Acellular Dermal Matrix Allograft For The Reconstruction Of Ureter Or Urethra

Objective:To evaluate the possibility of allodecellular extracellular matrix(ECM)- acellular dermal matrix allograft(ADMA) for the reconstruction of ureter or urethra and found an ideal replacement material to simplify the ureteroplastic and urethroplastic surgery.Methods:ADMA was used to treat the stricture of ureter in 11 patients(male 5 and female 6;mean age,44.5 years).The mean disease course was 20.5 months(range,12-39months).Of the 11 cases,5 had stricture of pelviureteric transition zone;3 had stricture of upper and middle ureter;3 had stricture of lower ureter.The stricture lenth ranged from 3 to 10cm. ADMA was used to treat the long stricture of urethral in 8 patients(mean age 56 years).The mean disease course was 16.7 months(range, 3-60months).The stricture length ranged 3 to 8cm(mean 5cm).Results:The procedure was performed successfully at one-stage in 11 cases of ureteral stricture without complication.The 11 cases were followed up for 6 months to 65 months(median,19.5 months).Postoperatively,the ureter stents were removed in 4 cases at 4 weeks and in other 7 cases at 8 weeks.The ureter functions of 9 patients were normal after operation.No stenosis,effusion and hydronephrosis were observed on IVU 6 months after operation.Ureteral stricture developed again in 2 cases and operation was performed again and succeed.The 8 cases of urethral stricture were followed up for an average 12.5 months(3-21months).Postoperatively,the Foley catheter were removed in 2 cases at 6 weeks and in other 6 cases at 8 weeks.Among the 8 patients,7(87.5%) voiled well.No stenosis and effusion were observed on excretory urogram(XU) 8 weeks after operation.Conclusions:ADMA can provide a frame for the host cells' growth,and it can be mixed with host tissues to provide a good intensive potency,so it might be an ideal tissue-engineering material for the replacement of ureter and urethra,without concern of rejection.