Novel Utilization of Hydro-Dissection and Thulium Fiber Laser to Endoscopically Harvest Bladder Mucosal Graft for Urethral Reconstruction: Step-By-Step Video Guide

Document Type

Conference Proceeding

Publication Date

5-2025

Publication Title

Journal of Urology

Abstract

INTRODUCTION AND OBJECTIVE: Bladder mucosa has optimal tissue characteristics for urethral reconstruction and endoscopic methods for harvesting bladder mucosa utilizing Holmium laser and hybrid water-knife have been described in the literature. We present a step-by-step video guide of a novel technique for harvesting bladder mucosa for urethral reconstruction utilizing hydro-dissection and the Thulium Fiber Laser (TFL) in a cadaveric model. METHODS: A single fresh female cadaver was placed in dorsal lithotomy and the bladder was entered with a continuous flow 27 Fr outer diameter rigid laser cystoscope. A 14.6 inch, 21 gauge sidekick injection needle and 30 cc of sterile saline was used to hydro-dissect the posterior bladder mucosa off the detrusor muscle. A 550-micron TFL fiber was used to harvest a rectangle of mucosa off the posterior bladder wall. A flexible grasper was used in parallel to the laser fiber to assist in graft manipulation. The graft was retrieved and prepared on the back table in the standard fashion. RESULTS: A 2 cm x 6 cm bladder mucosal graft was successfully harvested in under 17 minutes by a single surgeon without an assistant. Minimal char was appreciated along only the short edges of the mucosa. Optimal TFL laser settings used were 1 J x 10 Hz (10 W). Operative steps reviewed include hydro-dissection, laser settings, laser technique, flexible grasper manipulation, retrieval technique, and graft preparation. CONCLUSIONS: Endoscopic harvesting of bladder mucosal graft for urethral reconstruction is possible by hydro-dissection followed by graft excision using the Thulium Fiber Laser (TFL). This is a rapid procedure that can be done by a single surgeon without an assistant. This technique provides an excellent bladder mucosal graft that can be used for urethral reconstruction, obviating the need to harvest buccal mucosa. There are several potential benefits to using bladder mucosa including it being similar to urethral mucosa, large grafts can be harvested for long strictures, and avoids the pain associated with a buccal graft harvest. Further studies are needed to confirm these results in a clinical setting.

Volume

213

Issue

5S

First Page

e57

Last Page

e57

Comments

American Urological Association Annual Meeting, April 26-29, 2025, Las Vegas, NV

DOI

10.1097/01.JU.0001109724.97610.92.07

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