Urethral reconstruction with cells of the oral mucosa

Overview of the advantages of urethral reconstruction using tissue engineered oral mucosa!

The following doctors / hospitals cover the cost of urethral reconstruction using tissue engineered oral mucosa:

Prof. Dr. med. habil. Udo Rebmann

Prof. Dr. med. Dirk Fahlenkamp

Urethral reconstruction using tissue engineered oral mucosa in detail!

Reasons for urethral stricture

It often begins with an abnormal narrowing of the urethra, often described by doctors as urethral stricture. These narrow points have nothing to do with the prostate which is initially often considered the cause of the related symptoms. The flow of urine inside this tube is blocked and this obstruction can be caused by scar tissue (e.g.). A urethral stricture can appear at a later stage in life, but in rare cases it can also be inherent and should not be confused with phimosis (narrowing of the preputial orifice). A phimosis appears more often and represents a typical disease of the male. The likelihood of occurrence is 6 in 1,000 men.
Causes are often:

• Bacterial infections, e.g. gonorrhea, in colloquial speech also called clap.
• Other infections around the glans or below the foreskin, often caused by insufficient hygiene.
• Lesions or injuries around the pelvic or perineal area (with women).
• Mechanical over-strain of the urethra, e.g. in case of a cystoscopy with a catheter, surgery above the urethra, but also in case of weird sex games during which foreign objects enter the urethra.
• Tumors around the urethra.

And then there are also many cases with no identifiable cause. However, it is strongly recommended to receive medical treatment in any case of urethral stricture. Urologists currently favor on one of several medical treatments in particular: the gentle and almost painless reconstruction of the constricted part of the urethra using tissue substitute (urethraplasty). This implies the use of so called autologous cell transplant, which is at first cultivated in a laboratory from the patient’s own oral mucosa cells.

Symptoms of urethral stricture

Urethral stricture develops usually rather slowly and remains undiscovered in the beginning. Only with time the following symptoms can emerge and increase in their intensity:

• The urinary stream gets much weaker, is sometimes skewed, split or a weak drizzle.
• Occasionally there is an unpleasant burning sensation when urinating.
• Urination often occurs incomplete and the affected person continues to feel residual urine.
• A permanent desire to void makes it difficult for the affected person to leave the house.
• Occasional blood in the urine.
• Infections of the urethra and bladder occur more often.
• At an advanced stage, complete and dangerous urinary retention can occur and immediate surgery is inevitable in most cases.

These symptoms are not necessarily so specific that they clearly identify a urethral stricture. In fact, they strongly resemble the symptoms of a bladder-prostate infection or of an enlarged prostate gland. In addition, an overstretched bladder can be the consequence of the increased pressure on the bladder and can in turn cause eversions on the bladder wall (diverticulum). Yet another possible consequence is kidney congestion which often comes with permanent kidney damage.

Examination methods and diagnosis

Like many medical examinations, the diagnosis begins with a conversation between doctor and patient. Questions relating to medical history are asked, e.g. for how long the physical discomfort has already been observed or previous infections and injuries. The next important step is a lab examination of the urine which helps to safely exclude the possibility of a urinary tract infection. Measuring the quantity of urine (uroflowmetry) contributes to a safe diagnosis. Ultra sound examinations can help in measuring the amount of residual urine, assess the constitution of the urinary bladder as well as the kidneys. X-rays based on contrast agents finally allow for the localization and extend of the urethral stricture. A urethroscopy allows for an even more precise understanding of the situation but is generally not necessary anymore after the above mentioned examinations.

Urethral reconstruction using tissue engineered oral mucosa

This is a new and promising procedure with a high success rate. Autologous cell transplant is cultivated in a cleanroom laboratory from the patient’s own oral mucosa. Afterwards, this new piece of ‘urethra’ is implanted where the constricted urethra had surgically been removed. This kind of reconstruction is gentle on the patient and almost painless. A few cells are extracted from the oral mucosa of the patient to cultivate the tissue substitute, overall less than one square centimeter. After approximately three weeks, the substitute has developed itself already. The reconstruction of the urethra using cultivated cells from the patients themselves is a new and pioneering development in urology.

This procedure can replace a large number of previous surgeries, it promises high healing chances and rejection of the new tissue cannot occur. If and to what extend this new procedure will be applied in individual cases depends, of course, on the decision of the doctor in charge and the attending urologist.

Tissue Engineering

In urology, this kind of autologous cell transplantation – here specifically with tissue from the oral mucosa – is a first-time successful application of tissue substitutes in the field of Tissue Engineering. The German term comes from the English and defines the reconstruction of tissue or the cultivation of tissue. After all, it is the artificial production of organic tissue in a laboratory with the help of targeted cultivation of specific cells. With this tissue it is possible to replace diseased or dead patient tissue. Depending on the kind of cells, they are cultivated on a carrier substance. Today, tissue engineering products are considered modern pharmaceuticals for innovative therapies.

Conclusion

The especially cultivated transplant from tissue engineered oral mucosa offered many advantages during the treatment, or during surgery of the urethral stricture.

• The basis for cell proliferation is a very small area of the patient’s oral mucosa.
• This excludes almost any complications.
• Using autologous tissue transplant allows for very short anesthesia and surgery.
• Endogenous cells are especially resilient against the composition of the body’s own urine, they offer high mechanical stability and adapt quickly and perfectly to the place, form and extend of their field of application.
• This new method causes very little pain, is well tolerated and heals quickly.

The healing process after implanting the transplant is quick and complete. The result is a fully functioning urethra. These are the reasons that autologous tissue transplant is used today in the treatment of urethral strictures as well as hypospadia.

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