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Urothelial or oral mucosa cells for tissue-engineered urethroplasty: A critical revision of the clinical outcome |
Guido Barbaglia,b,Axel Heidenreichc,Vahudin Zugorc,Leonidas Karapanosc,Massimo Lazzerid,*()
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a Centro Chirurgico Toscano, Arezzo, Italy b Research Institute for Uronephrology, Sechenov, First Moscow State Medical University, Moscow, Russia c University Clinic and Policlinic for Urology, Cologne, Germany d Istituto Clinico Humanitas IRCCS, Clinical and Research Hospital, Rozzano, Italy |
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Abstract Objective: To report the clinical outcome of urethral reconstruction by cultured urothelial or oral mucosa cells for tissue-engineered urethroplasty. Methods: We systematically searched for studies reporting the use of tissue-engineered techniques for hypospadias and urethral stricture repair in humans in PubMed and Embase (OvidSP) through January, 1990 to June, 2018. We excluded studies based on titles that clearly were not related to the subject, studies in which tissue-engineered biomaterial were used only in laboratory or experimental animals, and in the absence of autologous cultured epithelial cells. Studies were also excluded if they were not published in English, had no disease background and adequate follow-up. Finally, we search all relevant abstract presented at two of the main urological meetings in the last 10 years: European Association of Urology (EAU) and American Urological Association (AUA). Results: A total of six articles, reporting the clinical use of tissue-engineered techniques in humans, were fully reviewed in our review. The epithelial cells were harvested from the urethra (10 patients), the bladder (11 patients) and the mouth (104 patients). The tissue-engineered grafts were used in children for primary hypospadias repair in 16 cases, and in adults for posterior and anterior urethral strictures repair in 109 cases. Tissue-engineered grafts were showed working better in children for primary hypospadias repair than in adults for urethral strictures repair. Conclusion: One hundred and twenty-five patients received tissue-engineered urethroplasty using cultured epithelial cells for primary hypospadias or urethral strictures repair. The studies demonstrate a high degree of heterogeneity respect to epithelial cells (from urethra, bladder, and mouth), type of scaffold, etiology, site of urethral stricture, number of patients, follow-up and outcomes.
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Received: 01 July 2018
Available online: 27 April 2019
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Corresponding Authors:
Massimo Lazzeri
E-mail: lazzeri.maximus@gmail.com
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Reference in the text | Journal year | Type of cells | Site of original cells | No. of patients | Urethral Pathology | Site of strictures | Success rate (%) | Mean follow-up | Romagnoli et al. [1] | New Engl J Med 1990 | Urethral | External urinary meatus | 2 | Hypospadias | | 100 | 18 months | Romagnoli et al. [11] | J Urol 1993 | Urethral | External urinary meatus | 8 | Hypospadias | | 100 | 18 months | Raya-Rivera et al. [12] | Lancet 2011 | Bladder urothelium | Bladder | 5 | Traumatic strictures | Posterior urethra | 90 | 71 months | Fossum et al. [13] | Acta Paediatrica 2012 | Bladder urothelium | Bladder | 6 | Hypospadias | | 100 | 7.25 years | Bhargava et al. [14] | Eur Urol 2008 | Oral mucosa | Mouth | 5 | Lichen sclerosus strictures | Anterior urethra | 0 | 33.6 months | Ram-Liebig et al. [15] | EBioMedicine 2017 | Oral mucosa | Mouth | 99 | Urethral strictures | Anterior urethra | 85 | 24 months |
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The main data of articles reporting outcomes of tissue-engineered urethroplasty using cultured epithelial cells in humans.
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[1] |
Romagnoli G, De Luca M, Faranda F, Bandelloni R, Franzi AT, Cataliotti F , et al. Treatment of posterior hypospadias by the autologous graft of cultured urethral epithelium. N Engl J Med 1990; 323:527-30.
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Atala A, Bauer SB, Soker S, Yoo JJ, Retik AB . Tissue-engineered autologous bladders for patients needing cystoplasty. Lancet 2006; 367:1241-6.
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Barbagli G, Lazzeri M . Clinical experience with urethral reconstruction using tissue-engineered oral mucosa: a quiet revolution. Eur Urol 2015; 68:917-8.
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Wessells H, Angermeier KW, Elliot S, Gonzalez CM, Kodama R, Peterson AC , et al. Male urethral stricture: America urological association guideline. J Urol 2017; 197:182-90.
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Zhang K, Zhou S, Zhang Y, Xu Y, Jin S, Sa Y , et al. Anterior urethra reconstruction with lateral lingual mucosa harvesting technique. Urology 2016; 90:208-12.
