Abstract
Current approaches for bladder reconstruction surgery are associated with many morbidities. Tissue engineering is considered an ideal approach to create constructs capable of restoring the function of the bladder wall. However, many constructs to date have failed to create a sufficient improvement in bladder capacity due to insufficient neobladder compliance. This review evaluates the biomechanical properties of the bladder wall and how the current reconstructive materials aim to meet this need. To date, limited data from mechanical testing and tissue anisotropy make it challenging to reach a consensus on the native properties of the bladder wall. Many of the materials whose mechanical properties have been quantified do not fall within the range of mechanical properties measured for native bladder wall tissue. Many promising new materials have yet to be mechanically quantified, which makes it difficult to ascertain their likely effectiveness. The impact of scaffold structures and the long-term effect of implanting these materials on their inherent mechanical properties are areas yet to be widely investigated that could provide important insight into the likely longevity of the neobladder construct. In conclusion, there are many opportunities for further investigation into novel materials for bladder reconstruction. Currently, the field would benefit from a consensus on the target values of key mechanical parameters for bladder wall scaffolds.
Highlights
IntroductionMultiple conditions can affect normal bladder function, including cancer (400 million people worldwide [1]), neurogenic conditions, radiation injury, intractable incontinence and congenital anomalies [2,3]
This review aims to evaluate the mechanical properties of the bladder wall and how the current research on materials used in bladder bioengineering has addressed these biomechanical challenges
Many conditions can affect bladder function which are currently treated using bladder reconstruction surgery [2,3]. These interventions aim to restore urine storage and voiding function often by implanting ileal segments into the bladder wall. These surgeries are associated with co-morbidity that significantly lowers the quality of life of the affected person [2,6]
Summary
Multiple conditions can affect normal bladder function, including cancer (400 million people worldwide [1]), neurogenic conditions, radiation injury, intractable incontinence and congenital anomalies [2,3] The treatment of these disorders includes interventions by partial (augmentation cystoplasty) or whole bladder (neobladder) reconstruction in order to regain urine storage and voiding functions. Gastrointestinal segments obtained from the patient during the surgery are used While this approach offers many advantages, such as the easy formation of hollow structures, pre-vascularization of the tissue and autologous origin [5], there are many disadvantages. These are caused mainly by the intestine metabolite reabsorption and mucous secretion [6] contributing to urinary tract infection, bladder perforation, carcinogenesis and many others [2,3,7]
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