Urologic applications of engineered tissue

Many congenital and acquired anomalies affect the genitourinary tract, necessitating surgical intervention. Among these are bladder exstrophy, hypospadias, epispadias, posterior urethral valves, myelomeningocele, bladder carcinoma, urethral stricture disease, stress urinary incontinence, pelvic organ prolapse, vesicoureteral reflux and traumatic injuries of the urinary tract. Surgical repair of these conditions often utilizes skin, oral mucosa or bowel autograft or xenograft material to replace missing tissue or to augment inadequate tissues. These materials are often sufficient to restore the basic anatomy of the organ to which they are being grafted, but they usually do not completely restore normal function. In addition, postoperative complications are common, especially in the case of bladder augmentation or neobladder creation with autologous bowel. The complications and inherent limitations of these procedures may be mitigated by the availability of alternative tissue sources. Therefore, there has been a great deal of interest in developing tissues engineered from autologous materials, such as mature bladder cells, bone marrow-derived stem cells and adipose tissue. Ideally, an engineered tissue would restore or preserve the normal function of the organ it is augmenting or replacing. In addition, the engineered tissue should be nonimmunogenic to minimize rejection or foreign-body reactions. For the purposes of this article, we will focus on selection of scaffolding materials, selection of cell sources, and the current applications and potential future roles of tissue engineering in urology.