A foreseeable tissue engineering approach to overcome the neurogenic bladder-related detrusor/urethral rhabdosphincter dyssynergia

I have read, with high interest, the Jednak’s review article “The evolution of bladder augmentation: from creating reservoir to reconstituting an organ” (1), where the literature regarding this subject has been carefully taken into consideration. Particularly, about the tissue engineering-based augmentation cystoplasty, the attention has been focused on the results reached by Atala and his group in patients suffering from end-stage myelomeningocele-induced poorly compliant/high pressure bladder (2).

Nevertheless, such tissue engineered arrangement remains functionally conditioned by spinal cord neuropathy-due detrusor/urethral rhabdosphincter dyssynergia. Hence, in my opinion, it would be suitable, for these patients, to implant, after total cystectomy together with removal of the urethral rhabdosphincter, a tissue engineered neobladder–rhabdosphincter complex – quite not influenced by spinal cord neuropathy effects – provided with inside neobladder wall embedded tension micro-electro-sensors (correlatively to intra-neobladder pressure) with micro-loop antenna to send, beyond a properly adjustable wall tension value threshold, modulated wireless e-m signals toward a rhabdosphincterial receiver–converter micro-electro device to promote, in turn, by suitable e-m field generation, the rhabdosphincter relaxation simultaneously with the neobladder contraction. What should be quite reversible following the micturition-due intra-neobladder pressure drop below the arranged levels.

Bright advances in the scaffold fabrication, emerging from recent progress in the field of both nanotechnology and material science research – from different “smart” synthetic polymers to silk fibroin-based biomaterials – besides in stem-cell biology, could make feasible a suitable setting of micro-electro-sensors inside the mentioned bladder/rhabdosphincter tissue engineered complex (3–5).

Conflict of Interest Statement

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

1. Jednak R. The evolution of bladder augmentation: from creating a reservoir to reconstituting an organ. Front Pediatr (2014) 2:10. doi: 10.3389/fped.2014.00010

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2. Atala A, Bauer SB, Soker S, Yoo JJ, Retik AB. Tissue engineered autologous bladders for patients needing cystoplasty. Lancet (2006) 367:1241–6. doi:10.1016/S0140-6736(06)68438-9

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3. Shakhssalim N, Rasouli J, Moghdasali R, Aghdas FS, Naji M, Soleimani M. Bladder smooth muscle cells interaction and proliferation on PCL/PLLA electrospun nanofibrous scaffold. Int J Artif Organs (2013) 36:113–20. doi:10.5301/ijao.5000175

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4. Chung YG, Algarrahi K, Franck D, Tu DD, Adam RM, Kaplan DL, et al. The use of bi-layer silk fibroin scaffolds and SIS matrices to support bladder tissue regeneration in a rat model of spinal cord injury. Biomaterials (2014) 35:7452–9. doi:10.1016/j.biomaterials.2014.05.044

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5. Alberti C. About recent developments of synthetic polymers for a suitable cell adhesion/growth support in tissue engineering-based either augmentation cystoplasty or neobladder. Ann Ital Chir (2014) 85:309–16.

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