Session: PD35: Trauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture & Diverticulum) I
PD35-10: Impact on postoperative oral morbidity and mid-term efficacy of anterior urethroplasty using an autologous tissue-engineered oral mucosa graft (MukoCell®) versus native oral mucosa graft
Introduction: The aim of our study was to compare the outcomes and complication rates of augmentation urethroplasty using autologous tissue-engineered oral mucosa graft (TEOMG) versus native oral mucosa graft (NOMG), aiming to determine the appropriate indications for TEOMG use (MukoCell®)in urethral surgery. Methods: We conducted a single-institution retrospective study on 153 patients undergoing augmentation urethroplasty for anterior urethral strictures > 2 cm in length from January 2016 to July 2020. TEOMG was used in 77 and NOMG in 76 patients, respectively. The success rate, complications including postinterventional oral morbidity, and risk factors of recurrence between both groups were analyzed. Postoperative follow-up (FU) examinations were performed at 6 and 12 months and subsequently yearly. A decrease of Qmax value <15 ml/s or further instrumentation were considered a failure. Results: Overall, TEOMG and NOMG had comparable success rates (68.8% vs. 78.9%, p=0.155) after a median follow-up of 52 (IQR 45-60) months for TEOMG and 53.5 (IQR 43-58) months for NOMG. Subgroup analysis revealed similar success rates according to surgical technique, stricture localization, and length. Only following repetitive urethral dilatations, TEOMG achieved significantly lower success rates (31.3% vs. 81.3%, p=0.003). Surgical time could be reduced through TEOMG use with a median of 104 (IQR 86-130) vs. 182 (IQR 154-214) minutes in the NOMG group (p < 0.001). Both early and late oral morbidity were diminished through the biopsy taken for TEOMG manufacture, compared to NOMG harvesting. Twelve months postoperatively, the prevalence of sensory disorders still showed a significant disparity between groups, with occurrence only in the NOMG group (0 vs. 9.2%, p=0.006). Conclusions: The success rate of augmentation urethroplasty using TEOMG was statistically comparable to NOMG at a mid-term FU. Surgical time was significantly shortened since no intraoperative mucosa harvesting was required, and oral complications were diminished through the preoperative biopsy for MukoCell® manufacture. SOURCE OF Funding: no funding
