Use of a fibrovascular tube in creation of neo-urethra during penile reconstruction

SummaryIntroductionThere are several techniques employed in the surgical treatment of total or partial penile reconstruction, hypospadias surgery, and urethral stricture. Urethral reconstruction is performed in different ways applying these techniques.ObjectiveWe evaluated use of a fibrovascular sheath to create a neo-urethra formed around a silicon tube.Material and methodsWe used nine male New Zealand rabbits for this study. In the first step, we placed a silicone tube under the skin in the lower abdomen of the rabbits and waited for the formation of a fibrovascular sheath to totally surround the tube. In the second step, the silicone tube was removed and the formed fibrovascular sheath was anastomosed with penile urethra over a silicone 8F Foley catheter. Ten days after the second step, the silicone Foley catheter was removed. Twenty days after the second step, we evaluated the newly created neo-urethra with a retrograde urethrogram. Thirty days after the second step, the rabbits were sacrificed and the bladder, urethra, and neo-urethra were removed for histopathological examination.ResultsSix of the rabbits completed the study. After the first operation, in the third month, formation of the fibrovascular sheath was observed around the silicon tube. After anastomosis and removal of the silicon Foley catheter, urine was seen to pass through the neo-urethral meatus. Urethrocystography showed that the neo-urethra and penile urethra were aligned and urine flow was regular. Histopathological evaluation showed that the structural integrity of the newly formed urethra was comparable with the structure of the regular urethra (Table) and the calibration did not change over time, although the newly formed urethra was not covered with uroepithelium.ConclusionsIn this study, we achieved promising results with use of a newly formed fibrovascular sheath as a neo-urethra.Summary Table. Evaluation methods of created neo-urethra and findings.Evaluation methodFindingsMacroscopicNeo-urethra is patentRadiologicNeo-urethra has same alignment with the penile urethraHistologic-Neo-urethra has comparable structure with the natural one-Mean cross-sectional after sacrifice is 2.664 mm2 (which was 2.808 mm2 before)-Urethral epithelium did not advance towards the neo-urethra