Tissue-engineered Urethras for Patients Needing Reconstruction

Urethras developed by patient’s own cells are quite effective and generally do not develop post-surgery strictures.

Engineered urethras can be used in patients who need complex urethral reconstruction. These may remain functional in a clinical setting for up to 6 years.

Urethra is an important part of the urinary system. Various accidental injuries impair the urethra and reconstruction is required. It is a delicate structure and its reconstruction is therefore, a medical concern and challenge.

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To assess and analyze the efficacy of urethras engineered from the patient’s own cells, in patients requiring reconstruction surgery, a study was conducted.

An important study was performed on five boys with urethral defects. Epithelial cells and muscles were elaborated and seeded onto tabularized polyglycolic acid. The surgeries were done between March19, 2004 and July20, 2007. The age group of boys at the time of surgery was 10-14 years, with median age being 11 years. The post surgery median follow up was 71 months9 range36-76 months).

Urethral reconstruction via tissue –engineered tubularised urethras was performed on the selected patients. Complete history of the patients was taken and subsequently International Continence Society (ICS) questionnaires were duly completed by the patients.

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Post surgery, routine microscopic urine analysis; cystourethroscopy, cystourethrography and flow measurements were done at 3, 6, 12, 24,36,48,60, and 72 months. Several endoscopic cup biopsies were also done at 3, 12, and 36 months, from the various sections of engineered urethras for study purposes.

An important finding was the presence of epithelial and muscle cells in all cultures due to the presence of AE1/AE3, á actin, desmin, and myosin antibodies. 27.1 mL/s (range 16-18) was the median end maximum urinary flow rate.

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Urethral biopsies confirmed and affirmed the development of normal architecture of the engineered grafts, within 3 months after implantation. The endoscopic and radiographic studies revealed the maintenance of wide urethral calibers with no strictures.

The final conclusion drawn from the study was that in clinical settings, the engineered tabularized urethras may remain functional up to 6 years and the patients requiring complex urethral reconstruction may opt for engineered urethras.

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Source: Studies published in The Lancet, conducted by Atlantida Raya-Rivera MD a b, Diego R Esquiliano MD a b, James J Yoo MD a, Prof Esther Lopez-Bayghen PhD b, Shay Soker PhD a, Prof Anthony Atala MD,

Source-Medindia