Bladder substitution. Prospects for the new millennium

Gastrointestinal segments are currently by far the most popular method to c reate a bladder substitute. Attempts have been made to further reduce the m orbidity and burden for patients by using minimal invasive techniques for b oth cystectomy and urinary diversion. However, laparoscopy for acceptable f orms of urinary diversion is time consuming and costly. A neobladder "off t he shelf" would be a better solution. Tissue engineering is an exciting new field which enables the cultivation a nd expansion of individual bladder cells obtained by transurethral biopsy, the attachment of these cells to a support matrix, and their reimplantation into the body. Advances both in biomaterials as well as in the cultivation and expansion of bladder cells are described. Promising routine clinical applications of tissue engineering may still nee d several years. Free neurovascular muscle transfer to the bladder demonstr ated both experimentally and clinically to be a suitable treatment modality in patients with bladder acontractility. This may therefore be the next lo gical step towards an improved bladder substitute by combining well vascula rized flaps with urothelial cell seeding. Thus a combination of commonly us ed flap techniques and tissue engineering may soon be possible.