Bioengineering solutions for ureteric disorders: clinical need, challenges and opportunities

Abstract

To summarise the causes of ureteric damage and the current standard of care, discussing the risks and benefits of available therapeutic options. We then focus on the current and future solutions that can be provided by ureteric bioengineering and provide a description of the ideal characteristics of a bioengineered product. MethodsWe performed a literature search in February 2021 in: Google Scholar, Medline, and Web of Science. Three searches were conducted, investigating: (a) the epidemiology of ureteric pathology, (b) the current standard of care, and (c) the state of the art in ureteric bioengineering. ResultsThe most-common causes of ureteric damage are iatrogenic injury and external trauma. Current approaches to treatment include stent placement or surgical reconstruction. Reconstruction can be done using either urological tissue or segments of the gastrointestinal tract. Limitations include scarring, strictures, and infections. Several bioengineered alternatives have been explored in animal studies, with variations in the choice of scaffold material, cellular seeding populations, and preimplantation processing. Natural grafts and hybrid material appear to be associated with superior outcomes. Furthermore, seeding of the scaffold material with stem cells or differentiated urothelial cells allows for better function compared to acellular scaffolds. Some studies have attempted to pre-implant the graft in the omentum prior to reconstruction, but this has yet to prove any definitive benefits. ConclusionThere is an unmet clinical need for safer and more effective treatment for ureteric injuries. Urological bioengineering is a promising solution in preclinical studies. However, substantial scientific, logistic, and economic challenges must be addressed to harness its transformative potential in improving outcomes.

Densified collagen tubular grafts for human tissue replacement and disease modelling applications

“…This notably includes blood vessel grafts (e.g. coronary and peripheral arteries, vascular access for hemodialysis) [1][2][3][4][5], but also grafts for the bile duct [6,7], small and large intestine [8][9][10], oesophagus [11,12], genitourinary [13,14] and tracheobronchial [15][16][17][18] systems, and as guiding conduits for peripheral nerves [19]. Artificial tissue is also sought for disease modelling in vitro [20][21][22], such as to reproduce vascular pathology in atherosclerosis [23] and Marfan syndrome [24].…”

Gelatin-grafted tubular asymmetric scaffolds promote ureteral regeneration via activation of the integrin/Erk signaling pathway

“…Iatrogenic accidents are the most common cause of ureteral trauma and are most frequent during gynecological and ureteroscopic surgeries ( Zhao et al, 2019 ; Kapetanos et al, 2022 ). Urologists face a tough challenge in addressing the issue of long-segment ureteral abnormalities.…”

“…However, long ureteral defects require the transplantation of other tissues like the small intestine and blood vessels. As a result, various problems, such as infection, anastomotic stenosis, chronic renal failure, and a shortage of donor tissue, are associated with these techniques due to the different natures of donor organizations ( de Jonge et al, 2014 ; Zamani et al, 2020 ; Kapetanos et al, 2022 ).…”

Densified Collagen Tubular Grafts for Human Tissue Replacement and Disease Modelling Applications

“…This notably includes blood vessel grafts (e.g. coronary and peripheral arteries, vascular access for hemodialysis) [1][2][3][4][5], but also grafts for the bile duct [6,7], small and large intestine [8][9][10], oesophagus [11,12], genitourinary [13,14] and tracheobronchial [15][16][17][18] systems, and as guiding conduits for peripheral nerves [19].…”

“…This notably includes blood vessel grafts (e.g. coronary and peripheral arteries, vascular access for hemodialysis) [1-5], but also grafts for the bile duct [6, 7], small and large intestine [8-10], oesophagus [11, 12], genitourinary [13, 14] and tracheobronchial [15-18] systems, and as guiding conduits for peripheral nerves [19]. Artificial tissue is also sought for disease modelling in vitro [20-22], such as to reproduce vascular pathology in atherosclerosis [23] and Marfan syndrome [24].…”