Tissue Engineered Oral Mucosa for Urethroplasty: Past Experience and Future Directions

IN this issue of the Journal Mikami et al (page 1882) describe the fabrication of tissue engineered (TE) oral mucosa. The use of TE oral mucosa provides a means of reducing the morbidity of the procedure in patients with lengthy strictures, for which large amounts of graft are required for augmentation or substitution urethroplasty. Clearly any such graft material must have cellular line stability and adequate intrinsic strength, acquire an adequate blood supply, and prove to be durable and resistant to fibrosis. In addition, the graft cellular type should be resistant to any underlying disease process such as lichen sclerosis, as is seen with oral mucosa. In particular it is important to keep in mind that the underlying disease process seen with true strictures compared to traumatic injuries of the urethra is one of ischemic spongiofibrosis. Therefore, the underlying graft bed is sometimes far from optimal and, thus, difficult to duplicate in an experimental setting by producing an acute urethral injury. Nevertheless, we acknowledge the importance of animal models such as that reported by Mikami et al.