J Urol. 2019 Jan 29:101097JU0000000000000087. doi: 10.1097/JU.0000000000000087. [Epub ahead of print]
Multi-Institutional Outcomes of Minimally Invasive Harvest of Rectal Mucosa Graft for Anterior Urethral Reconstruction.
Granieri MA1, Zhao LC1, Breyer BN2, Voelzke BB3, Baradaran N2, Grucela AL4, Marcello P5, Vanni AJ6.
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.
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.
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.
Urethral reconstruction with a transanal harvested rectal mucosa graft is a safe technique when a buccal mucosa graft is unavailable or not indicated.