Bladder augmentation using a new biomaterial composed of allogenie bladder submucosa

James J. Yoo, Anthony Atala

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The search for a suitable biomaterial to reconstruct the genitourinary tract has been a challenging task. Bowel has been widely used for urinary tract reconstruction, despite its subsequent complications. Biodegradable polymers seeded with cells and intestinal submucosa alone have been recently proposed as alternate materials for bladder augmentation. However, neither material is able to provide a scaffold which is entirely analogous to bladder tissue. Therefore, we investigated the possibility of using allogenic bladder submucosa, a tissue consisting of non-immunogenic acellular collagen, either with or without cells, as a material for bladder augmentation. Nine beagles underwent partial cystectomies. In five, the bladder tissue was microdissected and the mucosal and muscular layers separated. Both urothelial and smooth muscle cells were harvested and expanded separately. Canine bladder tissue was obtained from sacrificed animals and the submucosa was isolated and sterilized. The allogenic bladder submucosa was seeded with muscle cells on one side and urothelial cells on the opposite side. Nine beagles underwent cruciate cystotomies on Uie bladder dome. Augmentation cystoplasty was performed with the allogenic bladder submucosa seeded with cells in 5 animals, and with the allogenic bladder submucosa without cells in 4. Urodynamic studies and fluoroscopic cystography were performed in all dogs pre-operatively and post-operatively at 1 and 2 months. The augmented bladders were retrieved 2 months after augmentation. Bladders augmented with the allogenic bladder submucosa seeded with cells showed a 100% increase in capacity compared to bladders augmented with the cell-free allogenic bladder submucosa, which showed only a 30 increase in capacity. All animals showed a normal bladder compliance as evidenced by urodynamic studies. Histologically, all retrieved bladders contained a normal cellular organization consisting of a urothelial lined lumen surrounded by submucosal tissue and smooth muscle. An angiogenic response was evident in all specimens. These results show that allogenic bladder submucosa without cells, when used for bladder augmentation, is able to assimilate itself histologically to the native bladder, but contracts over time. However, the allogenic bladder submucosa seeded with urothelial and muscle cells is able to form new bladder tissue which is histologically and functionally undistinguishable from the native bladder. The allogenic bladder submucosa seeded with cells appears to be an excellent option as a biomaterial for bladder augmentation.

Original languageEnglish (US)
Number of pages1
JournalBritish Journal of Urology
Issue numberSUPPL. 2
StatePublished - Dec 1 1997

ASJC Scopus subject areas

  • Urology


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