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Urothelial or oral mucosa cells for tissue-engineered urethroplasty: A critical revision of the clinical outcome

Asian Journal of Urology 2020年第1期7卷 18-23页

作者： guido barbagli Axel Heidenreich Vahudin Zugor Leonidas Karapanos Massimo Lazzeri Centro Chirurgico Toscano ArezzoItaly Research Institute for Uronephrology SechenovFirst Moscow State Medical UniversityMoscowRussia University Clinic and Policlinic for Urology CologneGermany Istituto Clinico Humanitas IRCCS Clinical and Research HospitalRozzanoItaly

Objective:To report the clinical outcome of urethral reconstruction by cultured urothelial or oral mucosa cells for tissue-engineered urethroplasty.Methods:We systematically searched for studies reporting the use of tissue-engineered techniques for hypospadias and urethral stricture repair in humans in PubMed and Embase(OvidSP)through January,1990 to June,2018.We excluded studies based on titles that clearly were not related to the subject,studies in which tissue-engineered biomaterial were used only in laboratory or experimental animals,and in the absence of autologous cultured epithelial cells.Studies were also excluded if they were not published in English,had no disease background and adequate follow-up.Finally,we search all relevant abstract presented at two of the main urological meetings in the last 10 years:European Association of Urology(EAU)and American Urological Association(AUA).Results:A total of six articles,reporting the clinical use of tissue-engineered techniques in humans,were fully reviewed in our review.The epithelial cells were harvested from the urethra(10 patients),the bladder(11 patients)and the mouth(104 patients).The tissue-engineered grafts were used in children for primary hypospadias repair in 16 cases,and in adults for posterior and anterior urethral strictures repair in 109 cases.Tissue-engineered grafts were showed working better in children for primary hypospadias repair than in adults for urethral strictures repair.Conclusion:One hundred and twenty-five patients received tissue-engineered urethroplasty using cultured epithelial cells for primary hypospadias or urethral strictures repair.The studies demonstrate a high degree of heterogeneity respect to epithelial cells(from urethra,bladder,and mouth),type of scaffold,etiology,site of urethral stricture,number of patients,follow-up and outcomes.

关键词： Urethra Urethroplasty Tissue engineering Urethral mucosa Oral mucosa Surgical technique

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History and evolution of the use of oral mucosa for urethral reconstruction

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Asian Journal of Urology 2017年第2期4卷 96-101页

作者： guido barbagli Sofia Balo Francesco Montorsi Salvatore Sansalone Massimo Lazzeri Centro Chirurgico Toscano ArezzoItaly Division of Oncology/Unit of Urology IRCCS Ospedale San RaffaeleMilanItaly Department of Experimental Medicine and Surgery University of Tor VergataRomeItaly Department of Urology Istituto Clinico Humanitas IRCCSClinical and Research HospitalRozzanoItaly

We report here the history and evolution of the use of oral mucosa in reconstructive urethral surgery since it was first used for urethroplasty in 1894.Since that time,many authors have contributed to develop,improve and popularize the use of oral mucosa as a substitute material.Paediatric urologists should be considered pioneers on the use of oral mucosa as they used it to repair primary and failed hypospadias.The use of oral mucosa to repair penile and bulbar urethral strictures was described,for the first time,in 1993.Important evolutions in the technique for harvesting oral mucosa from the cheek were reported in 1996.Today,oral mucosa is considered the gold standard material for any type of anterior urethroplasty in a one-or two-stage repair due to its biological and structural characteristics that make it a highly versatile that is adaptable to any environment required by the reconstructive urethral surgery.As the future approaches,tissue engineering techniques will provide patients with new materials originating from the oral epithelial mucosal cells,which are cultured and expanded into a scaffold.However,the path to reach this ambitious objective is still long and many difficulties must be overcome along the way.

