.4±3.6 m/s, respectively (P=0.034). In addition, residual volumes before and after the “Sandwich” procedure for 12 months were 15 (0–20) mL and 0 (0–12.5) mL, respectively (P=0.107). Conclusion Our prospective study confirms that the “Sandwich” technique of the total urethral reconstruction is safe and feasible. It also very possibly takes the significant advantage in early recovery of urinary continence after LRP. However, multicenter, randomized controlled large sample randomized controlled trials are needed to further confirm this final conclusion.
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Affiliation(s)
- Yong Liu
- Department of Urology, Capital Medical University, Beijing Chaoyang Hospital, Beijing, 100021, People's Republic of China.,Department of Urology, Weihai Municipal Hospital, Weihai, 264200, People's Republic of China
| | - Qinxin Zhao
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Feiya Yang
- Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
| | - Mingshuai Wang
- Department of Urology, Capital Medical University, Beijing Chaoyang Hospital, Beijing, 100021, People's Republic of China
| | - Nianzeng Xing
- Department of Urology, Capital Medical University, Beijing Chaoyang Hospital, Beijing, 100021, People's Republic of China.,Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People's Republic of China
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19
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Rosenbaum CM, Fisch M, Vetterlein MW. Contemporary Management of Vesico-Urethral Anastomotic Stenosis After Radical Prostatectomy. Front Surg 2020; 7:587271. [PMID: 33324673 PMCID: PMC7725760 DOI: 10.3389/fsurg.2020.587271] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/28/2020] [Indexed: 11/26/2022] Open
Abstract
Vesico-urethral anastomotic stenosis is a well-known sequela after radical prostatectomy for prostate cancer and has significant impact on quality of life. This review aims to summarize contemporary therapeutical approaches and to give an overview of the available evidence regarding endoscopic interventions and open reconstruction. Initial treatment may include dilation, incision or transurethral resection. In treatment-refractory stenoses, open reconstruction via an abdominal (retropubic), transperineal or combined abdominoperineal approach is a viable option with high success rates. All of the open surgical procedures are generally accompanied by a high risk of developing de novo incontinence and patients may need further interventions. In such cases, subsequent artificial urinary sphincter implantation is the most common treatment option with the best available evidence.
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Affiliation(s)
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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20
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Zhang K, Fang X, Zhu J, Yang R, Wang Y, Zhao W, Mo X, Fu Q. Effective Reconstruction of Functional Urethra Promoted With ICG-001 Delivery Using Core-Shell Collagen/Poly(Llactide-co-caprolactone) [P(LLA-CL)] Nanoyarn-Based Scaffold: A Study in Dog Model. Front Bioeng Biotechnol 2020; 8:774. [PMID: 32754582 PMCID: PMC7381300 DOI: 10.3389/fbioe.2020.00774] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/18/2020] [Indexed: 11/17/2022] Open
Abstract
Hypospadias and urethral stricture are common urological diseases which seriously affect voiding function and life quality of the patients, yet current clinical treatments often result in unsatisfactory clinical outcome with frequent complications. In vitro experiments confirmed that ICG-001 (a well-established Wnt signaling inhibitor) could effectively suppress fibroblast proliferation and fibrotic protein expression. In this study, we applied a novel drug-delivering nanoyarn scaffold in urethroplasty in dog model, which continuously delivers ICG-001 during tissue reconstruction, and could effectively promote urethral recovery and resume fully functional urethra within 12 weeks. Such attempts are essential to the development of regenerative medicine for urological disorders and for broader clinical applications in human patients.
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Affiliation(s)
- Kaile Zhang
- Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaolan Fang
- Diagnostic Laboratory, Greenwood Genetic Center, Greenwood, SC, United States
| | - Jingjing Zhu
- Biomaterials and Tissue Engineering Laboratory, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, China
| | - Ranxing Yang
- Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Wang
- Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Weixin Zhao
- Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC, United States
| | - Xiumei Mo
- Biomaterials and Tissue Engineering Laboratory, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai, China
| | - Qiang Fu
- Department of Urology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
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21
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Abstract
Urethral stricturing is a narrowing of the urethral lumen as a result of ischaemic spongiofibrosis. The main challenge of currently available treatment options is recurrence of the stricture. Recent advancements in the treatment of urethral strictures mainly came from the fields of regenerative medicine and tissue engineering. Research efforts have primarily focused on decreasing the recurrence of stricture after internal urethrotomy and constructing tissue-engineered urethral substitutes to improve clinical outcomes of urethroplasty surgeries. The aim of this article is to review the most recent advancements in the management of urethral stricture disease in men.
