Randomized comparative study between buccal mucosal and acellular bladder matrix grafts in complex anterior urethral...

Area of Science:

• Urology
• Regenerative Medicine
• Biomaterials

Background:

• Urethral strictures present a significant reconstructive challenge due to limited graft materials and high recurrence rates.
• Buccal mucosa is a favored graft material for urethral reconstruction, offering durability and good survival rates.
• Acellular bladder matrix (ABM) is an emerging collagen-based biomaterial for urethral repair.

Purpose of the Study:

• To compare the efficacy of acellular bladder matrix (ABM) against buccal mucosal grafts in patients with complex urethral strictures.
• To evaluate graft survival, patency rates, and voiding function following reconstructive surgery.

Main Methods:

• A randomized comparative study involving 30 patients with urethral strictures of varying lengths and locations.
• Patients were assigned to receive either buccal mucosa or decellularized bladder matrix (DBM) grafts via an onlay procedure.
• Demineralized bone matrix (DBM) was utilized as an off-the-shelf biomaterial.

Main Results:

• In patients with healthy urethral beds (fewer than 2 prior operations), both ABM and buccal mucosa grafts showed similar success rates.
• In patients with unhealthy urethral beds (more than 2 prior operations), buccal mucosa grafts had a higher success rate (5/5) compared to ABM grafts (2/6).
• Both groups experienced significant improvements in postoperative uroflowmetry, and graft biopsies revealed normal urethral tissue characteristics.

Conclusions:

• Acellular bladder matrix (ABM) is a viable option for urethral reconstruction.
• Demineralized bone matrix (DBM) yields optimal results in patients with healthy urethral beds, minimal spongiofibrosis, and good urethral mucosa.
• Buccal mucosa remains a reliable option for complex urethral strictures, especially in cases with prior surgical interventions.