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Barbagli G, Fossati N, Sansalone S, Larcher A, Romano G, Dell’Acqua V , et al. Predictor of early and late complications after oral mucosal graft harvesting: multivariable analysis from a cohort off 553 consecutive patients. J Urol 2014; 191:688-93.
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Atala A, Guzman L, Retik AB . A novel inert collagen matrix for hypospadias repair. J Urol 1999; 162:1148-51.
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Chen F, Yoo JJ, Atala A . Experimental and clinical experiences using tissue regeneration for urethral reconstruction. World J Urol 2000; 18:67-70.
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El-Kassaby AW, Retik AB, Yoo JJ, Atala A . Urethral stricture repair with an off-the shelf collagen matrix. J Urol 2003; 169:170-3.
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Romagnoli G, De Luca M, Faranda F, Franzi AT, Cancedda R . One-step treatment of proximal hypospadias by the autologous graft of cultured urethral epithelium. J Urol 1993; 150:1204-7.
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[12] |
Raya-Rivera A, Esquiliano DR, Yoo JJ, Lopez-Bayghen E, Soker S, Atala A . Tissue-engineered autologous urethras for patients who need reconstruction: an observational study. Lancet 2011; 377:1175-82.
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Fossum M, Skikuniene J, Orrego A, Nordenskjöld A . Prepubertal follow-up after hypospadias repair with autologous in vitro cultured urothelial cells. Acta Paediatr 2012; 101:755e60.
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Bhargava S, Patterson JM, Inman RD, Macnell S, Chapple CR . Tissue-engineered buccal mucosa urethroplasty-clinical outcomes. Eur Urol 2008; 53:1263-70.
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[15] |
Ram-Liebig G, Barbagli G, Heidenreich A, Fahlenkamp D, Romano G, Rebmann U , et al. Results of use of tissueengineered autologous oral mucosa graft for urethral reconstruction: a multicenter, prospective, observational trial. EBioMedicine 2017; 23:185-92.
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[16] |
Corradini F, Zattoni M, Barbagli G, Bianchi G, Giovanardi M, Serafini C , et al. Comparative assessment of cultures from oral and urethral stem cells for urethral regeneration. Curr Stem Cell Res Ther 2016; 11:643-51.
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[17] |
Fossum M, Gustafson CJ, Nordenskj?ld A, Kratz G . Isolation and in vitro cultivation of human urothelial cells from bladder washings of adult patients and children. Scand J Plast Reconstr Surg Hand Surg 2003; 37:41-5.
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[18] |
Patterson JM, Bullock AJ, MacNeil S, Chapple CR . Methods to reduce the contraction of tissue-engineered buccal mucosa for use in substitution urethroplasty. Eur Urol 2011; 60:856-61.
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[19] |
Lazzeri M, Barbagli G, Fahlenkamp D, Romano G, Blasmeyer U, Knispel H , et al. Preclinical and clinical examination of tissueengineered graft for urethral reconstruction (MukoCell®) with regard to its safety. J Urol 2014;19:e122. https://doi.org/10.1016/j.juro. 2014. 02. 492.
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[20] |
Ram-Liebig G, Bednarz J, Stuerzebecher B, Fahlenkamp D, Barbagli G, Romano G , et al. Regulatory challenges for autologous tissue engineered products on their way from Bench to bedside in Europe. Adv Drug Deliv Rev 2015; 82e83:181-91.
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[21] |
Barbagli G, Akbarov I, Heidenreich A, Zugor V, Olianas R, Aragona M , et al. Anterior urethroplasty using a new tissue engineered oral mucosa graft: surgical techniques and outcomes. J Urol 2018; 200:448-56.
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[22] |
Cossu G, Birchall M, Brown T, De Coppi P, Culme-Seymor E, Gibbon S , et al. Lancet Commission: stem cells and regenerative medicine. Lancet 2017; 390:1623-714.
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Atala A . Regenerative bladder augmentation using autologous tissuedwhen will we get there? J Urol 2014; 191:1204-5.
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Kirtschig G, Becker K, Güntert A, Jasaitiene D, Cooper S, Chi CC , et al. Evidence-based (S3) guideline on (anogenital) lichen sclerosus. J Eur Acad Dermatol Venereol 2015;29: e1-43. https://doi.org/10.1111/jdv.13136.
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Barbagli G, Mirri F, Gallucci M, Sansalone S, Romano G, Lazzeri M . Histological evidence of urethral involvement in male patients with genital lichen sclerosus: a preliminary report. J Urol 2011; 185:2171-6.
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