ANAHEIM, Calif.—Tissue-engineered autologous bladder tissue shows promise in patients requiring cystoplasty, researchers reported here at the American Urological Association annual meeting.
Urologists in North Carolina enrolled seven patients with myelomeningocele (aged 4-19 years) who had high-pressure or poorly compliant bladders. A bladder biopsy was obtained six to seven weeks prior to scheduled surgery.
Urothelial and muscle cells were then grown in culture and seeded on a biodegradable bladder-shaped scaffold made of collagen or a composite of collagen and polyglycolic acid. Approximately seven weeks after the biopsy, the tissue was used for reconstruction and implanted with or without an omental wrap. The patients had a mean follow-up of 46 months.
Postoperatively, the mean bladder end-filling pressure decrease at capacity, volume increase, and compliance was greatest in the engineered bladders with an omental wrap (56%, 58%, and 2.79 fold, respectively), reported lead investigator Anthony Atala, MD, professor and chairman of the department of urology and director of the Institute for Regenerative Medicine at Wake Forest University in Winston-Salem, N.C.
Bladder compliance increased nearly 2.8-fold. Bowel function returned promptly after the surgery and no metabolic consequences were observed. In addition, urinary calculi did not form, mucus production was normal, and renal function was preserved.
Biopsies of the engineered bladder tissue showed adequate structural architecture and phenotype. “All patients have had an improvement in their quality of life. However, this work is still in progress. We are now expanding the trials, with the next phase including four centers in the U.S,” Dr. Atala said.