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Affiliation(s)
- Naside Mangir
- Department of Functional and Reconstructive Urology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK
| | - Christopher Chapple
- Department of Functional and Reconstructive Urology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK
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22
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Liu Y, Huang L, Yuan W, Zhang D, Gu Y, Huang J, Murphy S, Ali M, Zhang Y, Song L. Sustained release of stromal cell-derived factor-1 alpha from silk fibroin microfiber promotes urethral reconstruction in rabbits. J Biomed Mater Res A 2020; 108:1760-1773. [PMID: 32276293 DOI: 10.1002/jbm.a.36943] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 03/10/2020] [Accepted: 03/18/2020] [Indexed: 12/18/2022]
Abstract
We developed a stromal cell-derived factor-1 alpha (SDF-1α)-aligned silk fibroin (SF)/three-dimensional porous bladder acellular matrix graft (3D-BAMG) composite scaffold for long-section ventral urethral regeneration and repair in vivo. SDF-1α-aligned SF microfiber/3D-BAMG, aligned SF microfiber/3D-BAMG, and nonaligned SF microfiber/3D-BAMG scaffolds were prepared using electrostatic spinning and wet processing. Adipose-derived stem cell (ADSC) and bone marrow stromal cell (BMSC) migration was assessed in the SDF-1α-loaded scaffolds. Sustained SDF-1α release in vitro and vivo was analyzed using enzyme-linked immunosorbent assay (ELISA) and western blotting, respectively. The scaffolds were used to repair a 1.5 × 1 cm2 ventral urethral defect in male rabbits in vivo. General observation and retrograde urinary tract contrast assessment were used to examine urethral lumen patency and continuity at 1 and 3 months post-surgery. Postoperative rehabilitation was evaluated using histological detection. The composite scaffolds sustained SDF-1α release for over 16 days in vitro. SDF-1α-aligned SF nanofiber promoted regeneration of urethral mucosa, submucosal smooth muscles, and microvasculature, increased cellular proliferation, and reduced collagen deposition. SDF-1α expression was increased in reconstructed urethra at 3 months post-surgery in SDF-1α-aligned SF group. SDF-1α-aligned SF microfiber/3D-BAMG scaffolds may be used to repair and reconstruct long urethral defects because they accelerate urethral regeneration.
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Affiliation(s)
- Yang Liu
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, China.,Department of Urology, Weifang People's Hospital, Weifang Medical University, Weifang, Shandong, China
| | - Li Huang
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai, China
| | - Wei Yuan
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, China.,Department of Urology, Weifang People's Hospital, Weifang Medical University, Weifang, Shandong, China.,State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai, China
| | - Dongliang Zhang
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yubo Gu
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jianwen Huang
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Sean Murphy
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina
| | - Mohamed Ali
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina.,Department of Chemistry, Faculty of Science, Zagazig University, Zagazig, Egypt
| | - Yaopeng Zhang
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai, China
| | - Lujie Song
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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23
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Abstract
A castrated male Shih-Tzu dog was presented for evaluation of urine leakage after
urethrotomy. A fistula with urine leakage was identified in the perineal region. On
retrograde urethrography, the contrast extravasated from the penile urethra into the
subcutaneous tissue of the perineum. Urine leakage with urethrocutaneous fistula was
diagnosed. During surgery, the disrupted urethra wall and two urethral defects were
identified. A fascia lata autograft was used, rather than primary repair of the urethra.
Two pieces of fascia lata were harvested and sutured to the urethral defects. The fistula
was treated with debridement and drainage. No evidence of urine leakage and dysuria was
noted 6 months postoperatively. Thus, this case report describes successful urethral
reconstruction using a fascia lata autograft.
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Affiliation(s)
- Da-Eun Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, #120 Neungdong-ro, Gwangjin-gu, Seoul 05029, South Korea
| | - Kyu-Chang Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, #120 Neungdong-ro, Gwangjin-gu, Seoul 05029, South Korea
| | - Soon-Wuk Jeong
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, #120 Neungdong-ro, Gwangjin-gu, Seoul 05029, South Korea
| | - Hun-Young Yoon
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, #120 Neungdong-ro, Gwangjin-gu, Seoul 05029, South Korea
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24
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Abstract
RATIONALE Periurethral abscess is a life-threatening disease, and the occurrence of a urethral defect with periurethral abscess is a rare finding. In this case, the patient had a lengthy urethral defect from the bulbous urethra to the membranous urethra accompanied by periurethral abscess that developed within a short time. Herein, we report a case of a pedicle-sparing tunica vaginalis flap utilized in urethral reconstruction which degenerated due to fibrotic changes and soft tissue defects in the urethral bed. PATIENT CONCERNS The patient was a 36-year-old man with fever and lower urinary tract symptoms who had been treated with antibiotics and anti-inflammatory drugs for urinary tract infections 3 days before admission. Purulent necrosis was formed by the urethral abscess, and a long-length urethral defect was formed in the bulbous urethra. DIAGNOSIS Based on the initial computed tomography and laboratory findings, empirical antibiotics were administered to treat a lower urinary tract infection. On the 7th day of hospitalization, ultrasonography was performed due to the sudden swelling of the scrotum, and the patient was diagnosed with a periurethral abscess that was 10 × 3 cm in size. INTERVENTION Initial urinary diversion, wide debridement, and a large amount of abscess drainage were performed. Necrosis of the urethral ventral part caused a urethral defect that was 5 cm in size. After treatment with antibiotics, long-term disinfection and intermittent debridement were conducted and urethral reconstruction was performed using a tunica vaginalis flap with preserved vascular structure. OUTCOMES No complications occurred until 6 months after urethral reconstruction. LESSONS Urethral reconstruction using a tunica vaginalis flap is a good method for selected patients. Pedicle-sparing tunica vaginalis is an advantageous material for resolving urethral defects, especially when the surrounding circulation conditions are poor.
