Bioengineering solutions for ureteric disorders: clinical need, challenges and opportunities

Abstract

Objectives: To summarise the causes of ureteric damage and the current standard of care, discussing the risks and benefits of available therapeutic options. We then focus on the current and future solutions that can be provided by ureteric bioengineering and provide a description of the ideal characteristics of a bioengineered product.

Methods: We performed a literature search in February 2021 in: Google Scholar, Medline, and Web of Science. Three searches were conducted, investigating: (a) the epidemiology of ureteric pathology, (b) the current standard of care, and (c) the state of the art in ureteric bioengineering.

Results: The most-common causes of ureteric damage are iatrogenic injury and external trauma. Current approaches to treatment include stent placement or surgical reconstruction. Reconstruction can be done using either urological tissue or segments of the gastrointestinal tract. Limitations include scarring, strictures, and infections. Several bioengineered alternatives have been explored in animal studies, with variations in the choice of scaffold material, cellular seeding populations, and pre-implantation processing. Natural grafts and hybrid material appear to be associated with superior outcomes. Furthermore, seeding of the scaffold material with stem cells or differentiated urothelial cells allows for better function compared to acellular scaffolds. Some studies have attempted to pre-implant the graft in the omentum prior to reconstruction, but this has yet to prove any definitive benefits.

Conclusion: There is an unmet clinical need for safer and more effective treatment for ureteric injuries. Urological bioengineering is a promising solution in preclinical studies. However, substantial scientific, logistic, and economic challenges must be addressed to harness its transformative potential in improving outcomes.

Keywords: #UroTrauma; #Urology; Ureteric injury; bioengineered solution; tissue engineering; ureteric reconstruction.

Fig. 1

Epidemiology of ureteric injury. Iatrogenic injury comprises the primary causes of ureteric damage, being implicated in 75–90% of cases. Of these, most injuries are inflicted during major gynaecological surgery. [Colour figure can be viewed at wileyonlinelibrary.com]

Fig. 2

Surgical reconstruction of ureteric injury. The first surgical step is excision of affected tissue (A and B). Subsequently, depending on the site and location of the damage, either direct UU (C), or TUU (D), or UNC (E) are performed. UNC is usually performed with a Psoas hitch and/or Boari flap technique (not shown) when involving the distal segment of the ureter. [Colour figure can be viewed at wileyonlinelibrary.com]

Fig. 3

Characteristics of the ideal bioengineered product. The ideal solution should be biologically compatible, easily, and cost‐effectively manufactured, and technically easy to utilise. [Colour figure can be viewed at wileyonlinelibrary.com]

Fig. 4

Methods of construction of a ureteric bioengineered product. Synthetic, natural or hybrid scaffolds can be seeded with autologous or allogeneic cells that may be derived from stem cells or primary cells. The advantages and disadvantages of each approach are summarised in green and red text respectively. [Colour figure can be viewed at wileyonlinelibrary.com]