Multi-Institutional Outcomes of Minimally Invasive Harvest of Rectal Mucosa Graft for Anterior Urethral Reconstruction.

Autor:	Granieri MA; Department of Urology, New York University Langone Medical Center , New York , New York., Zhao LC; Department of Urology, New York University Langone Medical Center , New York , New York., Breyer BN; Department of Urology, University of San Francisco-California , San Francisco , California., Voelzke BB; Department of Urology, University of Washington , Seattle , Washington., Baradaran N; Department of Urology, University of San Francisco-California , San Francisco , California., Grucela AL; Division of Colorectal Surgery, Department of Surgery, New York University Langone Medical Center , New York , New York., Marcello P; Departments of Colon and Rectal Surgery, Lahey Hospital and Medical Center , Burlington , Massachusetts., Vanni AJ; Department of Urology, Lahey Hospital and Medical Center , Burlington , Massachusetts.
Jazyk:	angličtina
Zdroj:	The Journal of urology [J Urol] 2019 Jun; Vol. 201 (6), pp. 1164-1170.
DOI:	10.1097/JU.0000000000000087
Abstrakt:	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.
Databáze:	MEDLINE
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