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TO CROSS-LINK OR NOT TO CROSS-LINK?
THAT IS THE QUESTION
Anna RADFORD, Alexander TURNER, Junaid ASHRAF
and Ramnath SUBRAMANIAM
Leeds Childrens Hospital, Department of Paediatric Urology, Leeds, UNITED KINGDOM
PURPOSE
Acellular matrices (ACMs) may provide a potential strategy for complex hypospadias management.
We report our experience in patients who had ACMs used as a peri-urethral splint as part of com-
plex urethral reconstruction.
MATERIAL AND METHODS
From 2008-2016, 48 boys underwent urethral reconstruction using ACMs; 24 cross-linked porcine
dermal ACMs (XACMs) (median age 5.34 years (range 1.9-15.5)) and 24 had human non-
crosslinked dermal ACMs (NXACMs) (median age 5.5 years (range 2.8-18 years)). Prospective
outcome data was collected including complications and uroflowmetry.
RESULTS
All 48 boys made a good initial recovery. Median follow-up was 35.4 months (17-58 months)
in XACMs and 6 months (1-24 months) in the NXACM patients. Two complications occurred in
XACMs: removal of graft for infection; another skin-tethering. Two children developed fistulae
proximal to the graft in the NXAXMs secondary to proven infection. One further child developed
a tiny fistula proximal to the repair, which resolved spontaneously. None of the XACM developed
fistulae or late complications.
Uroflowmetry was performed in 17/24 XACM patients: QMax (r= 0.56, p=0.018) and average flow
(r=0.52, p=0.03) correlated with age. Ten children had uroflowmetry in the NXACMs demonstrating;
bell-shaped curves (10/10), good flow (10/10), no residual volume (10) and mean QMax = 9.6 ml/
sec (± 2.65). Statistical correlation was not performed due to small number of uroflow studies.
Failure to perform uroflowmetry in 22 children was due to; recent surgery (n =14) not toilet trained
(n = 4) and failure to attend clinic (n=4).
CONCLUSIONS
These results support the use of periurethral ACMs as a splint in complex and redo-urethroplasty.
Further work is required to formally assess ACMs and long-term clinical follow-up clinically needs
to be acquired.