Reconstrucción de agenesia e hipoplasia total de uretra mediante ingeniería de tejidos. Primer reporte mundial.

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Bibliographic Details
Title:	Reconstrucción de agenesia e hipoplasia total de uretra mediante ingeniería de tejidos. Primer reporte mundial.
Alternate Title:	Reconstruction of total agenesis and hypoplasia of the urethra by tissue engineering. First global report.
Authors:	Esquiliano-Rendón, Diego¹, Raya-Rivera, Atlántida M.¹, Ricardo M. Ordorica-Flores¹, Valencia-Mayoral, Pedro¹
Source:	Revista Mexicana de Cirugia Pediatrica. abr-jun2009, Vol. 16 Issue 2, p56-64. 9p. 3 Color Photographs, 1 Black and White Photograph, 1 Chart, 1 Graph.
Subjects:	URETHRA diseases, REGENERATIVE medicine, TISSUE engineering, POTTER'S syndrome, VATER syndrome, URETHROTOMY, URETHRA surgery, DIAGNOSIS
Abstract (English):	Introduction: Defects of the entire urethra are a challenge to the urologist. The use of neighboring genital tissue is the first choice of treatment with better functional results and fewer complications. However in long urethral defects this tissue is not sufficient and requires use of extragenital tissue. Regenerative medicine and tissue engineering also called could help solve the problems that occur with the use of non-urologic tissue grafts. We present our clinical experience using a urethral implant made of autologous tissue engineering as an alternative for the treatment and reconstruction of patients with complex urethral defects. Material and Methods: A four children underwent total urethral reconstruction using autologous tissue tubularized neouretral. Were scheduled for biopsy of the bladder, to select and stimulate cell multiplication. Then the cells were seeded in a temple of polyglycolic acid (PGA) or intestinal submucosa (SIS). Feasibility studies were performed (MTT) and cell proliferation in vitro neotejido construction, study of immunohistochemistry, electron microscopy and evaluated after the implant structure and functional characteristics in vivo neotejido. Results: The mean age at the time of urethroplasty was 5 years. The average follow-up in four cases was three years, the primary diagnosis were: Prune Belly Syndrome in 2 cases, more VACTER syndrome urethral duplication in one patient, genital ambiguity in partial peripheral resistance to androgens and perineal hypospadias. The transperineal approach was used, forming the urethra of two parts. Complications: Patients 1 and 2 had stenosis at the anastomosis that was solved with urethrotomy, patients 3 and 4 were carried out urethrocutaneous fistula primary closure of fistula. Electron microscopy showed the temple coated with cells, adequate viability. The urodynamic study reported median Fmax 20ml/ seg. (Range 12.5 to 31ml/seg.). When comparing peak flow postoperative 12m 3m there is a statistically significant increase of p = <0.032. Discussion: The Making of human urethral tissue engineering technology is an alternative management in patients with agenesis or severe hypoplasia of the urethra, the patients had severe associated pathologies that were handled by a multidisciplinary team, and complications such as fistula and stenosis resolved with minimal treatment. [ABSTRACT FROM AUTHOR]
Abstract (Spanish):	Introducción: Los defectos de la totalidad de la uretra son un reto para el Urólogo. La utilización de tejido genital vecino es la primera elección de tratamiento con mejores resultados funcionales y menos complicaciones. Sin embargo en defectos uretrales largos este tejido no es suficiente y se requieren utilización de tejido extragenital. La medicina regenerativa o también denominada ingeniería de tejidos podría ayudar a resolver los problemas que se presentan con el uso de injertos de tejido no urológico. Presentamos nuestra experiencia clínica utilizando un implante de tejido autólogo uretral fabricado con ingeniería de tejidos como una alternativa para el tratamiento y reconstrucción de pacientes con defectos de uretra complejos. Material y Métodos: A 4 niños se les realizó reconstrucción uretral total utilizando tejido neouretral tubularizado autólogo. Se programaron para realizar toma de biopsia vesical, para seleccionar