Objective: We present our preliminary experience with the use of autologous cell cultures of buccal mucosa (BM) in urethral repair.
Patients and methods: Five patients with urethral stenosis underwent staged urethral reconstruction with MB autologous cell culture grafts. MB biopsies were obtained from each patient. Keratinocytes and fibroblasts were isolated. This cellular suspension was seeded into Petri dishes. The cultures were kept in chemically specific ground for keratinocyte cultures. Once they reached the proper confluence and extension for urethral reconstruction, the cultures were transplanted in the patients. During the first stage of surgery, after the removal of healing tissues, the MB culture grafts were transplanted in order to recreate a neo-urethral plate. Six months later, the neo-urethral plate was re-tubularized.
Results: Average follow-up was 24 mo. We reported successful staged reconstruction in 2 cases (40%). Three cases (60%) were unsuccessful. One patient developed a scar retraction of the grafts after the first stage of surgery, which prevented broad urethral reconstruction. Two patients who had completed the staged reconstructive process,developed a re-stenosis. There were no reported graft site infections and none of the grafts was rejected.
Conclusions: We report the procedure in order to obtain and use an MB homologous cell culture. Using autologous material reduced the surgical time and wiped out the risk of rejection; on the other hand, the tissue was so thin and with no adequate scaffold that the healing retraction of the graft was increased, thus compromising the urethral reconstruction. Preliminary results confirm that bio- engineering applied to urethral surgery is far from obtaining adequate tissue with reference to extension, thickness and biological features.