Skip to main content
SpringerLink
Log in

Tubularized urethral replacement with unseeded matrices: what is the maximum distance for normal tissue regeneration?

  • Topic Paper
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

Complete urethral replacement using unseeded matrices has been proposed as a possible therapy in cases of congenital or acquired anomalies producing significant defects. Tissue regeneration involves fibrin deposition, re-epithelialization, and remodeling that are limited by the size of the defect. Scar formation occurs because of an inability of native cells to regenerate over the defect before fibrosis takes place. We investigated the maximum potential distance of normal native tissue regeneration over a range of distances using acellular matrices for tubular grafts as an experimental model.

Materials and methods

Tubularized urethroplasties were performed in 12 male rabbits using acellular matrices of bladder submucosa at varying lengths (0.5, 1, 2, and 3 cm). Serial urethrography was performed at 1, 3, and 4 weeks. Animals were sacrificed at 1, 3, and 4 weeks and the grafts harvested. Urothelial and smooth muscle cell regeneration was documented histologically with H&E and Masson’s trichrome stains.

Results

Urethrograms demonstrated normal urethral calibers in the 0.5 cm group at all time points. The evolution of a stricture was demonstrated in the 1, 2, and 3 cm grafts by 4 weeks. Histologically all grafts demonstrated ingrowth of urothelial cells from the anastomotic sites at 1 week. By 4 weeks, the 0.5 cm grafts had a normal transitional layer of epithelium surrounded by a layer of muscle within the wall of the urethral lumen. The 1, 2, and 3 cm grafts showed ingrowth and normal cellular regeneration only at the anastomotic edges with increased collagen deposition and fibrosis toward the center by 2 weeks, and dense fibrin deposition throughout the grafts by 4 weeks.

Conclusions

The maximum defect distance suitable for normal tissue formation using acellular grafts that rely on the native cells for tissue regeneration appears to be 0.5 cm. The indications for the use of acellular matrices in tubularized grafts may therefore be limited by the size of the defect to be repaired.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Atala A, Guzman L, Retik AB (1999) A novel inert collagen matrix for hypospadias repair. J Urol 162:1148

    Article  PubMed  CAS  Google Scholar 

  2. Chen F, Yoo JJ, Atala A (2000) Experimental and clinical experience using tissue regeneration for urethral reconstruction. World J Urol 18:67

    Article  PubMed  CAS  Google Scholar 

  3. Cilento B, Retik A, Atala A (1996) Urethral reconstruction using polymer scaffolds seeded with urothelial and smooth muscle cells. J Urol 155(Suppl):371A; Abstract 571

  4. Yoo JJ, Meng J, Oberpenning F et al (1998) Bladder augmentation using allogenic bladder submucosa seeded with cells. Urology 51:221

    Article  PubMed  CAS  Google Scholar 

  5. Iselin CE, Webster GD (1999) Dorsal onlay graft urethroplasty for repair of bulbar urethral stricture. J Urol 161:815

    Article  PubMed  CAS  Google Scholar 

  6. Caldamone AA, Edstrom LE, Koyle MA et al (1998) Buccal mucosal grafts for urethral reconstruction. Urology 51:15

    Article  PubMed  CAS  Google Scholar 

  7. De Filippo RE, Yoo JJ, Atala A (2002) Urethral replacement using cell seeded tubularized collagen matrices. J Urol 168:1789–1793

    Article  PubMed  Google Scholar 

  8. Kropfl D, Tucak A, Prlic D et al (1998) Using buccal mucosa for urethral reconstruction in primary and re-operative surgery. Eur Urol 34:216

    Article  PubMed  CAS  Google Scholar 

  9. Ehrlich RM, Alter G (1996) Split-thickness skin graft urethroplasty and tunica vaginalis flaps for failed hypospadias repairs. J Urol 155:131

    Article  PubMed  CAS  Google Scholar 

  10. Gaschignard N, Prunet D, Vasse N et al (1999) Skin graft urethroplasty. Prog Urol 9:112

    PubMed  CAS  Google Scholar 

  11. Barbagli G, Selli C, Tosto A et al (1996) Dorsal free graft urethroplasty. J Urol 155:123

    Article  PubMed  CAS  Google Scholar 

  12. Vincent MP, Horton CE, Devine CJ Jr (1988) An evaluation of skin grafts for reconstruction of the penis and scrotum. Clin Plast Surg 15:411

    PubMed  CAS  Google Scholar 

  13. Vyas PR, Roth DR, Perlmutter AD (1987) Experience with free grafts in urethral reconstruction. J Urol 137:471

    PubMed  CAS  Google Scholar 

  14. Pansadoro V, Emiliozzi P, Gaffi M et al (1999) Buccal mucosa urethroplasty for the treatment of bulbar urethral strictures. J Urol 161:1501

    Article  PubMed  CAS  Google Scholar 

  15. Riccabona M (1999) Reconstruction or substitution of the pediatric urethra with buccal mucosa: indications, technical aspects, and results. Tech Urol 5:133

    PubMed  CAS  Google Scholar 

  16. Yerkes EB, Adams MC, Miller DA et al (1999) Coronal cuff: a problem site for buccal mucosal grafts. J Urol 162:1442

    Article  PubMed  CAS  Google Scholar 

  17. Kinkead TM, Borzi PA, Duffy PG et al (1994) Long-term followup of bladder mucosa graft for male urethral reconstruction. J Urol 151:1056, severe fibrosis. Plast Reconstr Surg 103:964 (1999)

    Google Scholar 

  18. Chen F, Yoo JJ, Atala A (1999) Acellular collagen matrix as a possible “off the shelf”; biomaterial for urethral repair. Urology 54:407

    Article  PubMed  CAS  Google Scholar 

  19. Kassaby EA, Yoo JJ, Retik AB et al (2000) A novel inert collagen matrix for urethral stricture repair. J Urol 163(Suppl):70; abstract 308

    Google Scholar 

Download references

Conflict of interest statement

None.

Author information

Authors and Affiliations

  1. Department of Urology, LAC+USC Medical Center, 1200 N. State St. Suite 5900, Los Angeles, CA, 90033, USA

    Ryan P. Dorin

  2. Division of Urology, Childrens Hospital, Los Angeles, USA

    Ryan P. Dorin & Roger E. De Filippo

  3. Division of Urology, Children’s National Medical Center, Washington, DC, USA

    Hans G. Pohl

  4. Department of Urology, Wake Forest University School of Medicine, Winston-Salem, USA

    James J. Yoo & Anthony Atala

Authors
  1. Ryan P. Dorin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hans G. Pohl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roger E. De Filippo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James J. Yoo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anthony Atala
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ryan P. Dorin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dorin, R.P., Pohl, H.G., De Filippo, R.E. et al. Tubularized urethral replacement with unseeded matrices: what is the maximum distance for normal tissue regeneration?. World J Urol 26, 323–326 (2008). https://doi.org/10.1007/s00345-008-0316-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-008-0316-6

Keywords

Search

Navigation