A New Option for Urethral Repair

An off-the-shelf biomaterial is a viable option for repairing some cases of urethral stricture, eliminating the need for harvesting tissue from the cheek, according to our report in the Journal of Urology. In this study involving 30 patients with stricture, those with a healthy urethral bed had similar results using acellular bladder matrix as a graft material to those who received the current gold standard, the mucous membrane lining the cheek (buccal mucosal).

Male urethral stricture, a narrowing of the tube that empties urine from the body, can occur as a result of disease, injury or from scar tissue forming after certain medical procedures, including surgery for prostate cancer or the insertion of a scope into the urethra to treat an enlarged prostate.

Urethral strictures have been a reconstructive dilemma for many years due to the limited availability of tissue substitutes and the incidence of recurrence. When penile skin is not available, buccal mucosal grafts are a favored material. This randomized trial compared this current gold standard with accellular bladder matrix – bladder tissue from a cadaver donor that was processed to remove cells and leave only the support structure.

Eighteen to 36 months of follow up showed that in patients with a healthy urethral bed (less than two prior operations), the success rates of muccal mucosa and bladder matrix grafts were similar in terms of the urethras  remaining open. Both groups showed significant voiding improvement.            

(Randomized comparative study between buccal mucosal and acellular bladder matrix grafts in complex anterior urethral strictures. el-Kassaby A, AbouShwareb T, Atala A. J Urol. 2008 Apr;179(4):1432-6. Erratum in: J Urol. 2008 Jun;179(6):2490.)