y estimular multiplicación celular. Posteriormente las células fueron sembradas en un templete de ácido poliglicólico (PGA) o submucosa intestinal (SIS). Se realizaron estudios de viabilidad (MTT) y proliferación celular, construcción del neotejido in Vitro, estudio de inmunohistoquímica, microscopia electrónica y posterior al implante se evaluó estructura y características funcionales del neotejido in vivo.Resultados: La edad media al momento de la uretroplastía fue de 5 años. El promedio de seguimiento en los 4 casos fue de 3 años, los diagnósticos primarios fueron: Síndrome de Prune Belly en 2 casos, Síndrome de VACTER mas duplicación de uretra en un paciente, ambigüedad de genitales por resistencia parcial periférica a andrógenos e hipospadias perineal. El abordaje fue transperineal, conformando la uretra de dos porciones. Complicaciones: los pacientes 1 y 2 presentaron estenósis a nivel de anastomósis que se resolvió con uretrotomía, los pacientes 3 y 4 presentaron fístula uretrocutánea realizándose cierre primario de fístula. La microscopía electrónica mostró el templete recubierto con células, viabilidad adecuada. El estudio de urodinamia reporto mediana de Fmax 20ml/seg. (Rango de 12.5 a 31ml/seg.). Al comparar flujo máximo 3m con 12m posquirúrgico se observa un incremento estadísticamente significativo de p= <0.032. Discusión: La fabricación de uretra humana con tecnología de ingeniería de tejidos es una alternativa de manejo en pacientes con agenesia o hipoplasia severa de uretra, los pacientes presentaron patologías asociadas graves que fueron manejadas por un equipo multidisciplinarlo, y las complicaciones como fístulas y estenósis se resolvieron con mínimo tratamiento. [ABSTRACT FROM AUTHOR]
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Database:	MedicLatina

Description
Abstract:	Introduction: Defects of the entire urethra are a challenge to the urologist. The use of neighboring genital tissue is the first choice of treatment with better functional results and fewer complications. However in long urethral defects this tissue is not sufficient and requires use of extragenital tissue. Regenerative medicine and tissue engineering also called could help solve the problems that occur with the use of non-urologic tissue grafts. We present our clinical experience using a urethral implant made of autologous tissue engineering as an alternative for the treatment and reconstruction of patients with complex urethral defects. Material and Methods: A four children underwent total urethral reconstruction using autologous tissue tubularized neouretral. Were scheduled for biopsy of the bladder, to select and stimulate cell multiplication. Then the cells were seeded in a temple of polyglycolic acid (PGA) or intestinal submucosa (SIS). Feasibility studies were performed (MTT) and cell proliferation in vitro neotejido construction, study of immunohistochemistry, electron microscopy and evaluated after the implant structure and functional characteristics in vivo neotejido. Results: The mean age at the time of urethroplasty was 5 years. The average follow-up in four cases was three years, the primary diagnosis were: Prune Belly Syndrome in 2 cases, more VACTER syndrome urethral duplication in one patient, genital ambiguity in partial peripheral resistance to androgens and perineal hypospadias. The transperineal approach was used, forming the urethra of two parts. Complications: Patients 1 and 2 had stenosis at the anastomosis that was solved with urethrotomy, patients 3 and 4 were carried out urethrocutaneous fistula primary closure of fistula. Electron microscopy showed the temple coated with cells, adequate viability. The urodynamic study reported median Fmax 20ml/ seg. (Range 12.5 to 31ml/seg.). When comparing peak flow postoperative 12m 3m there is a statistically significant increase of p = <0.032. Discussion: The Making of human urethral tissue engineering technology is an alternative management in patients with agenesis or severe hypoplasia of the urethra, the patients had severe associated pathologies that were handled by a multidisciplinary team, and complications such as fistula and stenosis resolved with minimal treatment. [ABSTRACT FROM AUTHOR]