Abstract
Patients with spina bifida and a neurogenic bladder have traditionally been managed with clean intermittent catheterization and pharmacotherapy in order to treat abnormal bladder wall dynamics, protect the upper urinary tract from damage, and achieve urinary continence. However, some patients will fail this therapy and require surgical reconstruction in the form of bladder augmentation surgery using reconfigured intestine or stomach to increase the bladder capacity while reducing the internal storage pressure. Despite functional success of bladder augmentation in achieving a low pressure reservoir, there are several associated complications of this operation and patients do not have the ability to volitionally void. For these reasons, alternative treatments have been sought. Two exciting alternative approaches that are currently being investigated are tissue engineering and neuromodulation. Tissue engineering aims to create new bladder tissue for replacement purposes with both “seeded” and “unseeded” technology. Advances in the fields of nanotechnology and stem cell biology have further enhanced these tissue engineering technologies. Neuromodulation therapies directly address the root of the problem in patients with spina bifida and a neurogenic bladder, namely the abnormal relationship between the nerves and the bladder wall. These therapies include transurethral bladder electrostimulation, sacral neuromodulation, and neurosurgical techniques such as selective sacral rhizotomy and artificial somatic-autonomic reflex pathway construction. This review will discuss both tissue engineering techniques and neuromodulation therapies in more detail including rationale, experimental data, current status of clinical application, and future direction.
Highlights
When patients with spina bifida and a neurogenic bladder store urine under high pressure, upper tract deterioration and renal failure can occur necessitating the need for surgical reconstruction of the bladder
Much has been learned from the experience with bladder augmentation in terms of what can be done technically better in the operating room, it is generally accepted that while bladder augmentation provides the patient with an adequate urinary reservoir, this functional improvement is not risk-free and is associated with significant complications
Tissue engineering aims to regenerate new bladder tissue for augmentation purposes while neuromodulation attempts to alter the innervation of the neurogenic bladder to allow it to function in a more normal fashion
Summary
When patients with spina bifida and a neurogenic bladder store urine under high pressure, upper tract deterioration and renal failure can occur necessitating the need for surgical reconstruction of the bladder. Some of the complications of conventional enterocystoplasty include: infection, stone formation, intestinal obstruction, electrolyte imbalances, metabolic disturbances, bladder perforation, and possible tumor development. These potential complications demonstrate the need to investigate other management strategies for the neurogenic bladder found in patients with spina bifida. Tissue engineering aims to regenerate new bladder tissue for augmentation purposes while neuromodulation attempts to alter the innervation of the neurogenic bladder to allow it to function in a more normal fashion. Current advances in the areas of nanotechnology and stem cell biology aim to build on these initial successes to improve the degree of bladder regeneration that can be achieved
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
