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Related Experiment Videos

First prize: ureteral segmental replacement revisited.

Assaad El-Hakim1, Robert Marcovich, Kun-Yan Chiu

  • 1Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York, USA. assaad.el-hakim@muhc.mcgill.ca

Journal of Endourology
|November 15, 2005
PubMed
Summary

Grafting ureteral segments with autologous cells on small intestinal submucosa failed in pigs and dogs. However, urothelial cell-seeded de-epithelialized bowel segments successfully replaced ureters, showing promise for treating long ureteral strictures.

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Area of Science:

  • Regenerative Medicine
  • Urology
  • Tissue Engineering

Background:

  • Long ureteral strictures pose significant clinical challenges.
  • Previous attempts at ureteral replacement using natural and synthetic materials have been largely unsuccessful.
  • Autologous cell-seeded grafts are being explored for ureteral reconstruction.

Purpose of the Study:

  • To evaluate autologous cells seeded onto graft material for proximal ureteral replacement.
  • To determine if urothelial cell-seeded de-epithelialized small bowel could serve as an adequate ureteral replacement.
  • To assess the efficacy of different graft materials and cell seeding techniques in large animal models.

Main Methods:

  • Autologous pig bladder cells cultured on small intestinal submucosa (SIS) were used for ureteral replacement in pigs.

Related Experiment Videos

  • Autologous dog bladder cells cultured on porcine ureteral acellular matrix were used for ureteral replacement in dogs.
  • De-epithelialized small bowel segments seeded with autologous bladder cells were retubularized (Monti) for ureteral replacement.

    • Main Results:

    • Grafts on SIS in pigs and acellular matrix in dogs resulted in graft contraction and complete ureteral obstruction.
    • Despite obstruction, histological examination revealed muscle and urothelial regeneration in the dog model.
    • Urothelial cell-seeded de-epithelialized Monti bowel segments led to patent ureteral replacement without hydroureteronephrosis or renal dysfunction.

    Conclusions:

    • Seeding ureteral grafts with autologous bladder cells on xenogenic acellular matrices was unsuccessful in large animal models.
    • While muscle and urothelium regeneration occurred with ureteral acellular matrix, it did not prevent obstruction.
    • Urothelial cell-seeded de-epithelialized Monti bowel segments represent a promising approach for long proximal ureteral segment replacement, though further refinement is needed.