ABSTRACT
Hypertonic low-compliant bladder responsible for urinary incontinence or reflux in the upper urinary tract can develop during the course of several neurological disorders. Bladder augmentation performed to treat neurogenic bladder traditionally involves the use of intestinal segments, which can lead to complications such as urolithiasis, adhesion formation, increased intestinal mucus secretion, and metabolic disturbances. Small intestinal submucosa has been shown to promote bladder regeneration in vivo and to support three-dimensional growth of human bladder cells in vitro. Bladder augmentation with unseeded biomaterial relies on the ingrowth of smooth muscle and urothelial cells from the surrounding residual bladder tissue. The engineered bladders were removed subsequently for evaluation of their contractile response to various stimuli in organ-bath studies. In 2006, Atala and colleagues reported the first clinical trial of tissue-engineered bladders in seven patients who had myelomeningocele with poorly compliant bladders and frequent urinary leakage as often as every 30 minutes despite maximal pharmacotherapy.
