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Pediatric Surgery International

Published in:

01-04-2012 | Original Article

Bladder augmentation using acellular collagen biomatrix: a pilot experience in exstrophic patients

Authors: Paolo Caione, Renata Boldrini, Annamaria Salerno, Simona Gerocarni Nappo

Published in: Pediatric Surgery International | Issue 4/2012

Abstract

Purpose

A preliminary experience on in vivo bladder wall regeneration in a subset of patients born with exstrophy–epispadias complex is reported. The objective was to improve bladder capacity and compliance without bowel augmentation.

Methods

Five patients (3 males, 2 females), mean age 10.4 years, presenting poor bladder capacity and compliance after complete exstrophy repair, underwent bladder augmentation using small intestinal submucosa (SIS) scaffold. Ultrasonography, cystoscopy with cystogram, assessment of bladder volume and compliance and bladder biopsy were performed before surgery (T0), at 6 (T1) and 18 months (T2) follow-up. Histology was compared with normal bladder specimens. Wilcoxon test was adopted for statistics.

Results

Bladder capacity and compliance resulted increased (+30%) at T1 (p < 0.05) and remained stable at T2, despite dry intervals did not changed significantly. Bladder biopsy at T1 showed no evidence of SIS, but normal transitional mucosa and sero-muscular layer containing smooth muscle fascicles, small nerve trunks and vessels within abundant type-3 collagen. Muscle/collagen ratio was decreased compared with controls at T1 and T2 (p < 0.05). No kidney damage, bladder diverticula, or stones were observed at 3 years follow-up.

Conclusions

Bladder regeneration was feasible in these patients, but bladder capacity and compliance was poorly increased to obtain significant clinical benefit. Histology showed poor muscle components. The acellular matrix grafting failed to provide long-term effective results in terms of continence achievement.

Greenwell TJ, Venn SN, Mundy AR (2001) Augmentation cystoplasty. BJU Int 88:511–525PubMedCrossRef

Mitchell ME, Piser JA (1987) Intestinocystoplasty and total bladder replacement in children and young adults: follow-up in 129 cases. J Urol 138:579–582PubMed

Hamid R, Greenwell TJ, Nethercliffe JM, Freeman A, Venn SN, Woodhouse CRJ (2009) Routine surveillance cystoscopy for patients with augmentation and substitution cystoscopy for benign urological conditions: is it necessary? BJU Int 104(3):392–395PubMedCrossRef

Husmann DA, Rathbun SR (2008) Long-term follow-up of enteric bladder augmentation: the risk for malignancy. J Pediatr Urol 4:381–385PubMedCrossRef

Kropp BP, Eppley BL, Prevel CD, Rippy MK, Harruff RC, Badylak SF, Adams MC, Rink RC, Keating MA (1995) Experimental assessment of small intestinal submucosa as a bladder wall substitute. Urology 46:396–400PubMedCrossRef

Atala A (2004) Tissue engineering for replacement of organ function in the genito-urinary system. Am J Transplant 6(Suppl):58–73CrossRef

Cross WR, Thomas DFM, Southgate J (2003) Tissue engineering and stem cell research in Urology. BJU Int 92:165–171PubMedCrossRef

Brehmer B, Rohrmann D, Becker C, Rau G, Jakse G (2007) Different types of scaffolds for reconstruction of the urinary tract by tissue engineering. Urol Int 78:23–29PubMedCrossRef

Cheng EY, Kropp BP (2000) Urologic tissue engineering with small-intestinal submucosa: potential clinical applications. World J Urol 18:26–30PubMedCrossRef

10.

Sievert KD, Tanagho EA (2000) Organ-specific acellular matrix for reconstruction of the urinary tract. World J Urol 18:19–25PubMedCrossRef

11.

Colvert JR 3rd, Kropp BP, Cheng EY, Pope JC 4th, 3rd Brock JW, Adams MC, Austin P, Furness PD 3rd, Koyle MA (2002) The use of small intestinal submucosa as an off-the-shelf urethral sling material for pediatric urinary incontinence. J Urol 168:1872–1876PubMedCrossRef

12.

Dedecker F, Grynberg M, Staerman F (2005) Small intestinal submucosa (SIS): prospects in urogenital surgery. Prog Urol 15:405–407PubMed

13.

Liatsikos EN, Dinlenc CZ, Kapoor R, Norberto OB, Pikhasov D, Anderson AE, Smith AD (2001) Ureteral reconstruction: small intestine submucosa for the management of strictures and defects of the upper third of the ureter. J Urol 165:1719–1723PubMedCrossRef

14.

