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Bladder

  • Yun-Sok HaEmail author
  • Tae Gyun Kwon
Chapter
  • 794 Downloads

Abstract

Repair and reconstruction of damaged tissues and organs has been a major issue in the medical field. Since regenerative medicine and tissue engineering are proposed as a novel technique that can overcome current autologous transplantation or allograft, almost every urologic tissue and organ has been studied. And bladder regeneration has been focused as a potential organ of the translation into clinical application of this technology, in the near future. Cystectomy is most commonly performed to treat invasive cancer of the bladder. However, intestinal cystitis, congenital abnormalities, trauma, and infection can also require bladder reconstructive surgery. When radical cystectomy is required as treatment, the most common approach in clinical practice is enterocystoplasty (bladder reconstruction using intestinal segment). However, enterocystoplasty is associated with numerous complications not only significant morbidity of operation but also metabolic abnormalities that result from absorptive function and mucus secretion properties of the intestine.

Tissue engineering approaches offer innovative options for bladder reconstruction using biomaterials supplemented with cells and/or growth factors. Scaffolds made from molecularly defined biomaterials are instrumental in tissue regeneration; however, the search for suitable materials for bladder reconstruction has been a challenge. In addition, the effect of seeding/preseeding tissue-engineered constructs in bladder reconstruction is also a subject of debate, and different groups have reported the advantageous effects of adding cellular components. The currently favored approach for tissue engineering of the urinary bladder involves seeding acellular matrices with autologous bladder-derived smooth muscle and urothelial cells. A distinct advantage of this approach is the use of autologous cells, which circumvents the need for immunosuppression that is required with allogeneic transplantation. However, an alternative cell source would be enormously beneficial as it would increase the clinical applicability of this approach. An ideal stem cell source for bladder repair would (1) be capable of high efficiency differentiation into functional urothelial cells, endothelial cells, and peripheral neurocytes (which promote bladder contractility and compliance and restore histological structures with innate vasculature and innervation); (2) allow collection via a simple, noninvasive, safe, low-cost method; (3) have universal or “off-the-shelf” availability; and (4) generate urinary tract tissue-specific or organ-specific stem cells. Currently, it is unknown whether such “perfect” stem cells exist; however, harvest of human bladder muscle and urothelial cells with subsequent outgrowth may be useful for tissue replacement in genitourinary reconstruction. Tissue-engineered bladders would likely be functionally superior alternatives to enteric urinary diversions, which are currently used to reconstruct the genitourinary tract, and offer great promise to patients. However, a number of barriers must be overcome before this technology can be successfully integrated into clinical practice. This technology may become the preferred method for bladder tissue reconstruction and replace the current methods using gastrointestinal tissues.

Keywords

Regenerative medicine Urinary bladder Tissue engineering 

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Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of Urology, School of MedicineKyungpook National UniversityDaeguSouth Korea

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