Current status of tissue engineering applied to bladder reconstruction in humans

Abstract

Context and objective: Bladder reconstruction is performed to replace or expand the bladder. The intestine is used in standard clinical practice for tissue in this procedure. The complications of bladder reconstruction range from those of intestinal resection to those resulting from the continuous contact of urine with tissue not prepared for this contact. In this article, we describe and classify the various biomaterials and cell cultures used in bladder tissue engineering and reviews the studies performed with humans.

Acquisition of evidence: We conducted a review of literature published in the PubMed database between 1950 and 2017, following the principles of the PRISM declaration.

Synthesis of the evidence: Numerous in vitro and animal model studies have been conducted, but only 18 experiments have been performed with humans, with a total of 169 patients. The current evidence suggests that an acellular matrix, a synthetic polymer with urothelial and autologous smooth muscle cells attached in vitro or stem cells would be the most practical approach for experimental bladder reconstruction.

Conclusions: Bladder replacement or expansion without using intestinal tissue is still a challenge, despite progress in the manufacture of biomaterials and the development of cell therapy. Well-designed studies with large numbers of patients and long follow-up times are needed to establish an effective clinical translation and standardisation of the check-up functional tests.

Keywords: Artificial bladder; Artificial urinary diversion; Biomaterial vesical; Bladder biomaterial; Bladder engineering; Derivación urinaria artificial; Experimental bladder reconstruction; Ingeniería vesical; Reconstrucción vesical experimental; Vejiga artificial.