Tissue-engineered autologous bladders for patients needing cystoplasty.
BACKGROUND
Patients with end-stage bladder disease can be treated with cystoplasty using gastrointestinal segments. The presence of such segments in the urinary tract has been associated with many complications. We explored an alternative approach using autologous engineered bladder tissues for reconstruction.


METHODS
Seven patients with myelomeningocele, aged 4-19 years, with high-pressure or poorly compliant bladders, were identified as candidates for cystoplasty. A bladder biopsy was obtained from each patient. Urothelial and muscle cells were grown in culture, and seeded on a biodegradable bladder-shaped scaffold made of collagen, or a composite of collagen and polyglycolic acid. About 7 weeks after the biopsy, the autologous engineered bladder constructs were used for reconstruction and implanted either with or without an omental wrap. Serial urodynamics, cystograms, ultrasounds, bladder biopsies, and serum analyses were done.


RESULTS
Follow-up range was 22-61 months (mean 46 months). Post-operatively, the mean bladder leak point pressure decrease at capacity, and the volume and compliance increase was greatest in the composite engineered bladders with an omental wrap (56%, 1.58-fold, and 2.79-fold, respectively). Bowel function returned promptly after surgery. No metabolic consequences were noted, urinary calculi did not form, mucus production was normal, and renal function was preserved. The engineered bladder biopsies showed an adequate structural architecture and phenotype.


CONCLUSIONS
Engineered bladder tissues, created with autologous cells seeded on collagen-polyglycolic acid scaffolds, and wrapped in omentum after implantation, can be used in patients who need cystoplasty.
Atala
Anthony
A
Department of Urology and Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. aatala@wfubmc.edu
Bauer
Stuart B
SB
Soker
Shay
S
Yoo
James J
JJ
Retik
Alan B
AB
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003558:Cystoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008591:Meningomyelocele / Q000150:complications; D011184:Postoperative Period; D023822:Tissue Engineering / Q000379:methods*; D001745:Urinary Bladder Diseases / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*