Abstract
Urethral stricturing is a narrowing of the urethral lumen as a result of ischaemic spongiofibrosis. The main challenge of currently available treatment options is recurrence of the stricture. Recent advancements in the treatment of urethral strictures mainly came from the fields of regenerative medicine and tissue engineering. Research efforts have primarily focused on decreasing the recurrence of stricture after internal urethrotomy and constructing tissue-engineered urethral substitutes to improve clinical outcomes of urethroplasty surgeries. The aim of this article is to review the most recent advancements in the management of urethral stricture disease in men.
Highlights
Urethral stricturing is a narrowing of the urethral lumen as a result of ischaemic spongiofibrosis[1]
Posterior Urethral strictures (US) often result from direct trauma or surgical interventions, such as transurethral prostate resection or radical prostatectomy, and can be treated effectively with dilatation if they are a stenosis of the sphincetric area
Disruption injuries of the urethra, causing a stenosis, are not true strictures as defined above because there is discontinuity of the urethra, for example following a pelvic fracture or in the bulbar urethra following a fall astride injury, which is an indication for excision primary anastomosis (EPA) of the damaged segment with anastomosis of the two healthy urethral ends
Summary
Urethral stricturing is a narrowing of the urethral lumen as a result of ischaemic spongiofibrosis[1]. In the context of US disease, adipose-derived MSCs have been shown to decrease collagen I and III deposition[20] and result in less-extensive urethral fibrotic changes in imaging and histology in rat models[21] In this model, a stricture was created by injection of TGF-β1 into the rat urethra; TGF-β is the main regulator of tissue fibrosis in many biological processes[22]. Compared to cell-based adjuvant therapies after DVIU, tissue engineering approaches could be advantageous because cell-scaffold complexes can result in the concentration of therapeutic products at the injection site These products require a specialised regulatory pathway before being introduced into mainstream clinical practice. New treatments coming into clinical practice were regulated under either novel drug treatments or medical devices These failed to address the complexity and diversity of the newly emerging regenerative medicine products such as cell therapies, tissue engineering, and gene therapies. The cellular injectables could be considered ATMPs depending on the cellular elements involved and how much they have been manipulated
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