Small Intestinal Submucosa (SIS) Graft Urethroplasty: Short-term Results

August 13, 2007 – 12:17 pm | posted in Urology / Nephrology

UroToday.com- Several autologous grafts of flaps from genital and extragenital skin or mucosa have been proposed for urethral stricture repairs however; today the buccal mucosa graft (BMG) is considered the best urethral tissue for substitution. Each of these tissue options has donor site morbidity and requires time-consuming harvesting. The search continues for an off-the-shelf alternative that can function as well as the BMG.

A recent study by Enzo Palminteri and colleagues from Milan Italy examined the short-term results of a small intestinal submucosa (SIS) graft in penile and bulbar urethroplasties. The study is published in the June 2007 issue of European Urology.

Over a one-year period from 2003 to 2004, 20 men with a mean age of 41 years with anterior urethral strictures underwent urethroplasty using SIS grafts as an inlay or onlay patch graft. Stricture location was penile in 1 patient, bulbar in 16, and penile-bulbar in 3. Average stricture and graft length were 3 and 5.7 cm. A dorsal inlay graft was performed in 14 cases, ventral onlay graft in 1, and dorsal inlay plus ventral onlay in 5. The dorsal inlays were performed after incising the dorsal urethral plate and spreading in the mucosa open (much like a Snodgrass repair) and inlaying the SIS graft. Clinical outcome was considered successful if no postoperative procedure was needed. Mean follow-up period was 21 months.

Analysis of results showed that seventeen cases (85%) were considered successful and 3 (15%) were failures. Sixteen successes (94%) were bulbar repairs and one a penile-bulbar repair with stricture and graft average lengths 2.6 and 5.35 cm. Cystoscopy at 3 months revealed adequate caliber lumens but SIS grafted areas were not completely replaced by urothelium. The three failures were penile and penile-bulbar repairs with stricture and graft average lengths of 5.7 and 7.7 cm. Recurrences showed fibrous tissue involving the grafted area with extension into the penile and bulbar urethra.

In this short-term study SIS seems to have some promise in select urethral reconstructions. The graft seems to perform better in the bulbar urethra but further follow-up is necessary to recommend widespread use of this material.

Palminteri E, Berdondini E, Colombo F, Austoni E, Martínez-Piñeiro L

Eur Urol. 51(6):1695-1701, June 2007
doi:10.1016/j.eururo.2006.12.016

Reported by UroToday.com Contributing Editor Michael J. Metro, M.D

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