Tissue Engineering in Animal Models for Urinary Diversion: A Systematic Review

Abstract

Tissue engineering and regenerative medicine (TERM) approaches may provide alternatives for gastrointestinal tissue in urinary diversion. To continue to clinically translatable studies, TERM alternatives need to be evaluated in (large) controlled and standardized animal studies. Here, we investigated all evidence for the efficacy of tissue engineered constructs in animal models for urinary diversion. Studies investigating this subject were identified through a systematic search of three different databases (PubMed, Embase and Web of Science). From each study, animal characteristics, study characteristics and experimental outcomes for meta-analyses were tabulated. Furthermore, the reporting of items vital for study replication was assessed. The retrieved studies (8 in total) showed extreme heterogeneity in study design, including animal models, biomaterials and type of urinary diversion. All studies were feasibility studies, indicating the novelty of this field. None of the studies included appropriate control groups, i.e. a comparison with the classical treatment using GI tissue. The meta-analysis showed a trend towards successful experimentation in larger animals although no specific animal species could be identified as the most suitable model. Larger animals appear to allow a better translation to the human situation, with respect to anatomy and surgical approaches. It was unclear whether the use of cells benefits the formation of a neo urinary conduit. The reporting of the methodology and data according to standardized guidelines was insufficient and should be improved to increase the value of such publications. In conclusion, animal models in the field of TERM for urinary diversion have probably been chosen for reasons other than their predictive value. Controlled and comparative long term animal studies, with adequate methodological reporting are needed to proceed to clinical translatable studies. This will aid in good quality research with the reduction in the use of animals and an increase in empirical evidence of biomedical research.

Novel tubular constructs for urinary diversion: a biocompatibility study in pigs

“…In two systematic reviews we concluded that tissue engineering for urinary diversion or bladder augmentation should be performed in large animals, preferably in dogs or pigs (Sloff et al , ). In this study, a porcine model was chosen to compare the three different biomaterials in one animal, thereby eliminating inter‐animal variability.…”

Improving Research Practice in Rat Orthotopic and Partial Orthotopic Liver Transplantation: A Review, Recommendation, and Publication Guide

“…At a time when transparency is becoming more and more important in preclinical studies and several authors attempt systematic reviews and meta-analyses using preclinical data [118,119], the role of precise and standardized reporting has to be heavily emphasized.…”

Artificial urinary conduit construction using tissue engineering methods

“…In the paper by Sloff et al, all experiments describing the use of tissue engineering in urinary diversion construction conducted so far were evaluated [9]. They analyzed 8 works, of which 5 were related to urinary conduit and 3 to neo-bladder construction.…”

“…Urinary diversion can be divided into incontinent and continent (formed orthotopically or non-orthotopically). Incontinent ileocutaneostomy is most commonly used among surgeons and this type of urinary diversion has the greatest chances to be constructed using tissue engineering methods [9]. The use of an ileal segment, beside advantages such as maintaining ureter continuity together with urine outflow using autologous material with well developed blood supply, has number of disadvantages especially in the long-term follow-up [10,11,12].…”