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Vol. 42. Issue 7.
Pages 435-441 (September 2018)
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Vol. 42. Issue 7.
Pages 435-441 (September 2018)
Review article
DOI: 10.1016/j.acuroe.2018.06.001
Current status of tissue engineering applied to bladder reconstruction in humans
Estado actual de la ingeniería tisular aplicada a la reconstrucción vesical en humanos
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C. Gasanz
Corresponding author
carlosgasa@gmail.com

Corresponding author.
, C. Raventós, J. Morote
Servicio de Urología, Hospital Universitario Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Table 1. Types of natural derivatives most used.
Table 2. Types of most used acellular matrices.
Table 3. Types of synthetic polymers most used.
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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 OR a synthetic polymer with urothelial and autogenous smooth muscle cells 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, long follow-up times and standardisation of the check-up functional tests are needed to establish an effective clinical translation.

Keywords:
Experimental bladder reconstruction
Bladder biomaterial
Bladder engineering
Artificial bladder
Artificial urinary diversion
Resumen
Contexto y objetivo

La reconstrucción vesical es el procedimiento para sustituir o ampliar la vejiga, siendo el intestino el tejido utilizado en la práctica clínica habitual. Las complicaciones de su uso van desde las propias de una resección intestinal hasta las resultantes del contacto continuo de la orina con un tejido no preparado para ello. En este artículo se describen y clasifican los diferentes biomateriales y cultivos celulares utilizados en la ingeniería tisular vesical y se revisan los estudios realizados en humanos.

Adquisición de la evidencia

Se ha realizado una revisión de la literatura publicada en la base Pubmed entre 1950 y 2017, siguiendo los principios de la declaracion PRISMA.

Síntesis de la evidencia

Se han realizado múltiples estudios in vitro y en modelo animal, pero solo se han realizado 18 experimentos en humanos, con un total de 169 pacientes. La pruebas actuales indican que utilizar una matriz acelular o bien un polímero sintético y adherirle in vitro células uroteliales y musculares lisas autógenas, o bien células madre, sería la aproximación más realista para realizar una reconstrucción vesical experimental.

Conclusiones

La sustitución o ampliación vesical sin utilizar intestino continúa siendo hoy un reto, a pesar del progreso en la fabricación de biomateriales y del desarrollo de la terapia celular. Para plantear una traslación clínica efectiva será necesario en el futuro realizar estudios bien diseñados, con mayor número de pacientes y tiempo de seguimiento, además de estandarizar las pruebas funcionales de control.

Palabras clave:
Reconstrucción vesical experimental
Biomaterial vesical
Ingeniería vesical
Vejiga artificial
Derivación urinaria artificial

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