Bladder augmentation: Review of the literature and recent advances

Abstract

Bladder augmentation is an important tool in the management of children requiring reconstructions for urinary incontinence or preserving of the upper urinary tract in congenital malformations. We reviewed the literature and evaluated the long-term results of enterocystoplasty in the pediatric age group and summarized techniques, experimental options and future perspectives for the treatment of these patients. For this purpose, a directed Medline literature review for the assessment of enterocystoplasty was performed. Information gained from these data was reviewed and new perspectives were summarized. The ideal gastrointestinal (GI) segment for enterocystoplasty remains controversial. The use of GI segments for enterocystoplasty is associated with different short and long-term complications. The results of different centers reported in the literature concerning urological complications after enterocystoplasty are difficult to compare because of the non-comparable aspects and different items included by different authors. On the other hand, there are more and more case reports about cancer arising from bowel segments used for bladder augmentation in recent publications.Although bladder reconstruction with GI segments can be associated with multiple complications, such as metabolic disorders, calculus formation, mucus production, enteric fistulas and potential for malignancy, enterocystoplasty is unfortunately still the gold standard. However, there is an urgent need for the development of alternative tissues for bladder augmentation.

Neurogenic Bladder

“…The success rate of enterocystoplasty is reported to be as high as 90% [59]. Bladder augmentation has been performed in 25–30% of individuals with meningomyelocele [32].…”

“…The number of patients needing to perform intermittent catheterization following enterocystoplasty has been reported to range from 15%–75% [59]. …”

Nanotechnology and tissue-engineered organ regeneration

“…Enterocytoplasty remains a gold standard simply because there is little alternative. 93 Much like other organs and tissue that have been discussed, TE strategy has been postulated as a potential solution to the problem of bladder reconstruction and, now more than ever, nanotechnology is playing a more signifi cant role in scaffold development. A lot of work into the application of nanomaterial scaffolds in bladder TE has been a collaborative effort between research groups headed by T. J. Webster and P. Haberstrich.…”

Magnitude-dependent proliferation and contractility modulation of human bladder smooth muscle cells under physiological stretch

“…Mechanical stimuli are key regulators of cell structure and function in both normal and disease conditions [1]. In an effort to identify the effects of mechanical stretch on BSMCs, researchers over the past few decades have effectively employed a variety of experiments, which subjected cells to a uniform stretch (either uniaxial or equibiaxial) [2].…”