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MP41-09: Adipose-derived stromal vascular factor (SVF) injection in short recurrent bulbar stricture post DVIU – An initial experience

Saturday, May 13
3:30 PM - 5:30 PM
Location: BCEC: Room 156

Presentation Authors: Pankaj Joshi*, Fabio Castiglione, Devang Desai, Sandesh Surana, Hazem Orabi, Sanjay Kulkarni, Pune, India

Introduction:
A recent study showed that adipose-derived stem cells are able to counteract urethral stricture formation in rats. The aim of this study was to evaluate the feasibility of autologous adipose derived stromal vascular fraction (SVF) transplantation into male urethra stricture walls after direct vision incision of urethra (DVIU).


Methods: A prospective clinical study was undertaken after ethics approval and appropriate patient consent. The inclusion criteria were: male patients older than 18 years, with single short recurrent not-obliterating urethral stricture (<2 cm). The exclusion criteria were: patients not willing to consent, multiple strictures and those not deemed suitable for endoscopic management. Failure was defined as need for further interventions.
Preoperative workup included history, examination, retrograde urethrogram (RGU), voiding cystourethrogram (VCUG), urine culture, renal function tests, AUA score, IIEF, PROM. Plastic surgery team performs liposuction to extract 50 mls of fat from the patient’s abdominal wall. 50ml fat-SVF was obtained using a Goog Manufacturing Practice collagenase (Celase®, Cytori Therapeutics, San Diego, USA) according to a standard protocol. SVF was diluted in 5 ml saline solution for the injection.
A cystoscopy was performed and the stricture evaluated, a glide wire was placed and an urethrotomy performed at 6 o’clock position in bulbar urethra. Gide wire was left in situ. The SVF solution was injected at the site of the stricture and on either side of the stricture. A 12 Fr urinary catheter was placed. The urinary catheter was removed after 24 hrs. Follow up was of 3.5 months.


Results: Two patients were included in the study. The main characteristics are reported in table 1. No local or systemic side effects or complications were recorded. No recurrence of urethral stricture was detected in both patients after 3.5 months.
Table 1

Conclusions: This is the first study to demonstrate a successful autologous SVF transplantation in male urethral stricture after DVIU. Further studies are necessary to confirm the efficacy of SVF in preventing urethral stricture recurrence.

Source Of Funding: None

Pankaj Mangalkumar Joshi, MD

Kulkarni Reconstructive Urology Centre

Greetings to all from across the world.
I am Dr Pankaj M Joshi,Reconstructive Urologist at Kulkarni Reconstructive Urology Center,Pune,India
I have been trained by Dr Sanjay Kulkarni and work under him at his Institute.
Dr Sanjay Kulkarni is my GURU and Mentor
With his able guidance i am progressing each day ahead in Reconstructive Urology.
My interest is Management of Hypospadias (Especially failed and cripple),Chordee correction,Complex Urethroplasty and Pelvic frcature Urethral Injury.
In our institte we get complex referrals from across the world and this has widened my exposure to urethra.
I am happy to meet many Reconstructive Urologists who vsist us and make friendship.
Its my honour to be nominated to the Board of Directors of GURS and i wish to fuifil my duties to the best of my ability.
I place Patients and academic Society ahead of my personal wishes and ambitions and wish to do the same forever .
There are many diseases in urology which vary from continents but Stricture has similar pattern across the globe.
We need to move towards drafting uniform guidelines for management of stricture
Divided by Nations,United by Reconstruction......

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MP41-09: Adipose-derived stromal vascular factor (SVF) injection in short recurrent bulbar stricture post DVIU – An initial experience



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