Randomized comparative study between buccal mucosal and acellular bladder matrix grafts in complex anterior urethral strictures
Randomized comparative study between buccal mucosal and acellular bladder matrix grafts in complex anterior urethral strictures
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DOI：
10.1016/j.juro.2007.11.101
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发表时间：
2008-04-01
影响因子：
6.6
通讯作者：
Atala, Anthony
中科院分区：
文献类型：
--
作者：
El Kassaby, AbdelWahab;AbouShwareb, Tamer;Atala, Anthony
目的：由于组织替代物的有限性和复发率，尿道狭窄多年来一直是重建的难题。颊粘膜移植物由于其耐久性和良好的移植物存活率而在阴茎皮肤不可用的情况下一直是受欢迎的材料。最近，来源于膀胱的基于胶原的基质已经成功地用于患有狭窄疾病和尿道下裂的患者。我们进行了一项随机比较研究，以评估结果的脱细胞膀胱基质颊粘膜相比，在复杂的尿道strictures.Materials和方法：人脱钙骨基质，从尸体供体，加工和准备使用作为一个现成的材料。30例狭窄患者（年龄21 - 59岁，平均36.2岁）入组并使用标准方案进行评估。狭窄长度2 ~ 18 cm，平均6.9cm，其中球部狭窄11例，悬垂性狭窄7例，球部-管端狭窄12例。在30例患者中，7例既往未接受过干预，而其余23例接受过1至7次手术（平均1.9次）。所有患者被随机化，并交替分配到接受颊粘膜或脱钙骨基质，并进行onlay procedure.Results：所有患者，除2谁失去了在随访期间，随访18至36个月（平均25）。在尿道床健康的患者中（少于2次既往手术），颊粘膜移植物的成功率（10/10）与膀胱基质移植物的通畅率（8/9）相似。在尿道床不健康的患者中（既往手术超过2次），6例膀胱基质移植患者中只有2例成功，而所有5例颊粘膜移植患者均具有开放的尿道。术后尿流率测定显示两组患者排尿均有显著改善。移植物活检组织学显示正常尿道组织characteristics.Conclusions：这项研究表明，使用脱细胞膀胱基质是一个可行的选择尿道修复。脱矿骨基质作为一种现成的生物材料，在具有健康尿道床、无海绵纤维化和良好尿道粘膜的患者中获得最佳结果。
Purpose: Urethral strictures have been a reconstructive dilemma for many years due to the limited availability of tissue substitutes and incidence of recurrence. Buccal mucosal grafts have been a favored material in instances where penile skin is unavailable due to its durability and excellent graft survival. Recently collagen based matrices derived from the bladder have been used successfully in patients with stricture disease and hypospadias. We performed a randomized comparative study to assess the outcome of the acellular bladder matrix compared to buccal mucosa in patients with complex urethral strictures.Materials and Methods: Human demineralized bone matrix, obtained from cadaveric donors, was processed and prepared for use as an off-the-shelf material. Thirty patients with stricture 21 to 59 years old (mean 36.2) were enrolled and assessed using a standard protocol. The stricture length ranged from 2 to 18 cm (mean 6.9), of which 11 patients had bulbar, 7 had pendulous and 12 had combined bulbopendulous strictures. Of the 30 patients 7 had received no previous intervention while the remaining 23 had undergone 1 to 7 procedures (mean 1.9). All patients were randomized and alternatively assigned to receive either buccal mucosa or demineralized bone matrix and underwent an onlay procedure.Results: All patients except 2 who were lost during followup were followed for 18 to 36 months (mean 25). In patients with a healthy urethral bed (less than 2 prior operations) the success rate of buccal mucosa grafts (10 of 10) was similar to the bladder matrix grafts (8 of 9) in terms of patency. In patients with an unhealthy urethral bed (more than 2 prior operations) only 2 of 6 patients with a bladder matrix graft were successful, whereas all 5 patients with a buccal mucosa graft had a patent urethra. Postoperative uroflowmetry showed significant voiding improvement in both groups. Histology of the graft biopsies showed normal urethral tissue characteristics.Conclusions: This study demonstrates that the use of acellular bladder matrix is a viable option for urethral repair. Demineralized bone matrix as an off-the-shelf biomaterial achieves the best results in patients with a healthy urethral bed, no spongiofibrosis and good urethral mucosa.