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Affiliation(s)
- Sung Jin Kim
- Department of Urology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung
| | - Jongpill Lee
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chang-Hoo Park
- Department of Urology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung
| | - Jong Yeon Park
- Department of Urology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung
| | - Sang Hoon Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kun Suk Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Han Gwun Kim
- Department of Urology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung
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25
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Lv X, Feng C, Liu Y, Peng X, Chen S, Xiao D, Wang H, Li Z, Xu Y, Lu M. A smart bilayered scaffold supporting keratinocytes and muscle cells in micro/nano-scale for urethral reconstruction. Am J Cancer Res 2018; 8:3153-3163. [PMID: 29896309 PMCID: PMC5996367 DOI: 10.7150/thno.22080] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 01/30/2018] [Indexed: 11/05/2022] Open
Abstract
Rationale: In urethral tissue engineering, the currently available reconstructive procedures are insufficient due to a lack of appropriate scaffolds that would support the needs of various cell types. To address this problem, we developed a bilayer scaffold comprising a microporous network of silk fibroin (SF) and a nanoporous bacterial cellulose (BC) scaffold and evaluated its feasibility and potential for long-segment urethral regeneration in a dog model. Methods: The freeze-drying and self-assembling method was used to fabricate the bilayer scaffold by stationary cultivation G. xylinus using SF scaffold as a template. The surface morphology, porosity and mechanical properties of all prepared SF-BC scaffolds were characterized using Scanning electron microscopy (SEM), microcomputed tomography and universal testing machine. To further investigate the suitability of the bilayer scaffolds for tissue engineering applications, biocompatibility was assessed using an MTT assay. The cell distribution, viability and morphology were evaluated by seeding epithelial cells and muscle cells on the scaffolds, using the 3D laser scanning confocal microscopy, and SEM. The effects of urethral reconstruction with SF-BC bilayer scaffold was evaluated in dog urethral defect models. Results: Scanning electron microscopy revealed that SF-BC scaffold had a clear bilayer structure. The SF-BC bilayer scaffold is highly porous with a porosity of 85%. The average pore diameter of the porous layer in the bilayer SF-BC composites was 210.2±117.8 μm. Cultures established with lingual keratinocytes and lingual muscle cells confirmed the suitability of the SF-BC structures to support cell adhesion and proliferation. In addition, SEM demonstrated the ability of cells to attach to scaffold surfaces and the biocompatibility of the matrices with cells. At 3 months after implantation, urethra reconstructed with the SF-BC scaffold seeded with keratinocytes and muscle cells displayed superior structure compared to those with only SF-BC scaffold. Principal Conclusion: These results demonstrate that the bilayer SF-BC scaffold may be a promising biomaterial with good biocompatibility for urethral regeneration and could be used for numerous other types of hollow-organ tissue engineering grafts, including vascular, bladder, ureteral, bowel, and intestinal.
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26
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Joshi P, Kaya C, Surana S, Desai DJ, Orabi H, Iyer S, Kulkarni SB. A novel method in decision making for the diagnosis of anterior urethral stricture: using methylene blue dye. Turk J Urol 2017; 43:502-506. [PMID: 29201515 DOI: 10.5152/tud.2017.72368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/08/2017] [Indexed: 02/05/2023]
Abstract
Objective The use of methylene blue dye (MB) to highlight anatomical structures in urology has been well-established. Urethral stricture may extend about a centimeter beyond the abnormal area seen on urethrogram. Although the current literature suggests a tension-free and end- to- end anastomosis after excision of the strictured urethral segment with spongiofibrosis and surrounding corpus spongiosum in short bulbar strictures, some centers dealing with urethroplasty prefer anastomosis for short bulbar strictures while others prefer augmentation. With this study, use of MB for delineating stricture line and assessing spongiofibrosis in the diagnosis of urethral stricture was evaluated. Material and methods Five cc MB including 10 mg/mL is diluted with 10 cc saline. In the first scenario, MB is gently injected into urethra via the meatus before the urethroplasty procedure. Meanwhile, the extent of urethral segment stained by MB is noted. In the second scenario (MB spongiosography) in short bulbar stricture, insulin needles are inserted in spongiosa of the stricture site distally and proximally. MB is gently injected with distal needle. The two remaining needles are then observed. Presence of MB efflux in proximal needle implies deficiency of significant spongiofibrosis, so buccal augmentation is performed. Absence of efflux of MB implies significant spongiofibrosis and anastomotik site excised. Results Four hundred and ninety-two consecutive cases prospectively evaluated between 2010 and 2014. Precise staining of stricture was successfully observed in 464 (94%) patients. Grossly normal appearing urothelium remained pink. Histopathology confirmed that the stained urethra had a stricture. Of the 22 short bulbar idiopathic strictures, in 18 (82%) MB was seen across the stricture and urethral transection was avoided. Anastomosis was performed in 4 (18%) cases where no MB went across the primary excision. There were no known allergic complications. Conclusion MB aids in delineating the urethral lumen and exact site of stricture that needs augmentation. MB Spongiography in short bulbar strictures could be used as a beneficial guide in relation to the type of urethral repair to be performed in terms of augmentation versus excision and anastomosis.
