Buccal epithelium Expanded and Encapsulated in Scaffold-Hybrid Approach to Urethral Stricture (BEES-HAUS) procedure: A novel cell therapy-based pilot study

Abstract

Objectives: To describe the feasibility of a novel cell-based endoscopic technique using buccal epithelium, expanded and encapsulated in a thermoreversible gelation polymer scaffold for the treatment of urethral stricture.

Methods: Six male patients with bulbar urethral stricture ranging from 2.0 to 3.5 cm in length were included in this pilot study. Autologous buccal epithelial cells from a small buccal mucosal biopsy were isolated, cultured and encapsulated in thermoreversible gelation polymer scaffold, and were implanted at the stricture site after a wide endoscopic urethrotomy.

Results: All the patients voided well, with a mean peak flow rate of 24 mL/s. Urethroscopy carried out at 6 months showed healthy mucosa at the urethrotomy site. However, two of the six patients had recurrence at 18 and 24 months, respectively.

Conclusions: This endoscopic-based Buccal epithelium Expanded and Encapsulated in Scaffold-Hybrid Approach to Urethral Stricture (BEES-HAUS) technique is a promising alternative for the open substitution buccal graft urethroplasty. It is possible to achieve the benefits of open substitution buccal urethroplasty with this endoscopic technique.

Keywords: buccal mucosa; cell therapy; scaffold; urethral stenosis; urethral stricture.

Figure 1

Cells in culture in the TGP‐based method (magnification: ×20). The arrows indicate the cells with cobblestone morphology.

Figure 2

Follow‐up urethroscopy view at the implantation site: pink granulating tissue covering the urethrotomy site.

Figure 3

Photomicrograph of tissue from the implanted site of the urethra showing stratified squamous epithelium (magnification: ×400).

Figure 4

(a) Pre‐BEES‐HAUS procedure urethrogram. (b) Post‐BEES‐HAUS procedure urethrogram.