Clinic Research Of Pelvic Fracture Urethral Injury And Application Of Cell Sheets For Stress Urinary Incontinence

Objective: We retrospectively analyzed patients who underwent transperineal anastomotic urethroplasty after PFUI,and identified variables and predictors of stricture recurrence.One of the complications of pelvic fracture urethral injury is stress urinary incontinence.We used tissue engineering slings with adipose-derived stem cells(ADSCs)sheets and nanoyarn,and cell sheets fragment urethral injection for treatment of SUI.The therapeutic effect of two methods with cell sheets technique was discussed in histology and urodynamics.Materials and methods: We retrospectively analyzed 928 patients who underwent transperineal anastomotic urethroplasty after PFUI between 2005 and 2015.We identified variables that might be predictors of stricture recurrence after transperineal anastomotic urethroplasty: age,etiology of PFUI,location and length of stricture,emergency management,any previous failed surgery,concomitant injuries,and type of surgical techniques.We constructed the tissue engineering slings with ADSCs sheet and nanoyarn.canning electron microscope(SEM)was used to observe the microstructure of nano-yarn and ADSCs sheet.HE and masson staining were used to explore the histologic changes of ADSCs sheet and urethra.Leak point pressure(LPP)was used to observe the urodynamics of each group.In ADSCs sheet fragment injection section,Leak point pressure(LPP)was used to observe the urodynamics of each group,and immunocytochemistry and immunofluorescence were used to explore the regeneration of smooth muscle cells,blood vessels and nerve.Results: On univariate analysis,the location of the stricture(prostatic displacement),stricture length,previous failed surgery,and emergency management were factors that influenced stricture recurrence.On multivariate analysis,only prostatic displacement,stricture length(>3 cm),failed urethroplasty and ?2 prior failed internal urethrotomy were significant predictors of recurrence.The results of SEM show that the pore diameter of nanoyarn is larger than that of nanometer fiber and is more suitable for cell growth.Histological examination showed cell sheetsnanoyarn has a dense arrangement and better integration with the urethra tissue.The results of urodynamics showed no differences with the normal group.Cell sheets fragment urethral injection can recover the urodynamics change of animal model.The results of histology indicated more implanted cells differentiated into smooth muscle cells and endothelial cell.Cell sheets fragment urethral injection promotes blood vessels and nerve regeneration.Conclusion: In the management of PFUI by transperineal anastomotic urethroplasty,the prostatic displacement,the stricture length(>3 cm),and the incidence of previous failed surgery(?2 instances of failed internal urethrotomy and failed urethroplasty)were factors that may increase the risk of recurrence.Cell sheets-nanoyarn slings may produce a large amount of collagen at the junction of the urethra and integrated better with the urethra tissue.Furthermore,it has a dense arrangement which increased the mechanical properties of the sling.Cell sheets fragment urethral injection may increase the survival time of cells in the urethra and more implanted cells differentiated into smooth muscle cells.It also promoted blood vessels and nerve regeneration.These two methods provide a new direction for the treatment of SUI.