AB057. Intravesical laparoscopic harvest of bladder mucosa for urethroplasty

Background: It is difficult to perform urethroplasty for recurrent hypospadia and/or urethral stricture. In the case of not enough prepuce, traditionally, the most often use free graft is “buccal mucosa” and “bladder mucosa”. The bladder mucosa for urethroplasty is harvested by means of open surgery. That is quite traumatic, and causes post-operation abdominal wall pain, big scar, and is difficult to repeat the procedure due to scaring. We harvested the bladder mucosa by means of intravesical laparoscopy for urethroplasty. This is minimal invasive, cause minimal post-operation abdominal wall pain and small scar, and the procedure is repeatable. And the result of the urethroplasty is good.

Methods: The 7 years old boy was admitted in to our ward in September, 2007, due to recurrent peno-scrotal junction urethral severe stricture about 5 mm in length, the fistula was proximal to the severe stricture, and the urethra distal to the severe stricture was mild stricture (can but not easy to put a 10 Fr catheter). There was no prepuce available the repair. We removed the 5 mm severe stricture, the fistula and repair the urethra with bladder mucosa harvested by means of intravesical laparoscopy, and put a 10 Fr silicon urethral catheter as a stent for 10 days. After operation, the urethra distal to the repaired zone became more stricture (can but difficult to put an 8 Fr catheter). So we repair the distal urethral stricture with bladder mucosa harvested by means of intravesical laparoscopy in July, 2008. And put a 12 Fr catheter as a stent. The intravesical laparoscopy procedure as the follow: general anesthesia, supine position. Open the distal narrow urethra with a longitudinal midline incision. Put a 12 Fr Foley catheter. Full fill the bladder with NS via the catheter. US confirm that no intestine between the abdominal wall and the bladder wall in the position of the cephalic end of bladder dome in the midline. Put a 5 mm trocar in this position for the lens. Then replace the NS in the bladder with CO₂. Put a 5 mm and a 3 mm trocar on the right and left side of the first trocar respectively under the guide with US and the lens. Submucosal injection of 10 mL NS on the left (the first time on the right) lateral bladder wall. Dissect the mucosa (the size as you need) from bladder wall, and remove it from the bladder via the 5 mm trocar. Then put suprapubic cystostomic catheter. And urethroplasty has been done with the mucosa. Put a 12 Fr urethral stent.

Results: The operation time for opening the narrow urethra, put Foley catheter, fill the bladder, US guide and intravesical laparoscopy harvest of the bladder mucosa need around 90 min. No complication during the operation. The urethral stent was removed 14 days after operation. The boy void well. 3 weeks after operation uroflowmetry showed max flow rate 14.5 mL/s, average flow rate 8.7 mL/s.

Conclusions: The short term result of the urethroplasty with the bladder mucosa harvested by intravesical laparoscopy is good, but need further follow up for the long term result. Anyway, “intravesical laparoscopy harvest of bladder mucosa” is minimal invasive, cause minimal post-operation abdominal wall pain and small scar, and is repeatable. It is safe and practicable.

Keywords: Laparoscopy; bladder; urethroplasty