Skip to main content

Advertisement

Log in

Urethral Reconstruction Using Autologous Vein Grafts for the Management of Urethral Strictures

  • Regenerative Medicine (A Atala, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Urethral strictures may be caused by infections, trauma, or iatrogenic injuries. However, urethral reconstruction as a means of managing the long-segment urethral strictures can prove problematic. Various graft materials have been developed for use during urethroplasty. Although some graft techniques—including those using the buccal mucosa, bladder mucosa, colonic mucosa, and skin—have yielded good results, risks of surgical failure and donor site complications remain. Moreover, no graft material has yet been accepted as the clinical standard within the field of urology. This article provides a brief, updated review of both urethral strictures and clinically available graft materials for urethral reconstruction. In addition, we review previous studies involving autologous vein grafts for urethroplasty and discuss potential advances in the clinical use of these grafts.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Tritschler S, Roosen A, Fullhase C, Stief CG, Rubben H. Urethral stricture: etiology, investigation and treatments. Dtsch Arztebl Int. 2013;110:220–6.

    PubMed Central  PubMed  Google Scholar 

  2. Lumen N, Hoebeke P, Willemsen P, De Troyer B, Pieters R, Oosterlinck W. Etiology of urethral stricture disease in the 21st century. J Urol. 2009;182:983–7.

    Article  PubMed  Google Scholar 

  3. Chapple C, Barbagli G, Jordan G, et al. Consensus statement on urethral trauma. BJU Int. 2004;93:1195–202.

    Article  CAS  PubMed  Google Scholar 

  4. Mangera A, Chapple C. Management of anterior urethral stricture: an evidence-based approach. Curr Opin Urol. 2010;20:453–8.

    Article  PubMed  Google Scholar 

  5. Bullock TL, Brandes SB. Adult anterior urethral strictures: a national practice patterns survey of board certified urologists in the United States. J Urol. 2007;177:685–90.

    Article  PubMed  Google Scholar 

  6. Barbagli G, Palminteri E, Lazzeri M, Guazzoni G, Turini D. Long-term outcome of urethroplasty after failed urethrotomy versus primary repair. J Urol. 2001;165:1918–9.

    Article  CAS  PubMed  Google Scholar 

  7. Andrich DE, Mundy AR. What is the best technique for urethroplasty? Eur Urol. 2008;54:1031–41.

    Article  PubMed  Google Scholar 

  8. Guralnick ML, Webster GD. The augmented anastomotic urethroplasty: indications and outcome in 29 patients. J Urol. 2001;65:1496–501.

    Article  Google Scholar 

  9. Eltahawy EA, Virasoro R, Schlossberg SM, McCammon KA, Jordan GH. Long-term followup for excision and primary anastomosis for anterior urethral strictures. J Urol. 2007;177:1803–6.

    Article  PubMed  Google Scholar 

  10. Singh O, Gupta SS, Arvind NK. Anterior urethral strictures: a brief review of the current surgical treatment. Urol Int. 2011;86:1–10.

    Article  PubMed  Google Scholar 

  11. Mathur R, Aggarwal G, Satsangi B, Khan F, Odiya S. Comprehensive analysis of etiology on the prognosis of urethral strictures. Int Braz J Urol. 2011;37:362–9. discussion 9–70.

    Article  PubMed  Google Scholar 

  12. Kim BS, Kim HT, Kwon SY, et al. Nontransected ventral onlay-augmented urethroplasty using autologous saphenous vein graft in a rabbit model of urethral stricture. Urology. 2014;83:225–31. This article showed the effectiveness and feasibility of autologous saphenous vein graft for surgical management of long tract urethral stricture in an animal model.

    Article  PubMed  Google Scholar 

  13. Kamp S, Knoll T, Osman M, Hacker A, Michel MS, Alken P. Donor-site morbidity in buccal mucosa urethroplasty: lower lip or inner cheek? BJU Int. 2005;96:619–23.

    Article  PubMed  Google Scholar 

  14. Lee YT, Cho TW, Jeong HS, Lee YK, Hong YK. Reconfigured sigmoid colon neourethra: substitution of refractory posterior urethral stricture. Urology. 2005;65:157–9.

    Article  PubMed  Google Scholar 

  15. Raber M, Naspro R, Scapaticci E, et al. Dorsal onlay graft urethroplasty using penile skin or buccal mucosa for repair of bulbar urethral stricture: results of a prospective single center study. Eur Urol. 2005;48:1013–7.

    Article  PubMed  Google Scholar 

  16. Wessells H, McAninch JW. Current controversies in anterior urethral stricture repair: free-graft versus pedicled skin-flap reconstruction. World J Urol. 1998;16:175–80.

