Preliminary report with use of human decellularised dermis as a splint supporting complex urethroplasty
Anna Radford, FRCS, PhD, Ramnath Subramaniam, MD.
Leeds Teaching hospitals NHS trust, Leeds, United Kingdom.
Reconstruction of anomalies of the lower urinary tract can be challenging. Deficiency of good quality urethral and peri-urethral tissue is recognised as a contributory factor in development of post-urethroplasty complications. Acellular matrices (ACMs) provide a potential solution but selecting the most appropriate strategy remains undetermined. We report our experience and outcomes in patients who have had human dermal acellular matrix (HDACM) implanted as part of complex urethral reconstruction.
MATERIAL AND METHODS
From 2013 - 2016, 24 boys (median age 5.5 years (range 2.8 - 15.5)) underwent urethral reconstruction using a NDACM as a peri-urethral splint. Indications for surgery included: urethral fistulae (n= 12), redo-urethroplasty (n= 8), and urethral diverticulum (n= 2), urethral stenosis (n= 2). Outcome data was collected prospectively.
: All 24 boys made a good initial recovery. Median follow-up was; to 6 months (1-24 months). Wound complications in 3/24 (12.5 %), resulted in one urethral fistula. One child, with diverticulum, developed a tiny fistula at the proximal end of the repair, which seems to have resolved conservatively, with follow-up in clinic. Of those seen in clinic only 1/17 the parents reported to be unhappy with the outcome (5.88%). Uroflowmetry so far (n=10), demonstrated bell-shaped curves (10/10), mean QMax = 9.6 ml/sec (± 2.65).
These preliminary results in those boys who have had a HDACM implanted suggest it may be utilised as an adjunct to support and waterproofing in complex urethroplasty cases when there is a lack of quality, healthy tissues. Further work is required to formally assess integration and long term follow-up clinically needs to be acquired.
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