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Urethral defects may result from trauma, infection, medical or surgical procedures, or congenital abnormalities. They may be difficult to repair, with varying results. Researchers in the USA and Mexico (Lancet 2011; 377:1175–82 see also Comment, ibid: 1130–1) have had complete success in reconstructing the urethras of five boys aged 10–16 years in Mexico City for defects due to urethral trauma. Muscle and epithelial cells were expanded from tissue biopsies from each patient and seeded onto a tubularised scaffold. Urethral reconstruction was performed using the tissue-engineered tubularised urethras. Follow- up ranged from 36 to 76 months and urethral biopsies were taken at 3, 12, and 36 months. The presence of epithelial and muscle lineages in the reconstructed urethra was confirmed in all cultured biopsies. Each patient had adequate urinary flow and repeated radiography and endoscopy confirmed the maintenance of wide urethral calibres without strictures. Satisfactory function was maintained on follow-up for up to 6 years.
The focusing of attention on mortality in children under the age of 5 years has perhaps resulted in inadequate attention to the problems of older children, adolescents, and young adults. Now (Lancet 2011;377:1162–74; see also Comment, ibid:1128–30) mortality data from 50 countries for people aged 1–24 years over the period 1955–2004 have been presented. Over this 50-year period, in OECD, Central and South America and other countries, overall …