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Affiliation(s)
- Pankaj Joshi
- Kulkarni Reconstructive Urology Center, Pune, India
| | - Cevdet Kaya
- Department of Urology, Marmara University School of Medicine, İstanbul, Turkey
| | | | | | - Hazem Orabi
- Kulkarni Reconstructive Urology Center, Pune, India
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27
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Ubrig B, Schmidt-Heikenfeld E, Degener S, Roosen A, Boy A. Minimally Invasive Repair of a Prostatorectal Fistula with an Over-the-Scope Rectal Clip. J Endourol Case Rep 2017; 3:146-148. [PMID: 29098198 PMCID: PMC5665494 DOI: 10.1089/cren.2017.0097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Fistulae between the prostatic urethra and the rectum are rare. They may result from prostatic or rectal surgery. Predisposing factors are previous radiation or immunosuppression. The repair of such fistulae usually involves major surgery. Recently, clips that can be deployed over an endoscope have been developed to close gastrointestinal fistulae or access points for natural orifice surgery. We report the first case of effective treatment of a prostatorectal fistula with a rectal “over-the-scope” clip. Case Presentation: A 64-year-old man under chronic immunosuppression presented with an iatrogenic fistula between the prostatic urethra and the rectum after transurethral resection of the prostate. A transverse colostomy was placed but the fistula failed to heal conservatively. The fistula was effectively closed with an endorectal clip. Six weeks after the procedure, spontaneous micturition was started. Two weeks further, the colostomy was reversed. At 32 months of follow-up, the remains closed, micturition is unimpaired. Conclusion: In select cases of prostatorectal fistula, an endorectal clip may be effectively used for closure.
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Affiliation(s)
- Burkhard Ubrig
- Department of Urology, Augusta-Kranken-Anstalt gGmbH, Witten/Herdecke University, Bochum, Germany
| | | | - Stephan Degener
- Department of Urology, Augusta-Kranken-Anstalt gGmbH, Witten/Herdecke University, Bochum, Germany
| | - Alexander Roosen
- Department of Urology, Augusta-Kranken-Anstalt gGmbH, Witten/Herdecke University, Bochum, Germany
| | - Anselm Boy
- Department of Urology, Augusta-Kranken-Anstalt gGmbH, Witten/Herdecke University, Bochum, Germany
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28
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Abstract
To examine the rationale and applications of amniotic tissue augmentation in urological surgery. Published literature in English-language was reviewed for basic science and clinical use of amniotic or amnion-chorionic tissue in genitourinary tissues. Basic science and animal studies support the likely benefit of clinical applications of amnion-derived tissues in a variety of urologic interventions. The broad number of properties found in amniotic membrane, coupled with its immunologically privileged status presents a number of future applications in the urological surgical realm. These applications are in their clinical infancy and suggest that further studies are warranted to investigate the use of these products in a systematic fashion.
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Affiliation(s)
- Siam Oottamasathien
- Department of Surgery and Section of Pediatric Urology, University of Utah, Salt Lake City, Utah, USA.,Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA
| | - James M Hotaling
- Department of Surgery and Section of Pediatric Urology, University of Utah, Salt Lake City, Utah, USA.,Department of Surgery and Division of Urology Section of Men's Health, University of Utah, Salt Lake City, Utah, USA
| | - James R Craig
- Department of Surgery and Section of Pediatric Urology, University of Utah, Salt Lake City, Utah, USA.,Department of Surgery and Division of Urology Section of Men's Health, University of Utah, Salt Lake City, Utah, USA
| | - Jeremy B Myers
- Department of Surgery and Section of Pediatric Urology, University of Utah, Salt Lake City, Utah, USA.,Department of Surgery and Division of Urology Section of Men's Health, University of Utah, Salt Lake City, Utah, USA
| | - William O Brant
- Department of Surgery and Section of Pediatric Urology, University of Utah, Salt Lake City, Utah, USA.,Department of Surgery and Division of Urology Section of Men's Health, University of Utah, Salt Lake City, Utah, USA
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29
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Abstract
The purpose of this article was to perform a systematic review of the recent literature on urethral tissue engineering. A total of 31 articles describing the use of tissue engineering for urethra reconstruction were included. The obtained results were discussed in three groups: cells, scaffolds, and clinical results of urethral reconstructions using these components. Stem cells of different origin were used in many experimental studies, but only autologous urothelial cells, fibroblasts, and keratinocytes were applied in clinical trials. Natural and synthetic scaffolds were studied in the context of urethral tissue engineering. The main advantage of synthetic ones is the fact that they can be obtained in unlimited amount and modified by different techniques, but scaffolds of natural origin normally contain chemical groups and bioactive proteins which increase the cell attachment and may promote the cell proliferation and differentiation. The most promising are smart scaffolds delivering different bioactive molecules or those that can be tubularized. In two clinical trials, only onlay-fashioned transplants were used for urethral reconstruction. However, the very promising results were obtained from animal studies where tubularized scaffolds, both non-seeded and cell-seeded, were applied. Impact statement The main goal of this article was to perform a systematic review of the recent literature on urethral tissue engineering. It summarizes the most recent information about cells, seeded or non-seeded scaffolds and clinical application with respect to regeneration of urethra.
