Endoscopic urethroplasty with unseeded small intestinal submucosa collagen matrix grafts: A pilot study

Purpose: We evaluated small intestinal submucosa (SIS) as a substitute for skin in endoscopic urethroplasty performed as treatment for inflammatory and iatrogenic strictures of the male bulbar urethra, and in the early treatment of bulbomembranous urethral injuries associated with recent pelvic fractures. Tissue integration and epithelialization of SIS in endoscopic urethroplasty were assessed, as was the long-term maintenance of urethral patency following this treatment. Materials and Methods: Nine patients with bulbar urethral strictures defined by urethrography were enrolled in the study. Following optical urethrotomy the SIS grafts were tubularized over a purpose specific graft carrying balloon device and secured into the opened urethra as described for endoscopic urethroplasty. Patients were followed with urethroscopy and urethrography at regular intervals as per protocol or when symptoms arose. Failure was defined as the need for any further intervention. Results: Two patients with short inflammatory strictures maintained urethral patency without any intervention at 1 and 2 years, respectively. Stricture recurrence developed in 6 patients within 3 months of surgery. Of these, 3 have undergone subsequent open urethroplasty, 2 are currently awaiting urethroplasty and 1 is maintaining urethral patency with regular self-dilatation. One patient was lost to followup. Conclusions: Endoscopic urethroplasty with unseeded SIS grafts was unsuccessful in this study.