Objective: The aim of this study was to estimate the clinical effects of allogeneic acellular dermal matrix (ADM) in the surgical therapy of anterior urethral stricture (AUS). Methods: We retrospectively collected the clinical data of 49 patients with AUS who underwent urethral repair surgery with ADM in the Department of Urology of the Peking University People’s Hospital, and in the First Affiliated Hospital of the People’s Liberation Army, from September 2015 to January 2019. The changes in urine flow rate and conditions of urethral mucosal coverage were observed as well as complications and outcomes, and statistical analysis was performed. Results: The average maximum urine flow rates at the 1st, 6th, and 12th month post-surgery were 16.3 ± 1.5, 15.0 ± 1.9, and 14.6 ± 2.1 mL/s, respectively. These values were significantly higher than the preoperative maximum urine flow rate, 1.3 ± 0.5 mL/s (p < 0.05). Cystoscopy was performed in 11 patients 12 months after surgery, with microscopic assessment revealing good urethral epithelial mucosal coverage. Only 2 patients developed infection 2–4 weeks after surgery, while 7 patients developed noninfective urethral restricture 6–10 months after surgery and 1 patient developed urinary fistula 5 months after surgery. All of these statuses improved after receiving appropriate treatment. Conclusions: Use of ADM represents a new option for the surgical management of AUS repair and reconstruction, with positive clinical effects. In addition, it has the advantages of convenient for operation procedures and access, with no need for additional sampling surgery.

1.
Ribeiro-Filho
LA
,
Sievert
KD
.
Acellular matrix in urethral reconstruction
.
Adv Drug Deliv Rev
.
2015
;
82–3
:
38
46
.
2.
Mangera
A
,
Chapple
C
.
Management of anterior urethral stricture: an evidence-based approach
.
Curr Opin Urol
.
2010
;
20
(
6
):
453
8
.
3.
Chapple
C
,
Andrich
D
,
Atala
A
,
Barbagli
G
,
Cavalcanti
A
,
Kulkarni
S
, et al.
SIU/ICUD consultation on urethral strictures: the management of anterior urethral stricture disease using substitution urethroplasty
.
Urology
.
2014
;
83
(
3 Suppl
):
S31
47
.
4.
Morey
AF
,
Kizer
WS
.
Proximal bulbar urethroplasty via extended anastomotic approach: what are the limits?
J Urol
.
2006
;
175
(
6
):
2145
9
.
5.
Mangera
A
,
Patterson
JM
,
Chapple
CR
.
A systematic review of graft augmentation urethroplasty techniques for the treatment of anterior urethral strictures
.
Eur Urol
.
2011
;
59
(
5
):
797
814
.
6.
Li
X
,
Meng
X
,
Wang
X
,
Li
Y
,
Li
W
,
Lv
X
, et al.
Human acellular dermal matrix allograft: a randomized, controlled human trial for the long-term evaluation of patients with extensive burns
.
Burns
.
2015
;
41
(
4
):
689
99
.
7.
Daar
DA
,
Gandy
JR
,
Clark
EG
,
Mowlds
DS
,
Paydar
KZ
,
Wirth
GA
.
Plastic surgery and acellular dermal matrix: highlighting trends from 1999 to 2013
.
World J Plast Surg
.
2016
;
5
(
2
):
97
108
.
8.
Morrison
WA
,
Webster
HR
,
Kumta
S
.
Urethral reconstruction using the radial artery forearm free flap: conventional and prefabricated
.
Plast Reconstr Surg
.
1996
;
97
(
2
):
413
9
.
9.
Goldenberg
SL
,
Johnson
HW
,
Ettinger
SL
,
McLoughlin
MG
.
Patch autografts in the treatment of urethral stricture
.
Can J Surg
.
1983
;
26
(
5
):
418
22
.
10.
Aggarwal
SK
,
Goel
D
,
Gupta
CR
,
Ghosh
S
,
Ojha
H
.
The use of pedicled appendix graft for substitution of urethra in recurrent urethral stricture
.
J Pediatr Surg
.
2002
;
37
(
2
):
246
50
.
11.
Snow
BW
,
Cartwright
PC
.
Tunica vaginalis urethroplasty
.
Urology
.
1992
;
40
(
5
):
442
5
.
12.
Devine
PC
,
Sakati
IA
,
Poutasse
EF
,
Devine
CJ
 Jr
.
One stage urethroplasty: repair of ureteral strictures with a free full thickness patch of skin
.
