TISSUE ENGINEERING IN UROLOGIC SURGERY - 08/09/11
Resumen |
The genitourinary system is exposed to a variety of possible injuries from the time the fetus develops. Aside from congenital abnormalities, individuals may also suffer from other disorders, such as cancer, trauma, infection, iatrogenic injuries, or other conditions that may lead to genitourinary organ damage or loss, requiring eventual reconstruction.
Whenever there is a lack of native urologic tissue, reconstruction is usually performed with native nonurologic tissues, such as skin, gastrointestinal segments, or mucosa from multiple body sites.14, 45 The use of native nonurologic tissues in the genitourinary tract is common, due to a lack of a better alternative, despite the known possible adverse effects. For example, the use of bowel in genitourinary reconstruction is associated with a variety of complications.15 These include metabolic abnormalities, infection, perforation, urolithiasis, increased mucous production, and malignancy. Alternative approaches are constantly being explored in order to overcome the problems associated with the incorporation of nonurologic segments into the urinary tract.
Due to the complications associated with the use of native nonurologic tissues, such as gastrointestinal segments for genitourinary reconstruction, many investigators have sought to use synthetic materials as an alternative. The most common type of synthetic prostheses for urologic use are made of silicone. Silicone prostheses have been used for the treatment of urinary incontinence (artificial urinary sphincter)34; vesicoureteral reflux (detachable balloon system, silicone microparticles)13, 22; and impotence (penile prostheses).46 In some disease states, such as urinary incontinence or vesicoureteral reflux, artificial agents (Teflon paste, glass microparticles) have been used as injectable bulking substances; however, these substances are not entirely biocompatible.2, 4 The literature is replete with a wide array of complications (i.e., device malfunction, infection, and so forth) associated with these artificial devices.
Other natural tissues and synthetic materials that have been tried previously in experimental and clinical settings include omentum, peritoneum, seromuscular grafts, de-epithelialized segments of bowel, and polyvinyl sponge.15 These attempts have usually failed. It is evident that urothelial to urothelial anastomoses are preferable functionally. The limited amount of autologous urothelial tissue for reconstruction, however, generally precludes this option. There is a critical need for tissues to replace lost and functionally deficient genitourinary tissues.3 Engineering tissues using selective cell transplantation32 may provide a means to create functional new genitourinary tissues.
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| Address reprint requests to Anthony Atala, MD Children's Hospital Harvard Medical School 300 Longwood Avenue Boston, MA 02115 |
Vol 25 - N° 1
P. 39-50 - février 1998 Regresar al número
Artículo precedente
- THE FUTURE OF GENE THERAPY IN THE TREATMENT OF UROLOGIC MALIGNANCIES
- Jonathan W. Simons, Fray F. Marshall
- ORGAN TRANSPLANTATION IN THE TWENTY-FIRST CENTURY
- Markus Weber, Shaoping Deng, Kim Olthoff, Ali Naji, Clyde F. Barker, Abraham Shaked, Kenneth L. Brayman
Bienvenido a EM-consulte, la referencia de los profesionales de la salud.
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