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Affiliation(s)
- Stanislav Žiaran
- 1 Department of Urology, Faculty of Medicine, Comenius University in Bratislava, Bratislava 833 05, Slovak Republic
| | - Martina Galambošová
- 2 Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University in Bratislava, Bratislava 811 08, Slovak Republic
| | - L'uboš Danišovič
- 2 Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University in Bratislava, Bratislava 811 08, Slovak Republic.,3 Regenmed Ltd, Bratislava 811 02, Slovak Republic
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30
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Zhou S, Yang R, Zou Q, Zhang K, Yin T, Zhao W, Shapter JG, Gao G, Fu Q. Fabrication of Tissue-Engineered Bionic Urethra Using Cell Sheet Technology and Labeling By Ultrasmall Superparamagnetic Iron Oxide for Full-Thickness Urethral Reconstruction. Theranostics 2017; 7:2509-2523. [PMID: 28744331 PMCID: PMC5525753 DOI: 10.7150/thno.18833] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 04/21/2017] [Indexed: 01/18/2023] Open
Abstract
Urethral strictures remain a reconstructive challenge, due to less than satisfactory outcomes and high incidence of stricture recurrence. An “ideal” urethral reconstruction should establish similar architecture and function as the original urethral wall. We fabricated a novel tissue-engineered bionic urethras using cell sheet technology and report their viability in a canine model. Small amounts of oral and adipose tissues were harvested, and adipose-derived stem cells, oral mucosal epithelial cells, and oral mucosal fibroblasts were isolated and used to prepare cell sheets. The cell sheets were hierarchically tubularized to form 3-layer tissue-engineered urethras and labeled by ultrasmall super-paramagnetic iron oxide (USPIO). The constructed tissue-engineered urethras were transplanted subcutaneously for 3 weeks to promote the revascularization and biomechanical strength of the implant. Then, 2 cm length of the tubularized penile urethra was replaced by tissue-engineered bionic urethra. At 3 months of urethral replacement, USPIO-labeled tissue-engineered bionic urethra can be effectively detected by MRI at the transplant site. Histologically, the retrieved bionic urethras still displayed 3 layers, including an epithelial layer, a fibrous layer, and a myoblast layer. Three weeks after subcutaneous transplantation, immunofluorescence analysis showed the density of blood vessels in bionic urethra was significantly increased following the initial establishment of the constructs and was further up-regulated at 3 months after urethral replacement and was close to normal level in urethral tissue. Our study is the first to experimentally demonstrate 3-layer tissue-engineered urethras can be established using cell sheet technology and can promote the regeneration of structural and functional urethras similar to normal urethra.
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31
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Gamidov SI, Shneiderman MG, Pushkar DY, Vasil'ev AO, Govorov AV, Ovchinnikov RI, Popova AY, Dusmukhamedov RD. [Results of urethral reconstruction in adults after multiple hypospadias repairs]. Urologiia 2017. [PMID: 28631912 DOI: 10.18565/urol.2017.2.82-87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM To improve treatment results in patients after multiple hypospadias repairs by optimizing the postoperative management. MATERIALS AND METHODS Eighty-two patients (mean age 48.1+/-15.3 years) with urethral strictures secondary to failed hypospadias repairs underwent staged graft urethroplasty using oral mucosa (cheek, lip, tongue) as a grafting material. In 62 patients, at the end of surgery the bladder was drained with a standard Foley catheter. In twenty patients the bladder was drained with a modified silicone urethral catheter, which had an additional channel for delivering drugs and removing the urethral wound effluent, and a second additional channel for inflating a balloon fixed to the catheter tube at different parts of the catheter. RESULTS The mean length of the stricture was 5.4+/-1.2 cm (from 1 to 16 cm). Twenty-eight patients had postoperative complications. Using the modified catheter resulted in statistically significantly (p<0.05) smaller percentage of complications (10% vs 41.9%) compared to standard Foley catheter. Urinalysis and sperm test on the follow up examination at 12 months showed that only 9 (10.9%) patients had signs of the inflammatory process. Seventy-five patients (91.5%) rated the appearance of the penis as "good"; only 5 (6.1%) and 2 (2.4%) patients considered the result as "satisfactory" and "unsatisfactory", respectively. Eighty patient (97.6%) regarded the treatment result as "good" for the quality of urination and only two (2.4%) considered it "satisfactory". When assessing the strength of urinary stream, 64 (78.1%), 13 (15.8%) and 5 (6.1%) patients rated it as "good", "satisfactory", and "unsatisfactory", respectively. CONCLUSION The study findings shows that staged urethroplasty using the oral mucosa restores the urethral patency, reduces the severity of the inflammatory process, thus improving the quality of life of patients after failed hypospadias repair. The proposed modification of the catheter ensures the timely delivery of drugs to the surgical site, evacuation the wound effluent from the urethra and helps prevent strictures by periodically inflating the adjustable balloon-dilator.