J Urol
.
1968
;
99
(
2
):
191
3
.
13.
Orandi
A
.
One-stage urethroplasty
.
Br J Urol
.
1968
;
40
(
6
):
717
9
.
14.
McAninch
JW
,
Morey
AF
.
Penile circular fasciocutaneous skin flap in 1-stage reconstruction of complex anterior urethral strictures
.
J Urol
.
1998
;
159
(
4
):
1209
13
.
15.
Turkyilmaz
Z
,
Karabulut
R
,
Atan
A
,
Sonmez
K
.
Redo hypospadias repair: comparison of three different methods
.
Urol Int
.
2020
;
104
(
5–6
):
391
5
.
16.
Xie
H
,
Xu
YM
,
Fu
Q
,
Sa
YL
,
Zhang
J
,
Feng
C
, et al.
Long-term efficacy of penile skin flaps for reconstruction of anterior urethral stricture
.
Chin J Urol
.
2014
;
35
(
9
):
681
5
.
17.
Mundy
AR
.
The long-term results of skin inlay urethroplasty
.
Br J Urol
.
1995
;
75
(
1
):
59
61
.
18.
Memmelaar
J
.
Use of bladder mucosa in a one-stage repair of hypospadias
.
J Urol
.
1947
;
58
(
1
):
68
73
.
19.
Hao
C
,
Zhao
ZL
,
Li
CY
,
Li
YZ
,
Gu
Y
.
Ventral bladder mucosa onlay graft urethroplasty for the treatment of panurethral stricture
.
Chin J Urol
.
2016
;
37
(
3
):
195
8
.
20.
Ozgok
Y
,
Ozgur
TM
,
Kilciler
M
,
Tahmaz
L
,
Erduran
D
.
Use of bladder mucosal graft for urethral reconstruction
.
Int J Urol
.
2000
;
7
(
10
):
355
60
.
21.
Markiewicz
MR
,
Lukose
MA
,
Margarone
JR
,
Barbagli
G
,
Miller
KS
,
Chuang
S-K
.
The oral mucosa graft: a systematic review
.
J Urol
.
2007
;
178
(
2
):
387
94
.
22.
Atala
A
.
Tissue engineering and regenerative medicine: concepts for clinical application
.
Rejuvenation Res
.
2004
;
7
(
1
):
15
31
.
23.
Chen
F
,
Yoo
JJ
,
Atala
A
.
Acellular collagen matrix as a possible “off the shelf” biomaterial for urethral repair
.
Urology
.
1999
;
54
(
3
):
407
10
.
24.
Fiala
R
,
Vidlar
A
,
Vrtal
R
,
Belej
K
,
Student
V
.
Porcine small intestinal submucosa graft for repair of anterior urethral strictures
.
Eur Urol
.
2007
;
51
(
6
):
1702
8
.
25.
Hauser
S
,
Bastian
PJ
,
Fechner
G
,
Müller
SC
.
Small intestine submucosa in urethral stricture repair in a consecutive series
.
Urology
.
2006
;
68
(
2
):
263
6
. .
26.
Shi
L
,
Ronfard
V
.
Biochemical and biomechanical characterization of porcine small intestinal submucosa (SIS): a mini review
.
Int J Burns Trauma
.
2013
;
3
(
4
):
173
9
.
27.
Hosseini
J
,
Hosseini
S
,
Hosseini
MA
,
Rezaei
Y
.
Pericardium in reconstructive urologic surgeries: a systematic review and meta-analysis
.
Urol Int
.
2019
;
102
(
2
):
131
44
.
28.
Ribeiro-Filho
LA
,
Fazoli
A
,
Arap
MA
,
Mitre
A
,
Falci
R
,
Chambo
JL
, et al.
Cadaveric organ-specific acellular matrix for urethral reconstruction in humans: long term results
.
J Urol
.
2014
;
191
(
Supplement
):
e20
.
29.
Lin
J
,
Hao
JR
,
Jin
J
,
Deng
SM
,
Hu
J
,
Na
YQ
.
Homologous dermal acellular matrix graft for urethral reconstruction in man (report of 16 cases)
.
Natl Med J China
.
2005
;
85
(
15
):
1057
9
.
30.
Horiguchi
A
.
Substitution urethroplasty using oral mucosa graft for male anterior urethral stricture disease: current topics and reviews
.
Int J Urol
.
2017
;
24
(
7
):
493
503
.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.