Is tissue engineering and biomaterials the future for lower urinary tract dysfunction (LUTD)/pelvic organ prolapse (POP)?

Abstract

The fields of tissue engineering and regenerative medicine have seen major advances over the span of the past two decades, with biomaterials playing a central role. Although the term "regenerative medicine" has been applied to encompass most fields of medicine, in fact urology has been one of the most progressive. Many urological applications have been investigated over the past decades, with the culmination of these technologies in the introduction of the first laboratory-produced organ to be placed in a human body.1 With the quality of life issues associated with urinary incontinence, there is a strong driver to identify and introduce new technologies and the potential exists for further major advancements from regenerative medicine approaches using biomaterials, cells or a combination of both. A central question is why use biomaterials? The answer rests on the need to make up for inadequate or lack of autologous tissue, to decrease morbidity and to improve long-term efficacy. Thus, the ideal biomaterial needs to meet the following criteria: (1) Provide mechanical and structural support, (2) Maintain compliance and be biocompatible with surrounding tissues, and (3) Be "fit for purpose" by meeting specific application needs ranging from static support to bioactive cell signaling. In essence, this represents a wide range of biomaterials with a spectrum of potential applications, from use as a supportive or bulking implant alone, to implanted biomaterials that promote integration and eventual replacement by infiltrating host cells, or scaffolds pre-seeded with cells prior to implant. In this review we shall discuss the structural versus the integrative uses of biomaterials by referring to two key areas in urology of (1) pelvic organ support for prolapse and stress urinary incontinence, and (2) bladder replacement/augmentation.

Biomimetic implants for pelvic floor repair

“…One of the current treatments is the use of implants to assist in reconstructive surgery . Implants are either a‐cellular collagens derived from natural tissues (eg, autologous fascia or porcine small intestinal submucosa), or they are a synthetic knitted polymere (usually polypropylene), commonly known as “mesh,” with different weavings and textures . Natural tissue implants are variable in quality and often lack the mechanical strength required for load‐bearing areas like the pelvic floor.…”

Bladder reconstruction: The past, present and future

“…It employs the disciplines of cell biology, transplantation, material science and biomedical engineering, towards identifying alternatives that can re-establish and preserve the regular function of damaged tissues and organs ( Fig. 1) (33). Although the human body is outstanding in its ability to repair damaged tissue, these reparative processes are frequently restricted to the development of scar tissue.…”

Re: The Clinical Relevance of Cell-Based Therapy for the Treatment of Stress Urinary Incontinence

“…Companion articles for these include an excellent detailed but basic description of the development and use of biomaterial based scaffolds seeded with autologous urothelial and smooth muscle cells for human bladder tissue engineering, 2 and a brief review of the use of tissue engineering and its utilization for pelvic organ support for prolapse and stress incontinence and bladder augmentation and replacement. 3 Alan J. Wein, M.D., Ph.D. (hon.…”