Outcomes of adult urethroplasty with commercially available acellular matrix

Abstract

Background: Reconstruction for complex urethral strictures may necessitate grafting. Buccal mucosal graft (BMG) harvest involves additional morbidity, making 'off-the-shelf' options attractive. Multiple extracellular matrices (ECMs) have been used with varying degrees of success. We reviewed our experience with MatriStem (ACell, Inc., Columbia, MD, USA) to assess safety and clinical/histologic outcomes.

Methods: All patients undergoing acellular matrix-based reconstruction were included. Data regarding indications for surgery, patient demographics, subsequent procedures, clinical outcomes, and histologic analysis, when present, were collected.

Results: Eight patients undergoing urethral reconstruction with ECM were identified. All repairs were performed as staged procedures. Grafting was performed with either MatriStem alone or MatriStem and concomitant BMG. Seven patients (88%) underwent prior endoscopic intervention and five patients (71%) had failed to respond to one or multiple prior urethroplasties. Length of involved segments ranged from 2.5 to 15 cm. ECM graft placement was feasible and demonstrated excellent graft take. Among patients undergoing second-stage repairs (four of eight, 50%), 50% remained patent without the need for subsequent dilation.

Conclusions: Use of acellular matrix grafts in urethral reconstruction appears safe and feasible. Acellular matrix performs similarly to BMG with respect to graft take and contraction following staged repair. Further study is warranted.

Keywords: acellular matrix; off-the-shelf; reconstruction; urethral stricture disease; urethroplasty.

Figure 1A–C.

Patient with a BMG (patient’s right) and Acell MatriStem graft (patient’s left) placed concomitantly at the time of first-stage urethroplasty. Graft contraction rates were similar between the BMG and Acell. (a) At time of surgery (BMG 50%/ECM 50%), (b) 1 month postoperatively (BMG 53%/ECM 47%), (c) 4 months postoperatively (BMG 50%/ECM 50%). BMG, buccal mucosal graft; ECM, extracellular matrix.