Mucosa rectal??
J Urol. 2019 Jan 29:101097JU0000000000000087. doi: 10.1097/JU.0000000000000087. [Epub ahead of print]
Granieri MA1, Zhao LC1, Breyer BN2, Voelzke BB3, Baradaran N2, Grucela AL4, Marcello P5, Vanni AJ6.
Author information:
1. Department of Urology, New York University Langone Medical Center , New York , New York.
2. Department of Urology, University of San Francisco-California , San Francisco , California.
3. Department of Urology, University of Washington , Seattle , Washington.
4. Division of Colorectal Surgery, Department of Surgery, New York University Langone Medical Center , New York , New York.
5. Departments of Colon and Rectal Surgery, Lahey Hospital and Medical Center , Burlington , Massachusetts.
6. Department of Urology, Lahey Hospital and Medical Center , Burlington , Massachusetts.
Abstract
PURPOSE:
We report multi-institutional outcomes in patients who underwent urethroplasty with a rectal mucosa graft.
MATERIALS AND METHODS:
We used the TURNS (Trauma and Urologic Reconstructive Network of Surgeons) database to identify patients who underwent urethral reconstruction with transanal harvest of a rectal mucosa graft. We reviewed preoperative demographics, stricture etiology, previous management and patient outcomes.
RESULTS:
We identified 13 patients from April 2013 to June 2017. Median age at surgery was 54 years. The stricture etiology was lichen sclerosus in 6 of 13 patients (46%), idiopathic in 2 (15%), hypospadias in 1 (7%), prior gender confirming surgery in 3 (23%) and rectourethral fistula after radiation for prostate cancer in 1 (7%). Prior procedures included failed urethroplasty with a buccal mucosa graft in 9 of 13 patients (69%), direct vision internal urethrotomy in 2 (15 %) and none in 2 (15%). Median stricture length was 13 cm. Stricture location in the 9 cisgender patients was panurethral in 5 (56%), bulbopendulous in 2 (22%) and bulbar in 2 (22%). It was located at the junction of the fixed urethra extending into the neophallus in all 3 patients (100%) who underwent prior gender confirming surgery. Mean rectal mucosa graft length for urethroplasty was 10.6 cm (range 3 to 16). Repair types included dorsal or ventral onlay, or 2-stage repair. Stricture recurred at a median followup of 13.5 months in 2 of 13 patients ( 15%). Postoperative complications included glans dehiscence, urethrocutaneous fistula and compartment syndrome in 1 patient each (7%). No rectal or bowel related complications were reported.
CONCLUSIONS:
Urethral reconstruction with a transanal harvested rectal mucosa graft is a safe technique when a buccal mucosa graft is unavailable or not indicated.