Sutureless Rabbit Bladder Mucosa Patch Graft Urethroplasty Using Diode Laser And Solder

Andrew J. Kirsch, David T. Chang, Mark L. Kayton, Jeffrey Newhouse, Steven Libutti, Michael R. Treat, John P. Connor, Terry W. Hensle

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Fistula and strictures at the site of sutured anastomoses are frequent complications of major urethroplasty. We harvested bladder mucosa in 26 rabbits to repair large defects in the proximal urethra using laser-activated solder in the hope that such a repair would be stronger, faster to create and avoid common complications seen with conventional repair. Large oval defects were created in the proximal urethra in all animals undergoing urethroplasty. Twelve animals underwent bladder mucosa graft closure via diode (808 nm.) laser activation of an albumin-based solder (50 percent were suture-free). Fourteen additional animals underwent closure with 7-zero polydiaxanone suture (controls). Leak pressure and time of repair were recorded for each graft. Additional sections of bladder mucosa were harvested, transected and repaired by laser welding to determine tensile strength. In both groups, radiography, urethroscopy and clinical course were evaluated for as much as 6 weeks postoperatively. Urethroplasty time was significantly (p less than 0.01) shorter for the laser group (13.8 plus/minus 2.5 minutes) than for the sutured repair group (24.0 plus/minus 5.3 minutes). Initial leak pressures for the lasered grafts averaged at least 4 times those of sutured grafts (p less than 0.01). The tensile strength for lasered bladder mucosa was 3.16 plus/minus 1.12 kg./cm.2 Early retrograde urethrograms (RUG) performed at 7 days (n = 5) revealed urinary extravasation and fistula formation in 2 control animals compared with a normal urethral appearance in 3 lasered repairs. Early retrograde urethrograms performed at 21 days (n = 21) demonstrated smooth-walled urethras with no evidence of fistula, stricture, or urinary extravasation in the lasered group; varying degrees of reactive mucosal proliferation were seen in the controls. Urethroscopy confirmed these observations. At 6 weeks, histologic examination confirmed the presence of viable graft in all animals. We conclude that bladder mucosa patch graft urethroplasty using diode laser welding and albumin-based solder is an attractive alternative to conventional methods.

Original languageEnglish (US)
Pages (from-to)1303-1307
Number of pages5
JournalThe Journal of Urology
Volume153
Issue number4
DOIs
StatePublished - Jan 1 1995
Externally publishedYes

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Semiconductor Lasers
Mucous Membrane
Urinary Bladder
Rabbits
Transplants
Lasers
Urethra
Welding
Tensile Strength
Sutures
Fistula
Albumins
Pathologic Constriction
Urinary Fistula
Pressure
Radiography

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Kirsch, A. J., Chang, D. T., Kayton, M. L., Newhouse, J., Libutti, S., Treat, M. R., ... Hensle, T. W. (1995). Sutureless Rabbit Bladder Mucosa Patch Graft Urethroplasty Using Diode Laser And Solder. The Journal of Urology, 153(4), 1303-1307. https://doi.org/10.1016/S0022-5347(01)67590-6
Kirsch, Andrew J. ; Chang, David T. ; Kayton, Mark L. ; Newhouse, Jeffrey ; Libutti, Steven ; Treat, Michael R. ; Connor, John P. ; Hensle, Terry W. / Sutureless Rabbit Bladder Mucosa Patch Graft Urethroplasty Using Diode Laser And Solder. In: The Journal of Urology. 1995 ; Vol. 153, No. 4. pp. 1303-1307.
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Kirsch, AJ, Chang, DT, Kayton, ML, Newhouse, J, Libutti, S, Treat, MR, Connor, JP & Hensle, TW 1995, 'Sutureless Rabbit Bladder Mucosa Patch Graft Urethroplasty Using Diode Laser And Solder', The Journal of Urology, vol. 153, no. 4, pp. 1303-1307. https://doi.org/10.1016/S0022-5347(01)67590-6

Sutureless Rabbit Bladder Mucosa Patch Graft Urethroplasty Using Diode Laser And Solder. / Kirsch, Andrew J.; Chang, David T.; Kayton, Mark L.; Newhouse, Jeffrey; Libutti, Steven; Treat, Michael R.; Connor, John P.; Hensle, Terry W.

