S.I.S. ONLAY GRAFT IN BULBAR URETHRAL RECONSTRUCTION
(Original article : European Urology 2006:51 1695-1701)

Introduction
We evaluated the use of small intestinal submucosa (SIS) graft in penile and bulbar urethroplasties.

Materials and Methods
From 2003 to 2004, 20 men (mean age 41 years) with anterior urethral strictures underwent urethroplasty using SIS as an inlay or onlay patch graft. The stricture location was penile in 1 patient, bulbar in 16 and penile-bulbar in 3. Mean stricture length was 3 cm. Mean graft length was 5,7 cm. Dorsal inlay graft was performed in 14 cases, ventral onlay graft in 1, dorsal inlay plus ventral onlay in 5. The clinical outcome was considered a success at the time that any postoperative procedure was needed. Mean follow up was 21 months (range 13 to 35).

Results
17 cases out of 20 (85%) were successful and 3 (15%) were failures. There were no postoperative complications, such as infection or rejection, related to the use of a heterologous graft material. 16 out of 17 successes (94%) were bulbar repairs and 1 was a penile-bulbar repair, with 2,6 cm stricture mean length and 5,35 cm graft mean length. Cystoscopy at 3 months revealed adequate calibre lumens, but SIS grafted area was not completely replaced by the urothelium. The 3 failures were penile and penile-bulbar urethral repairs with stricture mean length 5,7 cm and graft mean length 7,7 cm. Recurrences showed fibrous tissue involving the grafted area and extending in penile and bulbar urethra.

Conclusions
In our medium-term results SIS is a safe and effective reconstructive material for anterior urethral repairs. Longer follow up and further investigations in selected patients are needed before widespread use is advocated.
Disclamer
Caution! Surgical images