Reconstructive Urology Tissue-Engineered Buccal Mucosa Urethroplasty—Clinical Outcomes Saurabh Bhargava a,b , Jacob M. Patterson a,b , Richard D. Inman a , Sheila MacNeil b , Christopher R. Chapple a, * a Section of Reconstruction, Urodynamics and Female Urology, Royal Hallamshire Hospital, Sheffield, UK b Department of Engineering Materials and Division of Biomedical Sciences and Medicine, The Kroto Research Institute, North Campus, University of Sheffield, Sheffield, UK european urology 53 (2008) 1263–1271 available at www.sciencedirect.com journal homepage: www.europeanurology.com Article info Article history: Accepted January 21, 2008 Published online ahead of print on February 4, 2008 Keywords: Balanitis xerotica obliterans Buccal mucosa Lichen sclerosus Oral mucosa Substitution urethroplasty Tissue engineering Urethroplasty Abstract Introduction: Whilst buccal mucosa is the most versatile tissue for urethral replacement, the quest continues for an ideal tissue replacement for the urethra when substantial tissue transfer is needed. Previously we described the development of autologous tissue-engineered buccal mucosa (TEBM). Here we report clinical outcomes of the first human series of its use in substitution urethroplasty. Methodology: Five patients with urethral stricture secondary to lichen scler- osus (LS) awaiting substantial substitution urethroplasty elected to undergo urethroplasty using TEBM, with full ethics committee support. Buccal mucosa biopsies (0.5 cm) were obtained from each patient. Keratinocytes and fibroblasts were isolated and cultured, seeded onto sterilised donor de- epidermised dermis, and maintained at air–liquid interface for 7–10 d to obtain full-thickness grafts. These grafts were used for urethroplasty in a one-stage (n = 2) or a two-stage procedure (n = 3). Follow-up was performed at 2 and 6 wk, at 3, 6, 9, and 12 mo, and every 6 mo thereafter. Results: Follow-up ranged from 32 to 37 mo (mean, 33.6). The initial graft take was 100%, as assessed by visual inspection. Subsequently, one patient had complete excision of the grafted urethra and one required partial graft excision, for fibrosis and hyperproliferation of tissue, respectively. Three patients have a patent urethra with the TEBM graft in situ, although all three required some form of instrumentation. Conclusions: Whilst TEBM may in the future offer a clinically useful auto- logous urethral replacement tissue, in this group of patients with LS urethral strictures, it was not without complications, namely fibrosis and contraction in two of five patients. # 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved. * Corresponding author. Section of Reconstruction, Urodynamics and Female Urology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK. Tel. +44 0114 2712559; Fax: +44 0114 2798318. E-mail address: c.r.chapple@shef.ac.uk (C.R. Chapple). 0302-2838/$ – see back matter # 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.eururo.2008.01.061