Abstract
End-stage neurogenic bladder usually results in the insufficiency of upper urinary tract, requiring bladder augmentation with intestinal tissue. To avoid complications of augmentation cystoplasty, tissue-engineering technique could offer a new approach to bladder reconstruction. This work reviews the current state of bioengineering progress and barriers in bladder augmentation or reconstruction and proposes an innovative method to address the obstacles of bladder augmentation. The ideal tissue-engineered bladder has the characteristics of high biocompatibility, compliance, and specialized urothelium to protect the upper urinary tract and prevent extravasation of urine. Despite that many reports have demonstrated that bioengineered bladder possessed a similar structure to native bladder, few large animal experiments, and clinical applications have been performed successfully. The lack of satisfactory outcomes over the past decades may have become an important factor hindering the development in this field. More studies should be warranted to promote the use of tissue-engineered bladders in clinical practice.
Highlights
The clinical manifestation of urinary incontinence or upper urinary tract impairment due to gradual decline in bladder function can be caused by congenital and acquired conditions [1]
The results indicated that muscle-derived cells (MDCs) migrated throughout small intestine submucosa (SIS), which developed to muscle layers, and the areal strain of MDCsSIS were significantly increased compared with SIS alone
The study results suggested that all bladder wall components involving urothelial cells (UCs) and smooth muscle cells (SMCs) facilitated bladder acellular matrix (BAM) scaffold ingrowth and obtained normal bladder capacities
Summary
The clinical manifestation of urinary incontinence or upper urinary tract impairment due to gradual decline in bladder function can be caused by congenital and acquired conditions [1] (such as bladder exstrophy, neurogenic bladder, and malignancies). The augmentation or replacement of bladder with intestinal tissue is the gold standard method for end-stage neurogenic bladder with upper urinary tract damage [2] Various complications, such as metabolic disturbance, mucus production, urolithiasis, infections [3], and even malignancy [4], are associated with bladder augmentation with intestinal tissue. Tissue-engineering technology could provide novel treatment options for bladder augmentation by regenerating epithelium and muscle using a variety of biomaterial scaffolds, along with autologous, or allogeneic cells and growth factors. This approach might lead to the regeneration of partial bladder tissue or construction of a neo-bladder [5]. We highlighted the current problems of bioengineered bladders and suggested future research directions of bioengineering approaches for bladder augmentation and reconstruction
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