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The First Oral Mucosal Graft Urethroplasty Was Carried Out in the 19th Century: The Pioneering Experience of Kirill Sapezhko (1857–1928)

2012; Elsevier BV; Volume: 62; Issue: 4 Linguagem: Inglês

10.1016/j.eururo.2012.06.035

1873-7560

Igor A. Korneyev, Dmitry O. Ilyin, D. Schultheiss, Christopher R. Chapple,

Urological Disorders and Treatments

Urethral stricture is a pathological narrowing of the urethra secondary to ischemic spongiofibrosis. The earliest description of urethral stricture management dates back to sixth century BCE in ancient India where Sushruta—founder of Ayurveda medicine in ancient India–describes the use of a reed catheter lubricated with clarified butter to dilate the urethra. After centuries of blind urethral dilations and external urethrotomies, the biggest leap in urethral stricture management came in 1894 courtesy of Professor Kirill Mikhailovich Sapezhko (1857–1928), a Russian surgeon, who was the first to use an oral mucosal graft (OMG) to augment a urethral stricture. Since then, a variety of techniques have been described including grafts, flaps, anastomotic and augmentation procedures. The surgical technique is directed by the length and location of the stricture. The treatment of choice for short bulbar urethral strictures is excision and primary anastomosis, although there has been recent interest in considering a Heineke–Miculicz approach where possible and avoiding transection. For longer bulbar or penile urethral strictures, graft augmentation is used. The current tendency is to favor OMGs over penile skin flaps due to lower incidence of donor site morbidity. OMG harvest is well accepted by patients and has a low morbidity. There are, however, situations that require a more extensive graft harvest such as full-length strictures and reoperative cases where a previous graft harvest has been obtained. These situations led us to develop a tissue-engineered oral mucosa substitute and perform the first-in-human study in five patients in 2004. This potential morbidity with extensive grafts has driven the investigation of tissue engineering techniques in urethral surgery. In this chapter, we aim to review recent advancements in urethral tissue engineering and discuss the key regulatory issues when translating tissue-engineered products into clinical practice.