    Article  CAS  PubMed  Google Scholar 

  17. Wu DL, Jin SB, Zhang J, Chen Y, Jin CR, Xu YM. Staged pendulous-prostatic anastomotic urethroplasty followed by reconstruction of the anterior urethra: an effective treatment for long-segment bulbar and membranous urethral stricture. Eur Urol. 2007;51:504–10. discussion 10–1.

    Article  PubMed  Google Scholar 

  18. Xu YM, Qiao Y, Sa YL, et al. 1-stage urethral reconstruction using colonic mucosa graft for the treatment of a long complex urethral stricture. J Urol. 2004;171:220–3. discussion 3.

    Article  PubMed  Google Scholar 

  19. Mantovani F, Trinchieri A, Castelnuovo C, Romano AL, Pisani E. Reconstructive urethroplasty using porcine acellular matrix. Eur Urol. 2003;44:600–2.

    Article  PubMed  Google Scholar 

  20. O'Riordan A, Narahari R, Kumar V, Pickard R. Outcome of dorsal buccal graft urethroplasty for recurrent bulbar urethral strictures. BJU Int. 2008;102:1148–51.

    Article  PubMed  Google Scholar 

  21. Xu YM, Qiao Y, Sa YL, et al. Substitution urethroplasty of complex and long-segment urethral strictures: a rationale for procedure selection. Eur Urol. 2007;51:1093–8. discussion 8–9.

    Article  PubMed  Google Scholar 

  22. Kiaii B, Moon BC, Massel D, et al. A prospective randomized trial of endoscopic versus conventional harvesting of the saphenous vein in coronary artery bypass surgery. J Thorac Cardiovasc Surg. 2002;123:204–12.

    Article  PubMed  Google Scholar 

  23. Foroutan HR, Khalili A, Geramizadeh B, Rasekhi AR, Tanideh N. Urethral reconstruction using autologous and everted vein graft: an experimental study. Pediatr Surg Int. 2006;22:259–62.

    Article  CAS  PubMed  Google Scholar 

  24. Frang D, Furka I, Koves S. Urethral replacement with autologous venous graft: an experimental study in the dog. Urol Res. 1982;10:145–7.

    Article  CAS  PubMed  Google Scholar 

  25. Hubner W, Rurka I, Porpaczy P, Miko I. Autologous everted vein graft for repairing long-section urethral defects. Urol Res. 1991;19:131–4.

    Article  CAS  PubMed  Google Scholar 

  26. Kahveci R, Kahveci Z, Sirmali S, Ozcan M. Urethral reconstruction with autologous vein graft: an experimental study. Br J Plast Surg. 1995;48:500–3.

    Article  CAS  PubMed  Google Scholar 

  27. Kjaer TB, Nilsson T, Madsen PO. Total replacement of part of the canine urethra with lyophilized vein homografts. Invest Urol. 1976;14:159–61.

    CAS  PubMed  Google Scholar 

  28. Ahmed A, Kalayi GD. Urethral stricture at Ahmadu Bello University Teaching Hospital, Zaria. East Afr Med J. 1998;75:582–5.

    CAS  PubMed  Google Scholar 

  29. Steenkamp JW, Heyns CF, de Kock ML. Internal urethrotomy versus dilation as treatment for male urethral strictures: a prospective, randomized comparison. J Urol. 1997;157:98–101.

    Article  CAS  PubMed  Google Scholar 

  30. Mundy AR, Andrich DE. Urethral strictures. BJU Int. 2011;107:6–26.

    Article  PubMed  Google Scholar 

  31. Fenton AS, Morey AF, Aviles R, Garcia CR. Anterior urethral strictures: etiology and characteristics. Urology. 2005;65:1055–8.

    Article  PubMed  Google Scholar 

  32. Park S, McAninch JW. Straddle injuries to the bulbar urethra: management and outcomes in 78 patients. J Urol. 2004;171:722–5.

    Article  PubMed  Google Scholar 

  33. Scott TM, Foote J. Early events in stricture formation in the guinea pig urethra. Urol Int. 1980;35:334–9.

    Article  CAS  PubMed  Google Scholar 

  34. Meria P, Anidjar M, Brouland JP, et al. An experimental model of bulbar urethral stricture in rabbits using endoscopic radiofrequency coagulation. Urology. 1999;53:1054–7.

    Article  CAS  PubMed  Google Scholar 

  35. Baskin LS, Constantinescu SC, Howard PS, et al. Biochemical characterization and quantitation of the collagenous components of urethral stricture tissue. J Urol. 1993;150:642–7.