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Affiliation(s)
- S I Gamidov
- Department of Andrology and Urology, V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia, Moscow, Russia.,Department of Obstetrics, Gynecology, Perinatology and Reproductology, I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia.,B.V. Leonov Department for Assisted Technologies in Infertility Treatment, V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia, Moscow, Russia.,Department of Urology, A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia.,Department of Urology and Andrology, N.I. Pirogov Russian National Research Medical University of Minzdrav of Russia, Moscow, Russia
| | - M G Shneiderman
- Department of Andrology and Urology, V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia, Moscow, Russia.,Department of Obstetrics, Gynecology, Perinatology and Reproductology, I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia.,B.V. Leonov Department for Assisted Technologies in Infertility Treatment, V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia, Moscow, Russia.,Department of Urology, A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia.,Department of Urology and Andrology, N.I. Pirogov Russian National Research Medical University of Minzdrav of Russia, Moscow, Russia
| | - D Yu Pushkar
- Department of Andrology and Urology, V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia, Moscow, Russia.,Department of Obstetrics, Gynecology, Perinatology and Reproductology, I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia.,B.V. Leonov Department for Assisted Technologies in Infertility Treatment, V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia, Moscow, Russia.,Department of Urology, A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia.,Department of Urology and Andrology, N.I. Pirogov Russian National Research Medical University of Minzdrav of Russia, Moscow, Russia
| | - A O Vasil'ev
- Department of Andrology and Urology, V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia, Moscow, Russia.,Department of Obstetrics, Gynecology, Perinatology and Reproductology, I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia.,B.V. Leonov Department for Assisted Technologies in Infertility Treatment, V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia, Moscow, Russia.,Department of Urology, A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia.,Department of Urology and Andrology, N.I. Pirogov Russian National Research Medical University of Minzdrav of Russia, Moscow, Russia
| | - A V Govorov
- Department of Andrology and Urology, V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia, Moscow, Russia.,Department of Obstetrics, Gynecology, Perinatology and Reproductology, I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia.,B.V. Leonov Department for Assisted Technologies in Infertility Treatment, V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia, Moscow, Russia.,Department of Urology, A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia.,Department of Urology and Andrology, N.I. Pirogov Russian National Research Medical University of Minzdrav of Russia, Moscow, Russia
| | - R I Ovchinnikov
- Department of Andrology and Urology, V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia, Moscow, Russia.,Department of Obstetrics, Gynecology, Perinatology and Reproductology, I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia.,B.V. Leonov Department for Assisted Technologies in Infertility Treatment, V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia, Moscow, Russia.,Department of Urology, A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia.,Department of Urology and Andrology, N.I. Pirogov Russian National Research Medical University of Minzdrav of Russia, Moscow, Russia
| | - A Yu Popova
- Department of Andrology and Urology, V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia, Moscow, Russia.,Department of Obstetrics, Gynecology, Perinatology and Reproductology, I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia.,B.V. Leonov Department for Assisted Technologies in Infertility Treatment, V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia, Moscow, Russia.,Department of Urology, A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia.,Department of Urology and Andrology, N.I. Pirogov Russian National Research Medical University of Minzdrav of Russia, Moscow, Russia
| | - R D Dusmukhamedov
- Department of Andrology and Urology, V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia, Moscow, Russia.,Department of Obstetrics, Gynecology, Perinatology and Reproductology, I.M. Sechenov First Moscow State Medical University of Minzdrav of Russia, Moscow, Russia.,B.V. Leonov Department for Assisted Technologies in Infertility Treatment, V.I. Kulakov Research Center for Obstetrics, Gynecology and Perinatology of Minzdrav of Russia, Moscow, Russia.,Department of Urology, A.I. Evdokimov Moscow State University of Medicine and Dentistry of Minzdrav of Russia, Moscow, Russia.,Department of Urology and Andrology, N.I. Pirogov Russian National Research Medical University of Minzdrav of Russia, Moscow, Russia
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Xue JD, Gao J, Fu Q, Feng C, Xie H. Seeding cell approach for tissue-engineered urethral reconstruction in animal study: A systematic review and meta-analysis. Exp Biol Med (Maywood) 2016; 241:1416-28. [PMID: 27022134 DOI: 10.1177/1535370216640148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 02/22/2016] [Indexed: 11/16/2022] Open
Abstract
We systematically reviewed published preclinical studies to evaluate the effectiveness of cell-seeded tissue engineering approach for urethral reconstruction in an animal model. The outcomes were summarized by success factors in the animal experiments, which evaluate the possibility and feasibility of a clinical application in the future. Preclinical studies of tissue engineering approaches for urethral reconstruction were identified through a systematic search in PubMed, Embase, and Biosis Previews (web of science SP) databases for studies published from 1 January 1980 to 23 November 2014. Primary studies were included if urethral reconstruction was performed using a tissue-engineered biomaterial in any animal species (with the experiment group being a cell-seeded scaffold and the control group being a cell-free scaffold) with histology and urethrography as the outcome measure. A total of 15 preclinical studies were included in our meta-analysis. The histology and urethrography outcome between the experimental and control groups were considered to be the most clinically relevant. Through this systematic approach, our outcomes suggested that applying the cell-seeded biomaterial in creating a neo-urethra was stable and effective. And multi-type cells including epithelial cells as well as smooth muscle cells or fibroblasts seemed to be a better strategy. Stem cells, especially after epithelial differentiation, could be a promising choice for future researches.
