MP60-12 MID-TERM RESULTS OF ANTERIOR URETHROPLASTY WITH TISSUE-ENGINEERED ORAL MUCOSA GRAFT MUKOCELL®

Abstract

INTRODUCTION AND OBJECTIVE: Anterior urethroplasty with buccal mucosa grafting is the standard procedure for recurrent urethral strictures of ≥2 cm length. Trying to avoid oral complications through harvesting buccal mucosa, a tissue-engineered oral mucosa graft (MukoCell®) was manufactured. Current multicenter retrospective studies report success rates of 67-84%. The objective of our institutional retrospective analysis is the assessment of the mid-term efficacy and complications of this method. METHODS: Between 05/2016 and 06/2019 a total of 77 patients with anterior urethral strictures underwent a urethroplasty with MukoCell®. Our cohort consisted of 45 patients with bulbar strictures (78,9%), 15 with penobulbar (19,5%), 11 with penile (14,3%), 4 with membranous (5,2%) and 2 with simultaneous bulbar and penile strictures (2,6%) respectively. Mean patient age was 59 years (range 16 to 87) with mean 2,5 previous endoscopic or anastomotic procedures (range 0 to 8). 4 different surgeons performed in 61 cases ventral/dorsal onlay techniques (79,2%), in 5 cases inlay-ASOPA technique (6,5%) and in 11 cases combined (Palminteri et al.) technique (14,3%). Mean stricture length was 5,3 cm (range 2 to 16). 8 (10,4%) strictures were traumatic, 39 (50,6%) iatrogenic, 21 (27,3%) idiopathic, 1 (1,3%) radiogenic, 1 (1,3%) associated with Lichen sclerosus, 2 (2,6%) former hypospadias and 2 (2,6%) had other causes. IPSS-Score, Uroflowmetry and post void residual measurement were recorded pre- and postoperatively twice a year. Retrograde urethrography was performed pre- and 3 weeks postoperatively and repeated by suspicion of recurrence. RESULTS: Mean follow up was 24 months (range 8 to 43). 24 patients (31,2%) developed a recurrence of the stricture (14 with bulbar, 4 penobulbar, 3 penile, 2 membranous and 1 simultaneous bulbar and penile localization and mean 2,3 previous endoscopic operations (range 1-6) after mean 6,5 months (range 1,5 to 17). None perioperative hemorrhage occurred in all patients. We reported 5 cases of perineal wound dehiscence, 5 UTIs, 7 contrast leaks in the postoperative urethrography and 1 urethrocutaneous fistula requiring surgical intervention (Clavien-dindo 3b). No local (oral-urethral) or general adverse events related to the use of MukoCell® were observed. CONCLUSIONS: The recurrence-free rate of anterior urethroplasty using MukoCell® in our hands was 68,8% after a two-year follow-up. A prospective multicenter study comparing „head-to-head“ the efficiency of this graft with the native oral mucosa will be initiated in Germany in 2020. Source of Funding: none