Urethral Reconstruction Using Cell-Based Tissue Engineering Approaches

Abstract

The estimated prevalence of urethral stricture disease is 229–627 per 100,000 males, though there are regional variations. Trauma, either from external force or iatrogenic causes, is currently the most common single cause of urethral stricture, although, as with prevalence, there are geographical variations. The presentation usually occurs with lower urinary tract symptoms, sometimes with urinary retention and, rarely, with watering can perineum. The symptoms are best evaluated with a combination of the American Urological Association (AUA) Symptom Index and urinary flow rate measurements for both new cases and suspected recurrences. Time-tested retrograde urethrography remains the gold standard for a confirmatory diagnosis; however, it is limited by its inability to evaluate the posterior urethra and associated morbidities, such as abscesses and fistulas, thus three-dimensional imaging techniques are emerging as adjunct investigations. These modalities are not currently used universally, but their unavailability is not expected to be a serious hindrance to decision-making by a versatile reconstructive urologist. Urethroplasty is regarded as the gold standard treatment for urethral stricture; excision and primary anastomosis, buccal mucosa graft, skin graft, and pedicle flap techniques have all been used. Notably, buccal mucosal graft urethroplasty has gained popularity above the others because of its versatility and success rate; this is considered to equate to urethral tissue engineering, which is at present confined to only a few centres.

Keywords

• Hypospadias
• tissue engineering (TE)
• urethral stricture
• urethroplasty