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Affiliation(s)
- Jing-Dong Xue
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Jing Gao
- Department of Obstetrics & Gynecology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Qiang Fu
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Chao Feng
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Hong Xie
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
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Pham KN, Sokoloff MH, Steiger CA. Severe gangrene at the glans penis requiring penectomy as the first major complication of Buerger's disease. Am J Clin Exp Urol 2016; 4:9-11. [PMID: 27069957 PMCID: PMC4749402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 11/22/2015] [Indexed: 06/05/2023]
Abstract
We report an interesting case of Buerger's disease that manifested at the glans penis in a 56 year-old former smoker. Penile involvement in Buerger's disease is rare. Our patient had no prior extremity or digit amputations in his 4-year history of Buerger's disease. However, our patient did suffer from recurrent penile ulcers over an 8-week timeframe that ultimately progressed to a gangrenous, unsalvageable glans penis. He underwent a partial penectomy and urethral reconstruction with excellent post-operative results.
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Affiliation(s)
- Khanh N Pham
- Department of Urology, University of Massachusetts Medical School Worcester, MA 01605, USA
| | - Mitchell H Sokoloff
- Department of Urology, University of Massachusetts Medical School Worcester, MA 01605, USA
| | - Charles A Steiger
- Department of Urology, University of Massachusetts Medical School Worcester, MA 01605, USA
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Abstract
Excision and end-to-end anastomosis (EPA) has been the preferred urethroplasty technique for short bulbar strictures and is associated with an excellent functional outcome. Driven by concerns over the potential morbidity associated with dividing the urethra, therefore compromising spongiosal blood flow, as well as spongiofibrosis being superficial in the majority of non-traumatic bulbar strictures, the non-transecting technique for bulbar urethroplasty has been developed with the aim of achieving the same success as EPA without the morbidity associated with transection. This manuscript highlights the fundamental principles underlying the ongoing debate-transection or non-transection of the strictured bulbar urethra? The potential advantages of avoiding dividing the corpus spongiosum of the urethra are discussed. The non-transecting anastomotic procedure together with its various modifications are decribed in detail. Our experience with this technique is presented. Non-transecting excision of spongiofibrosis with preservation of well vascularised underlying spongiosum provides an excellent alternative to dividing the urethra during urethroplasty for short non-traumatic proximal bulbar strictures.
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Affiliation(s)
- Simon Bugeja
- Reconstructive Urology Unit, University College London Hospital, London NW1 2BU, UK
| | - Daniela E Andrich
- Reconstructive Urology Unit, University College London Hospital, London NW1 2BU, UK
| | - Anthony R Mundy
- Reconstructive Urology Unit, University College London Hospital, London NW1 2BU, UK
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Aoki K, Hori S, Morizawa Y, Nakai Y, Miyake M, Anai S, Torimoto K, Yoneda T, Tanaka N, Yoshida K, Fujimoto K. [URETHROPLASTY FOR COMPLICATED ANTERIOR URETHRAL STRICTURES]. Nihon Hinyokika Gakkai Zasshi 2016; 107:227-232. [PMID: 29070735 DOI: 10.5980/jpnjurol.107.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
(Objectives) To compare efficacy and outcome of urethroplasty for complicated anterior urethral strictures. (Methods) Twelve patients, included 3 boys, with anterior urethral stricture underwent urethroplasty after the failure of either urethral dilatation or internal urethrotomy. We evaluated pre- and post-operative Q max and surgical outcome. (Results) Four patients were treated with end-to-end anastomosis, included a case of bulbar urethral elongation simultaneously, one patient was treated with augmented anastomotic urethroplasty, three patients were treated with onlay urethroplasty with prepucial flap, one patient was treated with tubed urethroplasty with prepucial flap (Ducket procedure) and three patients were treated with onlay urethroplasty with buccal mucosal graft. Postoperative Qmax improved in all patients without major complications and recurrence during follow-up periods ranging from 17 to 102 months (mean 55 months). (Conclusions) Urethroplasty is an effective therapeutic procedure for complicated anterior urethral stricture.
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Affiliation(s)
| | - Shunta Hori
- Department of Urology, Nara Medical University
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Lv X, Yang J, Feng C, Li Z, Chen S, Xie M, Huang J, Li H, Wang H, Xu Y. Bacterial Cellulose-Based Biomimetic Nanofibrous Scaffold with Muscle Cells for Hollow Organ Tissue Engineering. ACS Biomater Sci Eng 2015; 2:19-29. [PMID: 33418641 DOI: 10.1021/acsbiomaterials.5b00259] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In this study, we built a bilayer nanofibrous material by utilizing the gelatinization properties of potato starch (PS) to interrupt bacterial cellulose (BC) assembly during static culture to create more free spaces within the fibrous network. Then, muscle cells were cultured on the loose surface of the BC/PS scaffolds to build biomaterials for hollow organ reconstruction. Our results showed that the BC/PS scaffolds exhibited similar mechanical characters to those in the traditional BC scaffolds. And the pore sizes and porosities of BC/PS scaffolds could be controlled by adjusting the starch content. The average nanofiber diameters of unmodified BC and BC/PS composites is approximately to that of the urethral acellular matrix. Those scaffolds permit the muscle cells infiltration into the loose layer and the BC/PS membranes with muscle cells could enhance wound healing in vivo and vitro. Our study suggested that the use of bilayer BC/PS nanofibrous scaffolds may lead to improved vessel formation. BC/PS nanofibrous scaffolds with muscle cells enhanced the repair in dog urethral defect models, resulting in patent urethra. Improved organized muscle bundles and epithelial layer were observed in animals treated with BC/PS scaffold seeded by muscle cells compared with those treated with pure BC/PS scaffold. This study suggests that this biomaterial could be suitable for tissue engineered urinary tract reconstruction and this type of composite scaffold could be used for numerous other types of hollow organ tissue engineering grafts, including vascular, bladder, ureter, esophagus, and intestine.
