Читать книгу The SAGE Encyclopedia of Stem Cell Research - Группа авторов - Страница 126

Neurogenic bladder is a broad term describing various neurologic dysfunctions in the bladder and external urethral sphincter caused by disease or damage. The present standard for surgical treatment of the bladder is bladder augmentation using intestinal segments. However, intestinal tissues possess various functional characteristics similar to bladder tissue. There are a wealth of complications that can arise from this therapy. Regenerative medicine uses combinations of cells and biomaterials to induce regeneration of healthy tissue and offers an alternative approach for the replacement of lost or deficient organs including the bladder. There exists promising research using the foundations of regenerative medicine that have been demonstrated in children with neurogenic bladder caused by myelomeningocele, which is a birth defect in which the spinal canal and backbone do not close.

There are several preclinical experiences with alternatives to enterocystoplasty. Tissue expansion involving the progressive dilation of the bladder with an expansion balloon device has been suggested as a method of bladder augmentation. However, this has not yet been attempted clinically. In preclinical models, tissue expansion increased bladder capacity significantly. Histology of bladder tissue revealed that the bladder compliance was in the normal range. Seromuscular grafts replacing the traditional gastrointestinal segments used for bladder augmentation was another attempted approach. In preclinical models, seromuscular flaps used for bladder augmentation revealed normal re-epithelialization, but the tissue experienced significant shrinkage that severely limited the clinical feasibility of the technique. Using de-epithelialized segments over native tissue was also attempted and revealed little success. In recent years, seromuscular grafts have mostly been abandoned. Extracellular matrices and synthetic grafts for bladder repair have been used to encourage growth of bladder wall segments for partial bladder repair in vivo. These matrices are prepared by mechanical and chemical treatment of native tissue from allogenic or xenogenic donors to remove all the cellular components. In preclinical models of bladder augmentation, small intestine submucosa resulted in bladder wall regeneration in vivo. Bladder repair was shown to be more stabilized when small intestine submucosa was gained from distal ileum.