Ortac Mazhar, Ekerhult Teresa Olsen, Zhao Weixin, Atala Anthony
Wake Forest Institute for Regenerative Medicine, Winston Salem, NC, USA; Department of Urology, İstanbul University Faculty of Medicine, İstanbul, Turkey.
Wake Forest Institute for Regenerative Medicine, Winston Salem, NC, USA.
Urol Res Pract. 2023 Jan;49(1):11-18. doi: 10.5152/tud.2023.22226.
Despite developing surgical techniques in urethral surgery, the outcome and complications are still unsatisfactory. Alternative treatment modality has been coming up, particularly in patients with longer stricture, under revision surgery, and penile stricture. Tissue engineering grafts are a promising approach for substituting urethral reconstruction. Over the decades, numerous preclinical studies have been published to show the efficacy and safety of different origins of materials, the presence of autologous cells (acellular matrices or autologous cell-seeded matrices), and the construction of engineered tissue (patch or tubularized constructs) on animal models. However, the results of these studies have not yet reached the intended level for daily clinical practice. A PubMed database search was performed for articles, using specific keywords, published between 1998 and 2022, with a selection on using tissue-engineered grafts for urethroplasty. Many materials have been used as a graft, such as acellular bladder matrix, small intestinal submucosa, acellular dermal matrix, and polyglycolic acid with or without cells, and were evaluated according to the functional and anatomical outcomes comprising complications. According to current literature, tubularized scaffolds constructed from co-cultured cells have promising results for the future. However, high-quality evidence through randomized controlled studies with larger sample sizes, with a long-term follow-up is required to determine accurate outcomes.
尽管尿道外科手术技术不断发展，但其治疗效果和并发症仍不尽人意。替代治疗方式不断涌现，尤其是对于狭窄较长、接受翻修手术以及阴茎狭窄的患者。组织工程移植物是替代尿道重建的一种有前景的方法。几十年来，已经发表了大量临床前研究，以展示不同来源材料、自体细胞（脱细胞基质或自体细胞接种基质）的存在以及工程组织（补片或管状构建体）在动物模型上的有效性和安全性。然而，这些研究结果尚未达到日常临床实践的预期水平。利用特定关键词对1998年至2022年间发表在PubMed数据库中的文章进行了检索，筛选出使用组织工程移植物进行尿道成形术的文章。许多材料已被用作移植物，如脱细胞膀胱基质、小肠黏膜下层、脱细胞真皮基质以及含或不含细胞的聚乙醇酸，并根据包括并发症在内的功能和解剖学结果进行了评估。根据当前文献，由共培养细胞构建的管状支架在未来具有良好的前景。然而，需要通过更大样本量的随机对照研究并进行长期随访，以获得高质量证据来确定准确的治疗效果。
