2010, Number 2
Rev Mex Cir Pediatr 2010; 17 (2)
Reconstruction of total agenesis and hypoplasia of the urethra by tissue engineering. First global report
Esquiliano-Rendón D, Raya-Rivera AM, Ordorica-Flores RM, Valencia-Mayoral P
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Language: Spanish
References: 9
Page: 54-64
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ABSTRACT
Introduction: Defects of the entire urethra are a challenge to the urologist. The use of neighboring genital tissue is the first choice of treatment with better functional results and fewer complications. However in long urethral defects this tissue is not sufficient and requires use of extragenital tissue. Regenerative medicine and tissue engineering also called could help solve the problems that occur with the use of non-urologic tissue grafts. We present our clinical experience using a urethral implant made of autologous tissue engineering as an alternative for the treatment and reconstruction of patients with complex urethral defects.Material and Methods: A four children underwent total urethral reconstruction using autologous tissue tubularized neouretral. Were scheduled for biopsy of the bladder, to select and stimulate cell multiplication. Then the cells were seeded in a temple of polyglycolic acid (PGA) or intestinal submucosa (SIS). Feasibility studies were performed (MTT) and cell proliferation in vitro neotejido construction, study of immunohistochemistry, electron microscopy and evaluated after the implant structure and functional characteristics in vivo neotejido.
Results: The mean age at the time of urethroplasty was 5 years. The average follow-up in four cases was three years, the primary diagnosis were: Prune Belly Syndrome in 2 cases, more VACTER syndrome urethral duplication in one patient, genital ambiguity in partial peripheral resistance to androgens and perineal hypospadias. The transperineal approach was used, forming the urethra of two parts. Complications: Patients 1 and 2 had stenosis at the anastomosis that was solved with urethrotomy, patients 3 and 4 were carried out urethrocutaneous fistula primary closure of fistula. Electron microscopy showed the temple coated with cells, adequate viability. The urodynamic study reported median Fmax 20ml/ seg. (Range 12.5 to 31ml/seg.). When comparing peak flow postoperative 12m 3m there is a statistically significant increase of p = ‹ 0.032.
Discussion: The Making of human urethral tissue engineering technology is an alternative management in patients with agenesis or severe hypoplasia of the urethra, the patients had severe associated pathologies that were handled by a multidisciplinary team, and complications such as fistula and stenosis resolved with minimal treatment.
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