New methods of bladder augmentation (Reprinted from BJU Int, vol 85, pg 24-34, 2000)

Gastrointestinal segments are commonly used for bladder replacement or repa ir. However, when gastrointestinal tissue is in contact with the urinary tr act, several complications may ensue. Recent surgical approaches have relie d on native urological tissue for reconstruction. These are based on sound surgical principles, allowing for the exclusion of tissue that is not urolo gical. De-epithelialized bowel segments, either alone or over native urothe lium, have also been used. An experimental system of progressive dilatation for ureters and bladders has been proposed, This appears promising, althou gh it has yet to be attempted clinically, There has been a resurgence of in terest in the use of acellular collagen-based matrices as scaffolds for bla dder regeneration; experimental work is currently underway. Recently, funct ional bladder tissue has been engineered using selective cell transplantati on. This technique uses autologous cells, so avoiding rejection, Tissue is obtained from the host, the cells then dissociated and expanded in vitro, r e-attached to a matrix and implanted into the same host. Clinical trials ar e currently being arranged, Even though the use of bowel for bladder tissue replacement was first proposed over 100 years ago, it remains the gold sta ndard, despite its associated problems, It is evident that urothelial-uroth elial anastomoses are preferable functionally, Experience is currently bein g gained with the recent clinical and experimental approaches to augmentati on cystoplasty. It is hoped that this will result in more technologies and methods for bladder augmentation.