Use of Free Peritoneal and Bladder Mucosal Grafts as Ureteral Mucosa Substitutes for Management of Avulsion of the Ureteral Mucosa in a Dog Model

摘要

Background and Purpose: Avulsion of the ureteral mucosa is one of the most serious complications ofnureteroscopy and considered challenging for urologic surgeons. In this study, we developed two novel methodsnto reconstruct the impaired ureter.nMaterials and Methods: After ureteral mucosal avulsion in a canine model, ureteral reconstruction was performednin one of three ways: free tabularized peritoneal grafts (group A, n u0002 6); bladder mucosal graftsn(group B, n u0002 6); or simple stenting technique (control group [n u0002 3]). At postoperative week 10, evaluationnwith intravenous urography (IVU) was followed by harvesting of reconstructed ureter segments for pathologicnanalysis.nResults: IVU showed nonvisualization of the collecting system of the affected side and histologic evaluationnshowed imperforation or stenosis in all animals in the control group. IVU showed good visualization of thenreconstructed ureter without stenosis in group A and in most animals in group B. There was a mild dilationnbut no obvious stenosis in one animal in group B. Microscopically, all the reconstructed ureteral lumens werenuniformly lined with transitional epithelium. Extensive neovascularity was evident in the subepithelial layernwith a streaming of fibroblasts toward the neomucosa.nConclusion: Replacing the avulsed mucosa in the injured ureter with tubularized peritoneal free grafts ornbladder mucosal grafts may be an optimal method to manage avulsion of the ureteral mucosa.