Surgical Option for the Correction of Peyronie's Disease: An Autologous Tissue-Engineered Endothelialized Graft

Abstract

Introduction Surgical treatment is indicated in severe cases of Peyronie's disease. Incision of the plaque with subsequent graft material implantation is the option of choice. Ideal graft tissue is not yet available. Aim To evaluate the use of an autologous tissue-engineered endothelialized graft by the self-assembly method, for tunica albuginea (TA) reconstruction in Peyronie's disease. Methods Two TA models were created. Human fibroblasts were isolated from a skin biopsy and cultured in vitro until formation of fibroblast sheets. After 4 weeks of maturation, human umbilical vein endothelial cells (HUVEC) were seeded on fibroblasts sheets and wrapped around a tubular support to form a cylinder of about 10 layers. After 21 days of tube maturation, HUVEC were seeded into the lumen of the fibroblast tubes for the endothelialized tunica albuginea (ETA). No HUVEC were seeded into the lumen for the TA model. Both constructs were placed under perfusion in a bioreactor for 1 week. Main Outcome Measures Histology, immunohistochemistry, and burst pressure were performed to characterize mature tubular graft. Animal manipulations were also performed to demonstrate the impact of endothelial cells in vivo. Results Histology showed uniform multilayered fibroblasts. Extracellular matrix, produced entirely by fibroblasts, presented a good staining for collagen 1. Some elastin fibers were also present. For the TA model, anti-human von Willebrand antibody revealed the endothelial cells forming capillary-like structures. TA model reached a burst pressure of 584 mm Hg and ETA model obtained a burst pressure of 719 mm Hg. Conclusions This tissue-engineered endothelialized tubular graft is structurally similar to normal TA and presents an adequate mechanical resistance. The self-assembly method used and the autologous property of this model could represent an advantage comparatively to other available grafts. Further evaluation including functional testing will be necessary to characterize in vivo implantation and behavior of the graft.

Surgery for Peyronie's disease

“…47 Tissue engineered graft materials such as adipose tissue-derived stem cell seeded SIS, human acellular matrix tunica albuginea grafts, and autologous tissue engineered endothelialized tunica albuginea grafts are being investigated for incision/excision procedures. [68][69][70][71] Imbeault et al 71 demonstrated in vitro creation of artificial tunica albuginea using human dermal fibroblasts and human endothelial cells. They concluded that this tissue-engineered endothelialized tubular graft was structurally similar to normal tunic with a high burst pressure and adequate mechanical resistance.…”

“…Furthermore, the autologous property of this model could represent an advantage comparatively to other available grafts. 71 Such studies may help elucidate future surgical treatments for PD using tissue engineered grafts for reconstruction of the tunica albuginea. The biomechanical properties, compatibility with tunica albuginea, and the effective neovascularization of the tissue engineered grafts need to be investigated further before such basic research can be applied by the reconstructive urologist.…”

Genitourinary System

“…Mean penile girth was measured preoperatively and 6 months postoperatively in the flaccid and erect states; the mean penile girth had increased significantly after 6 months, and 94.2% of patients were satisfied with the procedure. In another study, 12 patients underwent repeated penile widening using biodegradable scaffolds enriched with expanded autologous scrotal dartos cells [96]; penile girth increased in both flaccid and erect states. Furthermore, 10-14 months after first surgery, biopsies showed highly vascularized loose tissue with collagen deposition and some inflammation, and after 22-24 months, biopsies revealed almost no inflammation and a tissue resembling normal dartos fascia.…”

“…Peyronie's disease is a benign, acquired wound-healingconnective-tissue disorder of the tunica albuginea that affects 3-9% of men [96]. Therapeutic options for Peyronie's disease include plication, incision and grafting, and penile prosthesis.…”

“…Recently, cell-seeded engineered scaffolds have been explored as an alternative to conventional grafting. Imbeault et al [96] used human fibroblasts to form a fibroblast sheet-human umbilical vein endothelial cells (HUVECs) were seeded on fibroblasts sheets and wrapped around a tubular support, and HUVECs were seeded into the lumen of the fibroblast sheets. This endothelialized tubular graft was structurally similar to normal tunica albuginea with adequate mechanical resistance.…”