Future trends in bladder reconstructive surgery.

Abstract

The incorporation of bowel into the urinary tract is associated with significant long-term complications. Therefore, considerable efforts are being made to avoid the use of enteric epithelium in bladder reconstruction. The simplest of these entail the use of native urothelium that is already available, with techniques such as auto-augmentation, auto-augmentation de-epithelialized enterocystoplasty, and ureterocystoplasty. Unfortunately, in many patients, the bladder is too small, or dilated ureters are not available, and these techniques cannot be applied. Recently, experimental techniques are examining the use of tissue expansion to the ureter and bladder to increase the volume of tissue available. Tissue engineering techniques are being applied to bladder regeneration, and considerable advances have already been made leading to in vivo animal experimentation, the results of which are very encouraging. The details of these most recent advances will be discussed in detail in this report.