Homologous dermal acellular matrix graft for urethral reconstruction in man (report of 16 cases)

Objective To investigated the value of homologous dermal acellular matrix graft (AMG) for urethral reconstruction in man ,and found an ideal replacement material to simplify the urethroplastic surgery. Methods 16 male patients ,aged 18-46(mean 26.5),with urethral diseases were treated with allograft of tissue engineering material AMG. The causes of urethroplasty were complex urethral stricture followed by pelvic fracture(13 cases), anterior urethral stricture(2 cases), hypospadia(1 case). During the operation, AMG was sutured to a tubular graft and replaced the defect urethra. A 18-22 Fr silicone catheter was inserted in the reconstructed urethra for 4-6 weeks. Results All 16 patients were voiding well after removing the catheter, urethrography reveal excellent caliber of the reconstructed urethra. Urethroscopic examination showed the graft urethra was covered by epithelial tissue and grew into the native tissue. But stenosis was developed in 3 patients postoperatively, 1 patients received transurethral incision,another 2 needed urethral sounding. The patients were followed-up for 12-72 months(mean 45.6),no rejection was observed, all patients voided normally except 4 cases needed urethral dilatation ~periodically. Conclusion The homologous dermal acellular matrix graft may serve as an ideal replacement material for complex urethral stricture or defect, without concern of rejection.