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Trans-anal colonic mucosa graft onlay for salvage urethroplasty
Alex Vanni, M.D., Leonard Zinman, MD.
Lahey Clinic, Burlington, MA, USA.

Background
Urethral reconstruction of strictures caused by lichen sclerosis (LS) is challenging with no universally accepted approach. Circumferential colonic mucosa graft urethroplasty has been described for the treatment of long segment urethral strictures, but required sigmoid resection to obtain the graft. Our objective was to perform a minimally invasive trans-anal colonic graft retrieval for subsequent onlay urethroplasty for patients requiring salvage urethroplasty after previous failed reconstruction or repair of complex panurethral LS stricture disease.
Methods
A retrospective review of 2 patients with LS urethral strictures who had a colonic mucosa graft ventral onlay urethroplasty. Urethroplasties were performed by AV and LZ. 1 patient had recurrent LS in a prior 1st stage buccal mucosa graft, while the other had a 20 cm panurethral stricture. Both patients had a Trans-anal Endoscopic Microsurgical (TEMS) retrieval of the colonic mucosal graft. The colonic grafts harvested were 12 x 3 cm and 10 x 4 cm respectively. Urethral reconstruction was assessed at 4-6 months with a retrograde urethrogram and cystoscopy. Failure was defined as recurrent stricture <17 Fr on cystoscopic assessment. Postoperative rectal evaluation was performed with a water-soluble enema before discharge and flexible sigmoidoscopy 1 month post-operatively.
Results
Both colonic graft urethroplasties are recurrence free at 4 and 6 months respectively. No post-operative complications occurred, and both patients are defecating normally.
Conclusions
TEMS colonic graft onlay urethroplasty can be performed safely in patients requiring complex long segment or salvage urethral reconstruction. Short-term results are encouraging for this novel technique.


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