Augmentation Cystoplasty and Extracellular Matrix Scaffolds: An Ex Vivo Comparative Study with Autogenous Detubularised Ileum

Abstract

BackgroundAugmentation cystoplasty (AC) with autogenous ileum remains the current gold standard surgical treatment for many patients with end-stage bladder disease. However, the presence of mucus-secreting epithelium within the bladder is associated with debilitating long-term complications. Currently, decellularised biological materials derived from porcine extracellular matrix (ECM) are under investigation as potential augmentation scaffolds. Important biomechanical limitations of ECMs are decreased bladder capacity and poor compliance after implantation.Methodology/Principal FindingsIn the present ex vivo study a novel concept was investigated where a two-fold increase in ECM scaffold surface-area relative to the resected ileal segment was compared in ovine bladder models after AC. Results showed that bladder capacity increased by 40±4% and 37±11% at 10 mmHg and compliance by 40.4±4% and 39.7±6% (ΔP = 0–10 mmHg) after AC with ileum and porcine urinary bladder matrix (UBM) respectively (p<0.05). Comparative assessment between ileum and UBM demonstrated no significant differences in bladder capacity or compliance increases after AC (p>0.05).ConclusionsThese findings may have important clinical implications as metabolic, infective and malignant complications precipitated by mucus-secreting epithelium are potentially avoided after augmentation with ECM scaffolds.

Mechanical characterisation of unidirectional and cross-directional multilayered urinary bladder matrix (UBM) scaffolds

“…The mechanical properties of multilayered UBM have been investigated and our tensile-testing findings are consistent with results from prior studies [4,13,23]. Interestingly, researchers have previously attempted to manipulate the material properties of UBM for different surgical subspecialties by varying the number of layers (from 4 to 8) and by modifying the sterilisation treatments used for manufacturing [13].…”

Augmentation cystoplasty in dogs: A comparative study of different tunica vaginalis grafts

“…AC has recently replaced urinary diversion due to its lower morbidity ( Davis et al., 2011 ; Watanabe et al., 2011 ). In addition, it reduces the likelihood of dehiscence and leads to better short-term urine storage ( Pozzi et al., 2006 ).…”