Rectal mucosal graft urethroplasty

Abstract

Introduction: Buccal mucosal graft urethroplasties have become the most common for strictures longer than 2 cm with excellent results, ease of use, low morbidity, and durability [1]. Scenarios in which buccal grafts are not easily accessible nor technically available such as prior use or head and neck radiation have lead reconstructive urologists to explore other substitutions. Early data over the past few years for rectal mucosal grafts is promising [2,3]. We demonstrate the integral steps to a staged urethroplasty utilizing a rectal mucosal graft [4]. Methods: A 53-year-old man with history of a traumatic work-related pelvic crush injury resulting in devascularization and subsequent disruption of his urethra. He has already undergone two prior unsuccessful urethral reconstructive surgeries using bilateral buccal grafts. Pre-operative work up shows loss of urethra from just distal to external sphincter to distal penile urethra. With consideration of his prior surgical history, he elects for rectal mucosal harvest. Results: Transanal endoscopic harvest of rectal mucosa and staged urethroplasty was performed successfully. Conclusions: This video highlights that the rectal mucosa is a feasible and technically available graft in patients’ whose buccal mucosa is not readily available or adequate. We demonstrate the steps to harvesting and utilizing a rectal mucosal graft