Tissue Engineering and Reconstructive Surgery in Urology

Abstract

This review tries to cover not only all fields of tissue engineering (TE) and grafting in urology but also the ethical and legal aspects of the approaches [1]. Each of the topics deserves a review on its own merits. The legal aspects are increasingly important but there is a profound overlap to the political discussion. The clinicians who read European Urology and who are usually not involved in the development of TE approaches are more interested in the outcomes of TE and reconstructive surgery using grafts. Moreover, the judgement of the reviewer remains important to get focussed on the overwhelming literature. Unfortunately, the word count restrictions compromise the value of the review in the specific fields (eg, small intestine submucosa [SIS] grafting). In urethral reconstruction, for example, SIS was introduced for bladder and urethral reconstruction >12 yr ago from preclinical studies, but long-term data on follow-up have not been sufficiently reported [2]. From more classical approaches such as endoscopic urethrotomies and buccal mucosa grafting we know that the final judgement of the technique needs a follow-up of >3 yr [3–5]. Therefore, single case reports of an inferior outcome of SIS urethral grafting should not influence the view on this technique in 2007 [6]. Moreover, SIS grafting in children (mostly hypospadias repair) needs to be reviewed differently from the use of SIS in the reconstruction of recurrent strictures due to infection, surgery, or trauma in mostly elderly patients. In the same context, a review on the stem cell approaches in the treatment of stress urinary incontinence deserves a more detailed judgement