Ureteral segmental replacement using multilayer porcine small-intestinal submucosa.

Area of Science:

• Biomaterials Science
• Regenerative Medicine
• Urology

Background:

• Ureteral reconstruction often requires tissue engineering solutions.
• Small-intestinal submucosa (SIS) has shown potential as a biomaterial for tissue repair.
• Enhanced strength SIS materials are being developed for demanding applications.

Purpose of the Study:

• To evaluate the efficacy of a novel multilayer porcine small-intestinal submucosa (SIS) graft, Surgisis ES, for segmental ureteral replacement.
• To assess the biocompatibility, regenerative potential, and long-term patency of SIS grafts in a porcine model.

Main Methods:

• Segmental ureteral defects (2-cm) were created in five pigs.
• Left ureters were replaced with tubularized SIS grafts; right ureters served as controls (primary anastomosis).
• Graft patency, inflammation, and regeneration were assessed grossly and histologically at 3, 6, and 12 weeks.

Main Results:

• Both SIS grafts and control ureters were patent at 3 and 6 weeks.
• SIS grafts showed signs of ureteral inflammation and adhesions.
• By 12 weeks, all SIS grafts resulted in complete ureteral occlusion and hydroureteronephrosis, while controls remained patent.

Conclusions:

• Surgisis ES facilitated watertight anastomoses and supported initial urothelial and muscle regeneration.
• Despite initial promise, the SIS grafts ultimately failed to provide functional, long-term ureteral replacement due to fibrosis and occlusion.
• Further research is needed to identify suitable biomaterials for successful ureteral reconstruction.