Surgical reconstruction of the urinary bladder is performed on patients of all ages for a diverse range of conditions, including congenital abnormalities, bladder dysfunction, trauma and cancer. The most common material utilized to augment or replace the bladder during these procedures is a segment of the patient's own intestine. However, this procedure (‘enterocytoplasty’) is associated with significant clinical complications that arise due to the exposure of the epithelial lining of the intestine to urine. A number of alternative approaches are being actively developed to find a practical and functional substitute for native bladder tissue. These range from ‘composite enterocystoplasty’, where the de-epithelialized intestine wall is lined with bladder epithelial cells that have been propagated in vitro, to augmenting the urinary system with natural or synthetic biomaterials that may incorporate in vitro-propagated cells. However, if tissue-engineered products are to have therapeutic application in bladder reconstruction, a number of issues remain to be addressed; these issues are discussed briefly below.
WuX. R.LinJ. H.WalzT.HänerM.YuJ.AebiU.SunT. T.Mammalian uroplakins. A group of highly conserved urothelial differentiation-related membrane proteins. J. Biol. Chem., 1994, 269, 13716–13724.
2.
LobbanE. D.SmithB. A.HallG. D.HarndenP.RobertsP.SelbyP. J.TrejdosiewiczL. K.SouthgateJ.Uroplakin gene expression by normal and neoplastic human urothelium. Am. J. Pathol., 1998, 153, 1957–1967.
ComerM. T.ThomasD. F. M.TrejdosiewiczL. K.SouthgateJ.Reconstruction of the urinary bladder by auto-augmentation, enterocystoplasty and composite enterocystoplasty. Adv. Exp. Medicine Biol., 1999, 462, 43–47.
5.
HuttonK. A.TrejdosiewiczL. K.ThomasD. F.SouthgateJ.Urothelial tissue culture for bladder reconstruction: An experimental study. J. Urol., 1993, 150, 721–725.
6.
SouthgateJ.HuttonK. A.ThomasD. F.TrejdosiewiczL. K.Normal human urothelial cells in vitro: Proliferation and induction of stratification. Lab. Invest., 1994, 71, 583–594.
7.
SouthgateJ.MastersJ. R.TrejdosiewiczL. K.Culture of human urothelium. In Culture of Epithelial Cells (Eds FreshneysR. I.FreshneyM. G.), 2002 (John Wiley, New York), pp. 381–399.
8.
ScrivenS. D.TrejdosiewiczL. K.ThomasD. F.M.SouthgateJ.Urothelial cell transplantation using biodegradable synthetic scaffolds. J. Mater. Sci.: Mater. Medicine, 2001, 12, 991–996.
9.
BoothC.HarndenP.TrejdosiewiczL. K.ScrivenS.SelbyP. J.SouthgateJ.Stromal and vascular invasion in an human in vitro bladder cancer model. Lab. Invest., 1997, 76, 843–857.
10.
SugasiS.LesbrosY.BissonI.ZhangY. Y.KuceraP.FreyP.In vitro engineering of human stratified urothelium: Analysis of its morphology and function. J. Urol., 2002, 164, 951–957.
11.
ScrivenS. D.BoothC.ThomasD. F.TrejdosiewiczL. K.SouthgateJ.Reconstitution of human urothelium from monolayer cultures. J. Urol., 1997, 158, 1147–1152.
12.
FraserM.ThomasD. F. M.TrejdosiewiczL. K.PittE.HarndenP.SouthgateJ.Composite cystoplasty with cultured urothelial cells (submitted for publication).
13.
OberpenningF.MengJ.YooJ. J.AtalaA.De novo reconstitution of a functional mammalian urinary bladder by tissue engineering. Nat. Biotechnol., 1999, 17, 149–155.
14.
ElbahnasyA. M.ShalhavA.HoenigD. M.FigenshauR.ClaymanR. V.Bladder wall substitution with synthetic and non-intestinal organic materials. J. Urol., 1998, 159, 628–637.
15.
van WachemP. B.van LuynM. J.Olde DaminkL. H.DijkstraP. J.FeijenJ.NieuwenhuisP.Biocompatibility and tissue regenerating capacity of crosslinked dermal sheep collagen. J. Biomed. Mater. Res., 1994, 28, 353–363.
16.
ChengE. Y.KroppB. P.Urologic tissue engineering with small-intestinal submucosa: Potential clinical applications. World J. Urol., 2000, 18, 26–30.
17.
SievertK. D.TanaghoE. A.Organ-specific acellular matrix for reconstruction of the urinary tract. World J. Urol., 2000, 18, 19–25.
18.
KroppB. P.SawyerB. D.ShannonH. E.RippyM. K.BadylakS. F.AdamsM. C.KeatingM. A.RinkR. C.ThorK. B.Characterization of small intestinal submu-cosa regenerated canine detrusor: Assessment of reinnervation, in vitro compliance and contractility. J. Urol., 1996, 156, 599–607.
19.
ReddyP. P.BarrierasD. J.WilsonG.BagliD. J.McLorieG. A.KhouryA. E.MerguerianP. A.Regeneration of functional bladder substitutes using large segment acellular matrix allografts in a porcine model. J. Urol., 2000, 164, 936–941.
20.
ProbstM.PiechotaH. J.DahiyaR.TanaghoE. A.Homologous bladder augmentation in dog with the bladder acellular matrix graft. BJU Int., 2000, 85, 362–371.
21.
KimB. S.BaezC. E.AtalaA.Biomaterials for tissue engineering. World J. Urol., 2000, 18, 2–9.
22.
SouthgateJ.HarndenP.SelbyP. J.ThomasD. F.M.TrejdosiewiczL. K.Urothelial tissue regulation: Unraveling the role of the stroma. Adv. Exp. Medicine Biol., 1999, 462, 19–30.
23.
GormarF. E.BerndA.Bereiter-HahnJ.HolzmannH.A new model of epidermal differentiation: Induction by mechanical stimulation. Arch. Dermatol. Res., 1990, 282, 22–32.
24.
GrinnellF.Fibroblasts, myofibroblasts, and wound contraction. J. Cell Biol., 1994, 124, 401–404.
25.
ShyyJ. Y.ChienS.Role of integrins in cellular responses to mechanical stress and adhesion. Curr. Opin. Cell Biol., 1997, 9, 707–713.
26.
BaskinL. S.MacarakE. J.DuckettJ. W.SnyderH. M.HowardP. S.Culture of urethral fibroblasts: Cell morphology, proliferation and extracellular matrix synthesis. J. Urol., 1993, 150, 1260–1266.
27.
CoplenD. E.HowardP. S.DuckettJ. W.SnyderH. M.MacarakE. J.Cultured bladder cells and their response to mechanical strain. Adv. Exp. Medicine Biol., 1995, 385, 207–214.