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Affiliation(s)
- XiangGuo Lv
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - JingXuan Yang
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai, China
| | - Chao Feng
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zhe Li
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai, China
| | - ShiYan Chen
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai, China
| | - MinKai Xie
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - JianWen Huang
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - HongBin Li
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - HuaPing Wang
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Materials Science and Engineering, Donghua University, Shanghai, China
| | - YueMin Xu
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai, China
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Sun D, Yang Y, Wei Z, Xu Y, Zhang X, Hong B. Engineering of pre-vascularized urethral patch with muscle flaps and hypoxia-activated hUCMSCs improves its therapeutic outcome. J Cell Mol Med 2014; 18:434-43. [PMID: 24460735 PMCID: PMC3955150 DOI: 10.1111/jcmm.12157] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 09/09/2013] [Indexed: 01/01/2023] Open
Abstract
Tissue engineering has brought new hopes for urethral reconstruction. However, the absence of pre-vascularization and the subsequent degradation of materials often lead to the failure of in vivo application. In this study, with the assistance of hypoxia-activated human umbilical cord mesenchymal stem cells (hUCMSCs), pedicled muscle flaps were used as materials and pre-incubated in ventral penile subcutaneous cavity of rabbit for 3 weeks to prepare a pre-vascularized urethral construct. We found that small vessels and muscle fibres were scattered in the construct after 3 weeks' pre-incubation. The construct presented a fibrous reticular structure, which was similar to that of the corpus spongiosum under microscope examination. The produced constructs were then used as a patch graft for reconstruction of the defective rabbit urethra (experimental group), natural muscular patch was used as control (control group). Twelve weeks after the reconstructive surgery, urethrography and urethroscope inspections showed wide calibres of the reconstructed urethra in the experimental group. Histopathological studies revealed that fibrous connective tissues and abundant muscle fibres constituted the main body of the patch-grafted urethra. In contrast, in the control group, only adipose tissue was found in the stenosis-reconstructed urethra, replacing the originally grafted muscular tissue. To our knowledge, this is the first report that successfully constructed a pre-vascularized urethral construct by using hypoxia-activated hUCMSC and pedicled muscle flaps. More importantly, the pre-vascularized construct showed a good performance in urethral reconstruction when applied in vivo. The study provided a novel strategy for tissue engineering of pre-vascularized urethral construct for the defective urethra, representing a further advancement in urethral reconstruction.
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Affiliation(s)
- Dongchong Sun
- Department of Urology, People's Liberation Army General Hospital, Beijing, China
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Li C, Xu YM, Li HB. Preliminary experimental study of urethral reconstruction with tissue engineering and RNA interference techniques. Asian J Androl 2013; 15:430-3. [PMID: 23542139 PMCID: PMC3739635 DOI: 10.1038/aja.2013.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 11/19/2012] [Accepted: 01/04/2013] [Indexed: 12/13/2022] Open
Abstract
This study investigated the feasibility of replacing urinary epithelial cells with oral keratinocytes and transforming growth factor-β1 (TGF-β1) small interfering RNA (siRNA)-transfected fibroblasts seeded on bladder acellular matrix graft (BAMG) in order to reconstruct tissue-engineered urethra. Constructed siRNAs, which expressed plasmids targeting TGF-β1, were transfected into rabbit fibroblasts. The effective siRNA was screened out by RT-PCR and was transfected into rabbit fibroblasts again. Synthesis of type I collagen in culture medium was measured by enzyme-linked immuno sorbent assay (ELISA). Autologous oral keratinocytes and TGF-β1 siRNA-transfected fibroblasts were seeded onto BAMGs to obtain a tissue-engineered mucosa. The tissue-engineered mucosa was assessed morphologically and with the help of scanning electron microscopy. The TGF-β1 siRNA decreased the expression of fibroblasts synthesis type I collagen. Oral keratinocytes and TGF-β1 siRNA-transfected fibroblasts were seeded onto sterilized BAMG to obtain a tissue-engineered mucosa for urethral reconstruction. The compound graft was assessed using scanning electron microscope. Oral keratinocytes and TGF-β1 siRNA-transfected fibroblasts had a good compatibility with BAMG. The downregulation of fibroblasts synthesis type I collagen expression by constructed siRNA interfering TGF-β1 provided a potential basis for genetic therapy of urethral scar. Oral keratinocytes and TGF-β1 siRNA-transfected fibroblasts had good compatibility with BAMG and the compound graft could be a new choice for urethral reconstruction.
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Affiliation(s)
- Chao Li
- Department of Urology, Sixth People’s Hospital, Shanghai Jiaotong University, Shanghai 200233, China.
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Abstract
A five-year-old girl presented with post traumatic urinary incontinence secondary to rupture of the bladder neck into the vagina. Operative repair included a midline exposure with resection of the symphysis pubis, separation of the bladder neck from the vagina, repair of the torn bladder neck and urethral substitution with ileum. Normal continence and voiding was achieved.
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Affiliation(s)
- Lavanya Kannaiyan
- Department of Paediatric Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu-632 004, India
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