    CAS  PubMed  Google Scholar 

  36. Cavalcanti AG, Costa WS, Baskin LS, McAninch JA, Sampaio FJ. A morphometric analysis of bulbar urethral strictures. BJU Int. 2007;100:397–402.

    Article  PubMed  Google Scholar 

  37. Cavalcanti AG, Yucel S, Deng DY, McAninch JW, Baskin LS. The distribution of neuronal and inducible nitric oxide synthase in urethral stricture formation. J Urol. 2004;171:1943–7.

    Article  CAS  PubMed  Google Scholar 

  38. Zhang P, Shi M, Wei Q, et al. Increased expression of connective tissue growth factor in patients with urethral stricture. Tohoku J Exp Med. 2008;215:199–206.

    Article  CAS  PubMed  Google Scholar 

  39. Barbagli G, De Stefani S, Annino F, De Carne C, Bianchi G. Muscle- and nerve-sparing bulbar urethroplasty: a new technique. Eur Urol. 2008;54:335–43.

    Article  PubMed  Google Scholar 

  40. Barbagli G, Guazzoni G, Lazzeri M. One-stage bulbar urethroplasty: retrospective analysis of the results in 375 patients. Eur Urol. 2008;53:828–33.

    Article  PubMed  Google Scholar 

  41. Barbagli G, Palminteri E, Guazzoni G, Montorsi F, Turini D, Lazzeri M. Bulbar urethroplasty using buccal mucosa grafts placed on the ventral, dorsal or lateral surface of the urethra: are results affected by the surgical technique? J Urol. 2005;174:955–7. discussion 7–8.

    Article  PubMed  Google Scholar 

  42. Fichtner J, Filipas D, Fisch M, Hohenfellner R, Thuroff JW. Long-term outcome of ventral buccal mucosa onlay graft urethroplasty for urethral stricture repair. Urology. 2004;64:648–50.

    Article  PubMed  Google Scholar 

  43. Andrich DE, Mundy AR. What's new in urethroplasty? Curr Opin Urol. 2011;21:455–60. This study provides an overview of current trends about urethroplasty and suggested the best surgical options according to the type of urethral strictures.

    Article  PubMed  Google Scholar 

  44. Patterson JM, Chapple CR. Surgical techniques in substitution urethroplasty using buccal mucosa for the treatment of anterior urethral strictures. Eur Urol. 2008;53:1162–71.

    Article  PubMed  Google Scholar 

  45. Barbagli G, Lazzeri M. Urethral reconstruction. Curr Opin Urol. 2006;16:391–5.

    Article  PubMed  Google Scholar 

  46. Lee YJ, Kim SW. Current management of urethral stricture. Korean J Urol. 2013;54:561–9. This article provides a brief updated review of the surgical options for the management of different sites and different types of anterior urethral stricture. This review also covers present controversies in urethral reconstruction.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Barbagli G, De Angelis M, Palminteri E, Lazzeri M. Failed hypospadias repair presenting in adults. Eur Urol. 2006;49:887–94. discussion 95.

    Article  PubMed  Google Scholar 

  48. Andrich DE, Greenwell TJ, Mundy AR. The problems of penile urethroplasty with particular reference to 2-stage reconstructions. J Urol. 2003;170:87–9.

    Article  CAS  PubMed  Google Scholar 

  49. Manoj B, Sanjeev N, Pandurang PN, Jaideep M, Ravi M. Postauricular skin as an alternative to oral mucosa for anterior onlay graft urethroplasty: a preliminary experience in patients with oral mucosa changes. Urology. 2009;74:345–8.

    Article  PubMed  Google Scholar 

  50. Mathur RK, Sharma A. Tunica albuginea urethroplasty for panurethral strictures. Urol J. 2010;7:120–4.

    PubMed  Google Scholar 

  51. Ozgok Y, Ozgur Tan M, Kilciler M, Tahmaz L, Erduran D. Use of bladder mucosal graft for urethral reconstruction. Int J Urol. 2000;7:355–60.

    Article  CAS  PubMed  Google Scholar 

  52. Xu YM, Qiao Y, Sa YL, Zhang J, Fu Q, Song LJ. Urethral reconstruction using colonic mucosa graft for complex strictures. J Urol. 2009;182:1040–3.

    Article  PubMed  Google Scholar 

  53. Xu YM, Sa YL, Fu Q, Zhang J, Si JM, Liu ZS. Oral mucosal grafts urethroplasty for the treatment of long segmented anterior urethral strictures. World J Urol. 2009;27:565–71.