In: The Journal of Urology, Vol. 153, No. 4, 01.01.1995, p. 1303-1307.

Research output: Contribution to journalArticle

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AU - Kirsch, Andrew J.

AU - Chang, David T.

AU - Kayton, Mark L.

AU - Newhouse, Jeffrey

AU - Libutti, Steven

AU - Treat, Michael R.

AU - Connor, John P.

AU - Hensle, Terry W.

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N2 - Fistula and strictures at the site of sutured anastomoses are frequent complications of major urethroplasty. We harvested bladder mucosa in 26 rabbits to repair large defects in the proximal urethra using laser-activated solder in the hope that such a repair would be stronger, faster to create and avoid common complications seen with conventional repair. Large oval defects were created in the proximal urethra in all animals undergoing urethroplasty. Twelve animals underwent bladder mucosa graft closure via diode (808 nm.) laser activation of an albumin-based solder (50 percent were suture-free). Fourteen additional animals underwent closure with 7-zero polydiaxanone suture (controls). Leak pressure and time of repair were recorded for each graft. Additional sections of bladder mucosa were harvested, transected and repaired by laser welding to determine tensile strength. In both groups, radiography, urethroscopy and clinical course were evaluated for as much as 6 weeks postoperatively. Urethroplasty time was significantly (p less than 0.01) shorter for the laser group (13.8 plus/minus 2.5 minutes) than for the sutured repair group (24.0 plus/minus 5.3 minutes). Initial leak pressures for the lasered grafts averaged at least 4 times those of sutured grafts (p less than 0.01). The tensile strength for lasered bladder mucosa was 3.16 plus/minus 1.12 kg./cm.2 Early retrograde urethrograms (RUG) performed at 7 days (n = 5) revealed urinary extravasation and fistula formation in 2 control animals compared with a normal urethral appearance in 3 lasered repairs. Early retrograde urethrograms performed at 21 days (n = 21) demonstrated smooth-walled urethras with no evidence of fistula, stricture, or urinary extravasation in the lasered group; varying degrees of reactive mucosal proliferation were seen in the controls. Urethroscopy confirmed these observations. At 6 weeks, histologic examination confirmed the presence of viable graft in all animals. We conclude that bladder mucosa patch graft urethroplasty using diode laser welding and albumin-based solder is an attractive alternative to conventional methods.

AB - Fistula and strictures at the site of sutured anastomoses are frequent complications of major urethroplasty. We harvested bladder mucosa in 26 rabbits to repair large defects in the proximal urethra using laser-activated solder in the hope that such a repair would be stronger, faster to create and avoid common complications seen with conventional repair. Large oval defects were created in the proximal urethra in all animals undergoing urethroplasty. Twelve animals underwent bladder mucosa graft closure via diode (808 nm.) laser activation of an albumin-based solder (50 percent were suture-free). Fourteen additional animals underwent closure with 7-zero polydiaxanone suture (controls). Leak pressure and time of repair were recorded for each graft. Additional sections of bladder mucosa were harvested, transected and repaired by laser welding to determine tensile strength. In both groups, radiography, urethroscopy and clinical course were evaluated for as much as 6 weeks postoperatively. Urethroplasty time was significantly (p less than 0.01) shorter for the laser group (13.8 plus/minus 2.5 minutes) than for the sutured repair group (24.0 plus/minus 5.3 minutes). Initial leak pressures for the lasered grafts averaged at least 4 times those of sutured grafts (p less than 0.01). The tensile strength for lasered bladder mucosa was 3.16 plus/minus 1.12 kg./cm.2 Early retrograde urethrograms (RUG) performed at 7 days (n = 5) revealed urinary extravasation and fistula formation in 2 control animals compared with a normal urethral appearance in 3 lasered repairs. Early retrograde urethrograms performed at 21 days (n = 21) demonstrated smooth-walled urethras with no evidence of fistula, stricture, or urinary extravasation in the lasered group; varying degrees of reactive mucosal proliferation were seen in the controls. Urethroscopy confirmed these observations. At 6 weeks, histologic examination confirmed the presence of viable graft in all animals. We conclude that bladder mucosa patch graft urethroplasty using diode laser welding and albumin-based solder is an attractive alternative to conventional methods.

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