Palminteri E, Berdondini E, Colombo F, Austoni E (2007) Small intestinal submucosa (SIS) graft urethroplasty: short-term results. Eur Urol 51:1695–1701PubMedCrossRef

15.

Fiala R, Vidlar A, Vrtal R, Belej K, Student V (2007) Porcine small intestinal submucosa graft for repair of anterior urethral strictures. Eur Urol 51:1702–1708PubMedCrossRef

16.

Atala A, Bauer SB, Soker S, Yoo JJ, Retik AB (2006) Tissue-engineered autologous bladders for patients needing cystoplasty. Lancet 367:1241–1246PubMedCrossRef

17.

Caione P, Capozza N, Zavaglia D, Palombaro G, Boldrini R (2006) In vivo bladder regeneration using small intestinal submucosa: experimental study. Pediatr Surg Int 22(7):593–599PubMedCrossRef

18.

Marte A, Di Meglio D, Cotrufo AM, Di Iorio G, De Pasquale M, Vessella A (2002) A long-term follow-up of autoaugmentation in myelodysplastic children. BJU Int 89:928–931PubMedCrossRef

19.

Campodonico F, Benelli R, Michelazzi A, Ognio E, Toncini C, Maffezzini M (2004) Bladder cell culture on small intestinal submucosa as bioscaffold: experimental study on engineered urothelial graft. Eur Urol 46:531–537PubMedCrossRef

20.

Kropp BP (1998) Small-intestine submucosa for bladder augmentation: a review of preclinical studies. World J Urol 16:262–267PubMedCrossRef

21.

Bodylak SF, Kropp B, McPherson T, Liang H, Snyder PW (1998) Small intestinal submucosa: a rapidly resorbed bioscaffold for augmentation cystoplasty in a dog model. Tissue Eng 4:379–387CrossRef

22.

Atala A (2001) Tissue engineering in urology. Curr Urol Rep 2:83–92PubMedCrossRef

23.

Gorham SD, Monsour MJ, Scott R (1987) The in vitro assessment of a collagen/vicryl (polyglactin) composite film together with candidate suture materials for use in urinary tract surgery. I. Physical testing. Urol Res 15:53–59PubMedCrossRef

24.

Baumert H, Simon P, Hekmati M, Fromont G, Levy M, Balaton A, Molinié V, Malavaud B (2007) Development of a seeded scaffold in the great omentum: feasibility of on in vivo bioreactor for bladder tissue engineering. Eur Urol 52:884–892PubMedCrossRef

25.

Lais A, Paolocci N, Ferro F, Bosman C, Boldrini R, Caione P (1996) Morphometric analysis of smooth muscle in the exstrophy–epispadias complex. J Urol 156:819–821PubMedCrossRef

26.

Caione P, Zavaglia D, Capozza N (2007) Pelvic floor reconstruction in female exstrophic complex patients: different results from males? Eur Urol 52(6):1777–1782PubMedCrossRef

27.

Fierabracci A, Caione P, Di Giovine M, Zavaglia D, Bottazzo GF (2007) Identification and characterization of adult stem/progenitor cells in the human bladder (bladder spheroids): perspectives of application in pediatric surgery. Pediatr Surg Int 23:837–839PubMedCrossRef

28.

Nagele U, Maurer S, Feil G, Back C, King J, Sievert KD, Stenzl A (2008) In vivo investigation of tissue-engineered multilayered urothelium established from bladder washings. Eur Urol 54:1414–1422PubMedCrossRef

29.

Nuininga JE, Koens MJ, Tiemessen DM, Oosterwijk E, Daamen WF, Geutjes PJ, van Kuppevelt TH, Feitz WF (2010) Urethral reconstruction of critical defects in rabbits using molecularly defined tubular type I collagen biomatrices: key issues in growth factor addition. Tissue Eng Part A 16(11):3319–3328PubMedCrossRef

Title: Bladder augmentation using acellular collagen biomatrix: a pilot experience in exstrophic patients
Authors: Paolo Caione
Renata Boldrini
Annamaria Salerno
Simona Gerocarni Nappo
Publication date: 01-04-2012
Publisher: Springer-Verlag
Published in: Pediatric Surgery International / Issue 4/2012
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-012-3063-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Bladder augmentation using acellular collagen biomatrix: a pilot experience in exstrophic patients

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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