A foreseeable tissue engineering approach to overcome the neurogenic bladder-related detrusor/urethral rhabdosphincter dyssynergia
- LD of Surgical Semeiotics, University of Parma, Parma, Italy
I have read, with high interest, the Jednak’s review article “The evolution of bladder augmentation: from creating reservoir to reconstituting an organ” (1), where the literature regarding this subject has been carefully taken into consideration. Particularly, about the tissue engineering-based augmentation cystoplasty, the attention has been focused on the results reached by Atala and his group in patients suffering from end-stage myelomeningocele-induced poorly compliant/high pressure bladder (2).
Nevertheless, such tissue engineered arrangement remains functionally conditioned by spinal cord neuropathy-due detrusor/urethral rhabdosphincter dyssynergia. Hence, in my opinion, it would be suitable, for these patients, to implant, after total cystectomy together with removal of the urethral rhabdosphincter, a tissue engineered neobladder–rhabdosphincter complex – quite not influenced by spinal cord neuropathy effects – provided with inside neobladder wall embedded tension micro-electro-sensors (correlatively to intra-neobladder pressure) with micro-loop antenna to send, beyond a properly adjustable wall tension value threshold, modulated wireless e-m signals toward a rhabdosphincterial receiver–converter micro-electro device to promote, in turn, by suitable e-m field generation, the rhabdosphincter relaxation simultaneously with the neobladder contraction. What should be quite reversible following the micturition-due intra-neobladder pressure drop below the arranged levels.
Bright advances in the scaffold fabrication, emerging from recent progress in the field of both nanotechnology and material science research – from different “smart” synthetic polymers to silk fibroin-based biomaterials – besides in stem-cell biology, could make feasible a suitable setting of micro-electro-sensors inside the mentioned bladder/rhabdosphincter tissue engineered complex (3–5).
Conflict of Interest Statement
The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
3. Shakhssalim N, Rasouli J, Moghdasali R, Aghdas FS, Naji M, Soleimani M. Bladder smooth muscle cells interaction and proliferation on PCL/PLLA electrospun nanofibrous scaffold. Int J Artif Organs (2013) 36:113–20. doi:10.5301/ijao.5000175
4. Chung YG, Algarrahi K, Franck D, Tu DD, Adam RM, Kaplan DL, et al. The use of bi-layer silk fibroin scaffolds and SIS matrices to support bladder tissue regeneration in a rat model of spinal cord injury. Biomaterials (2014) 35:7452–9. doi:10.1016/j.biomaterials.2014.05.044
Keywords: neurogenic bladder, detrusor-sphincter dyssynergia, tissue engineering, pediatrics, urology
Citation: Alberti C (2014) A foreseeable tissue engineering approach to overcome the neurogenic bladder-related detrusor/urethral rhabdosphincter dyssynergia. Front. Pediatr. 2:122. doi: 10.3389/fped.2014.00122
Received: 22 September 2014; Paper pending published: 12 October 2014;
Accepted: 23 October 2014; Published online: 10 November 2014.
Edited by:Lisandro Ariel Piaggio, Universidad Nacional Del Sur, Argentina
Reviewed by:Germán Fernando Falke, Hospital Universitario Austral, Argentina
Copyright: © 2014 Alberti. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.