    Article  PubMed  Google Scholar 

  54. Bhargava S, Patterson JM, Inman RD, MacNeil S, Chapple CR. Tissue-engineered buccal mucosa urethroplasty-clinical outcomes. Eur Urol. 2008;53:1263–9.

    Article  PubMed  Google Scholar 

  55. Jordan GH. Scrotal and perineal flaps for anterior urethral reconstruction. Urol Clin North Am. 2002;29:411–6. viii.

    Article  PubMed  Google Scholar 

  56. Vyas PR, Roth DR, Perlmutter AD. Experience with free grafts in urethral reconstruction. J Urol. 1987;137:471–4.

    CAS  PubMed  Google Scholar 

  57. Kinkead TM, Borzi PA, Duffy PG, Ransley PG. Long-term followup of bladder mucosa graft for male urethral reconstruction. J Urol. 1994;151:1056–8.

    CAS  PubMed  Google Scholar 

  58. Foinquinos RC, Calado AA, Janio R, Griz A, Macedo Jr A, Ortiz V. The tunica vaginalis dorsal graft urethroplasty: initial experience. Int Braz J Urol. 2007;33:523–9. discussion 9–31.

    Article  PubMed  Google Scholar 

  59. Greenwell TJ, Venn SN, Mundy AR. Changing practice in anterior urethroplasty. BJU Int. 1999;83:631–5.

    Article  CAS  PubMed  Google Scholar 

  60. Bhargava S, Chapple CR. Buccal mucosal urethroplasty: is it the new gold standard? BJU Int. 2004;93:1191–3.

    Article  CAS  PubMed  Google Scholar 

  61. Simonato A, Gregori A, Ambruosi C, et al. Lingual mucosal graft urethroplasty for anterior urethral reconstruction. Eur Urol. 2008;54:79–85.

    Article  PubMed  Google Scholar 

  62. Mangera A, Chapple CR. Tissue engineering in urethral reconstruction—an update. Asian J Androl. 2013;15:89–92. This article evaluated the progress made in finding a tissue engineered substitute for the human urethra and discussed different approaches for developing these grafts.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  63. Ransley PG, Duffy PG, Oesch IL, Van Oyen P, Hoover D. The use of bladder mucosa and combined bladder mucosa/preputial skin grafts for urethral reconstruction. J Urol. 1987;138:1096–8.

    CAS  PubMed  Google Scholar 

  64. Andrich DE, Mundy AR. Substitution urethroplasty with buccal mucosal-free grafts. J Urol. 2001;165:1131–3. discussion 3–4.

    Article  CAS  PubMed  Google Scholar 

  65. Kropfl D, Tucak A, Prlic D, Verweyen A. Using buccal mucosa for urethral reconstruction in primary and re-operative surgery. Eur Urol. 1998;34:216–20.

    Article  CAS  PubMed  Google Scholar 

  66. Asopa HS, Sharma LK. The epithelial structure of autogenous vein graft when utilized as a ureteral substitute in dogs. Experimental study. Int Surg. 1969;52:141–3.

    CAS  PubMed  Google Scholar 

  67. Pompeius R, Ekroth R. Vein patch grafting for repair of short ureteric strictures. Scand J Urol Nephrol. 1977;11:245–7.

    Article  CAS  PubMed  Google Scholar 

  68. Razdan AN, Asopa HS, Bhargava KS, Sharma LK. Replacement of the ureter by autogenous vein graft. Indian J Med Res. 1969;57:1361–5.

    CAS  PubMed  Google Scholar 

  69. Seidel CL, Lewis RM, Bowers R, et al. Adaptation of canine saphenous veins to grafting. Correlation of contractility and contractile protein content. Circ Res. 1984;55:102–9.

    Article  CAS  PubMed  Google Scholar 

  70. Breitenecker G, Eichelter P, Staudacher M, Weissenhofer W. Lyophilised vein as a vascular prosthesis. Thoraxchir Vask Chir. 1972;20:169–78.

    CAS  PubMed  Google Scholar 

  71. Shaeer OK, El-Sadat A. Urethral substitution using vein graft for hypospadias repair. J Pediatr Urol. 2006;2:518–21.

    Article  CAS  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Dr. Bum Soo Kim and Dr. Tae Gyun Kwon each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tae Gyun Kwon.

Additional information

This article is part of the Topical Collection on Regenerative Medicine

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, B.S., Kwon, T.G. Urethral Reconstruction Using Autologous Vein Grafts for the Management of Urethral Strictures. Curr Urol Rep 16, 467 (2015). https://doi.org/10.1007/s11934-014-0467-5

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11934-014-0467-5

Keywords

Navigation