Tissue-engineered autologous bladders for patients needing cystoplasty.
Level 4 - case-series / case-control
Prospective uncontrolled case series.
PubMed 16631879 · doi:10.1016/S0140-6736(06)68438-9
What was done
Seven patients aged 4–19 years with myelomeningocele and high-pressure or poorly compliant bladders underwent bladder biopsy to harvest urothelial and muscle cells. Cells were expanded in culture and seeded onto biodegradable scaffolds (collagen alone or collagen-polyglycolic acid composite). Approximately 7 weeks after biopsy, autologous constructs were implanted for cystoplasty reconstruction with or without an omental wrap. Outcomes were monitored over 22–61 months (mean 46 months) using serial urodynamics, cystograms, ultrasounds, biopsies, and serum analyses.
What was found
The greatest functional gains occurred in composite engineered bladders with an omental wrap, demonstrating a 56% decrease in mean bladder leak point pressure at capacity, a 1.58-fold increase in volume, and a 2.79-fold increase in compliance. Bowel function resumed promptly, renal function remained preserved, and no metabolic abnormalities, calculi, or abnormal mucus occurred. Biopsies showed adequate structural architecture and phenotype.
Why it matters
This first-in-human study demonstrated the feasibility of using lab-grown, autologous cell-seeded scaffolds to reconstruct diseased bladders, offering a potential alternative to gastrointestinal cystoplasty and its associated complications.
Limits
The study is a very small, uncontrolled case series (n = 7) with heterogeneous interventions (varied scaffold compositions and use of omental wraps). Detailed statistical variance and long-term durability comparisons against standard enteric augmentation were not evaluated.
Cited by
- supports Anthony Atala has engineered organs including the bladder, urethra, and esophagus, as well as full-thickness skin for transplantation using stem cells.