OBJECTIVES: To investigate the feasibility of small intestinal submucosa graft for the repair of selected anterior urethral strictures. METHODS: From June 2009 to May 2011, 28 men (mean age 39 years) with anterior urethral strictures underwent urethroplasty using a four-layer small intestinal submucosa patch graft in an onlay or inlay fashion. The stricture was localized to the bulbar urethra in eight patients, the bulbopenile area in nine patients and the distal penile urethra in 10 patients. Failed hypospadias was observed in one patient. The mean stricture length was 4.6 cm (range 3.5-7.0 cm). RESULTS: The mean follow-up period was 24.8 months (range 12-30 months). No postoperative complications, such as infection or rejection, were related to the use of heterologous graft material. The patients voided well postoperatively, with peak flows between 16 and 44 mL/s (mean 25.4 mL/s) in 26 patients. Two patients (7.1%) developed a urethral narrowing; this occurred at 5 months in one patient and 6 months in the other, and cystoscopy, which was carried out at 20 and 24 weeks, respectively, showed clear cicatricial tissue at the proximal anastomotic site. Dilation was carried out once every 4-6 months for recurrent stricture in one patient and lingual mucosal graft urethroplasty was carried out in the other patient at 18 months postoperatively. Biopsies were obtained in four patients at 18, 24, 36 and 42 weeks, respectively. Squamous epithelium with or without hyperkeratosis was observed on histological examination of the small intestinal submucosa-grafted areas. CONCLUSIONS: The small intestinal submucosa matrix appears to be a safe and effective reconstructive material for selective use in urethral reconstructive surgery.
OBJECTIVES: To investigate the feasibility of small intestinal submucosa graft for the repair of selected anterior urethral strictures. METHODS: From June 2009 to May 2011, 28 men (mean age 39 years) with anterior urethral strictures underwent urethroplasty using a four-layer small intestinal submucosa patch graft in an onlay or inlay fashion. The stricture was localized to the bulbar urethra in eight patients, the bulbopenile area in nine patients and the distal penile urethra in 10 patients. Failed hypospadias was observed in one patient. The mean stricture length was 4.6 cm (range 3.5-7.0 cm). RESULTS: The mean follow-up period was 24.8 months (range 12-30 months). No postoperative complications, such as infection or rejection, were related to the use of heterologous graft material. The patients voided well postoperatively, with peak flows between 16 and 44 mL/s (mean 25.4 mL/s) in 26 patients. Two patients (7.1%) developed a urethral narrowing; this occurred at 5 months in one patient and 6 months in the other, and cystoscopy, which was carried out at 20 and 24 weeks, respectively, showed clear cicatricial tissue at the proximal anastomotic site. Dilation was carried out once every 4-6 months for recurrent stricture in one patient and lingual mucosal graft urethroplasty was carried out in the other patient at 18 months postoperatively. Biopsies were obtained in four patients at 18, 24, 36 and 42 weeks, respectively. Squamous epithelium with or without hyperkeratosis was observed on histological examination of the small intestinal submucosa-grafted areas. CONCLUSIONS: The small intestinal submucosa matrix appears to be a safe and effective reconstructive material for selective use in urethral reconstructive surgery.