关键词： Oral mucosa Cheek Urethra Urethroplasty Tissue engineering Reconstructive urology

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Long-term results of the surgical treatment of Peyronie＇s disease with Egydio＇s technique： a European multicentre study

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Asian Journal of Andrology 2011年第6期13卷 842-845页

作者： Salvatore Sansalone Giulio Garaffa Rados Djinovic Stefano Pecoraro Mauro Silvani guido barbagli Alessandro Zucchi Giuseppe Vespasiani Carla Loreto Department of Urology School of Medicine Tor Vergata University of Rome Rome 00133 italy St Peter＇s Andrology University College London Hospitals London WIG 6BJ UK Department of Urology School of Medicine Serbian Academy of Science and Arts University of Belgrade Belgrade 11000 Serbia Department of Nephro-Urology Malzoni Medical Center Avellino Avellino 83100 Italy Department of Urology General Hospital Biella 13900 Italy Center for Reconstructive Urethral Surgery Arezzo 52100 Italy Department of Urology and Andrology University of Perugia Perugia 06123 Italy Department of Bio-Medical Sciences Anatomy Section University of Catania Catania 95100 Italy

The long-term outcomes of 157 patients affected by Peyronie＇s disease （PD） who underwent penile straightening with Egydio＇s technique between January 2004 and December 2008 are reported. Only patients with PD who were stable for at least 6-12 months prior to surgery were enrolled in this study. Preoperative assessment included a dynamic echo colour Doppler ultrasound scan to evaluate the degree of penile deformity and the peak systolic velocity in the cavernosal arteries and an assessment of erectile function with the administration of the International Index of Erectile Function 5 （IIEF-5） questionnaire. Stretched penile length was recorded pre- and postoperatively. Surgical complications, cosmesis and sexual function, patient satisfaction and postoperative erectile function were assessed postoperatively at 3 months, I year and 2 years, respectively. After a median follow-up period of 20 months （range： 12-24 months）, we found that mild residual curvature （12%） and glans hypoesthesia （3%） were the only causes of partial dissatisfaction. No rejection of the graft was observed. All patients recovered their ability to penetrate with no difficulty. In addition, an intraoperative average increase of 2.5 cm （range： 1.7-4.1 cm） in stretched penile length was recorded, with all patients engaging in penetrative sexual intercourse. In conclusion, this procedure represents a safe and reproducible technique for the correction of penile curvature resulting from PD and yields excellent cosmetic and functional results.

关键词： Egydio＇s technique erectile dysfunction graft Peyronie＇s disease

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The Role of Dilation and Internal Urethrotomy as a Risk Factor of Failure in Patients Who Undergoing One-Stage Bulbar Oral Graft Urethroplasty

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Open Journal of Urology 2012年第1期2卷 16-19页

作者： guido barbagli Giorgio Guazzoni Salvatore Sansalone Giuseppe Romano Massimo Lazzeri 3Clinical Research Institute “Prof. M. Fanfani” Florence Italy

Purpose: To test the hypothesis if dilation or direct visual internal urethrotomy (DVIU) are predictive of urethroplasty failure. Retrospective study, from 1999 to 2010, including184 patients (median age 37 years) who underwent ventral onlay oral graft urethroplasty for bulbar strictures. Exclusion criteria were traumatic strictures, lichen sclerosus, failed hypospadias repair, failed urethroplasty, panurethral strictures, and incomplete medical charts. Pre-operative evaluation included clinical history, physical examination, urine culture, residual urine measurement, uroflowmetry, urethrography, ultrasound and urethroscopy. Surgery was considered a failure when any post-operative instrumentation was needed. Median follow-up was 48 months. Out of 184 patients, 38 (20.7%) had not undergone previous treatment, 7 (3.8%) had undergone dilation, 81 (44%) DVIU and 58 (31.5%) DVIU associated with dilation. Out of 184 patients, 157 (85.3%) were successful and 27 (14.7%) failures. Out of 38 patients who had not undergone previous treatment, 33 (86.8%) were successful;out of 7 patients who had undergone dilation, 6 (85.7%) were successful;out of 81 patients who had undergone DVIU, 72 (88.9%) were successful;out of 58 patients who had undergone DVIU and dilation, 46 (79.3%) were successful. According to the number of previous DVIU, ventral graft urethroplasty for bulbar strictures showed high failure rate in patients who had undergone more than four DVIU associated or not with dilation.

关键词： Urethral Stricture Direct Vision Internal Urethrotomy Dilation Urethroplasty

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