Laser welding with albumin-based solder: Experimental full-tubed skin graft urethroplasty

Background and Objective: Fistula and stricture formation at the site of sutured anastomoses are frequent complications of major urethroplasty. We performed urethroplasty using laser-welded skin tube grafts in the hope that in addition to being free of suture holes, grafts would be as strong as or stronger than sutured controls. Study Design/Material and Methods: Scrotal skin was harvested from each of 11 rabbits and fashioned into tubes 3-4 cm in length using either conventional suture techniques or laser welding. Welding was performed using an 808-nm diode laser and a dye enhanced solder composed of albumin and sodium hyaluronate. Laser power density was 15.9 watts/cm ². For each graft, leak pressure, and urethroplasty time (tube creation and anastomosis to native urethra) were measured. Results: Urethroplasty time was significantly shorter and initial leak pressures were seven times greater in the laser-welded group. Conclusions: The near-uniform occurrence of strictures in both groups suggests that the rabbit is not an ideal model for free tube graft urethroplasty. However, our data indicate that laser welding with albumin-based solder, when used in the appropriate setting, may offer the potential for the rapid creation of watertight grafts in reconstructive urology.