Abstract
SummaryBladder augmentation is a demanding surgical procedure and exclusively offered for selected children and has only a small spectrum of indications. Paediatric bladder voiding dysfunction occurs either on a basis of neurological dysfunction caused by congenital neural tube defects or on a basis of rare congenital anatomic malformations. Neurogenic bladder dysfunction often responds well to a combination of specific drugs and/or intermittent self-catheterization. However, selected patients with spinal dysraphism and children with congenital malformations like bladder exstrophy and resulting small bladder capacity might require bladder augmentation. Ileocystoplasty is the preferred method of bladder augmentation to date. Because of the substantial long-and short-term morbidity of augmentation cystoplasty, recent studies have tried to incorporate new techniques and technologies, such as the use of biomaterials to overcome or reduce the adverse effects. In this regard, homografts and allografts have been implemented in bladder augmentation with varying results, but recent studies have shown promising data in terms of proliferation of urothelium and muscle cells by using biological silk grafts.
Highlights
Loss or malfunction of the lower urinary tract may cause urinary incontinence and chronic renal failure
Modern treatment of lower urinary tract dysfunctions consists of clean intermittent catheterization, medical treatment and surgical reconstruction
In this article we review various conditions and surgical options, and highlight new concepts for the use of biomaterials and tissue engineering in the field of urinary bladder reconstruction
Summary
Loss or malfunction of the lower urinary tract may cause urinary incontinence and chronic renal failure. The most common underlying conditions are spinal dysraphism (spina bifida), congenital malformations (exstrophy-epispadias complex, cloacal malformations) and trauma. Modern treatment of lower urinary tract dysfunctions consists of clean intermittent catheterization (as proposed by Lapides in 1972 [1]), medical treatment (anticholinergic medication and botulinum toxin A [2, 3]) and surgical reconstruction (augmentation cystoplasty, creation of a catheterizable conduit [4, 5]). In this article we review various conditions and surgical options, and highlight new concepts for the use of biomaterials and tissue engineering in the field of urinary bladder reconstruction
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