Tissue formation following implantation of cultured elastic chondrocytes for treatment of vesicoureteral reflux

Abstract

Vesicoureteral reflux (VUR) is the retrograde passage of urine from the bladder into the ureter and kidneys during voiding. Its pathophysiology appears to be related to the valve mechanism of the ureterovesical junction, high intravesical pressure, bladder neurogenic disorder or immature bladder. Abnormal location of the ureteral orifice is implicated in the short ureteral tunnel, which in turn compromises the flap-valve mechanism. Endoscopic subureteric injection of various materials has become a universally accepted mode of treatment for VUR in recent years. Different kinds of injection materials have been used for injection with various success rates [1–3]. Tissue engineering is an interdisciplinary field that applies the principles of engineering and life sciences to the development of biological substitutes that restore, maintain or improve the function of tissue or of a whole organ [4]. Treatment of VUR by endoscopic implantation of cultured autologous elastic chondrocytes (ACI—autologous chondrocyte implantation) under the ureteral orifice—a method based on tissue engineering technologies—has proved to be successful in eliminating or downgrading high-grade VUR and has enabled surgical treatment to be abandoned in paediatric patients [5]. We have developed a method for implantation of cultured elastic chondrocytes, together with the patient’s autologous plasma, for treating VUR in patients with chronic renal failure who are candidates for renal transplantation [6]. The effectiveness of cell implantation for VUR treatment is usually evaluated by X-ray contrast cystography, but it is normally not possible to investigate the quality of regenerated tissue. In the present case we were able to in-