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Bladder Tissue Engineering
Published in Gilson Khang, Handbook of Intelligent Scaffolds for Tissue Engineering and Regenerative Medicine, 2017
Tissue engineering of the bladder has a longstanding history. This is (partly) due to the medical need to replace bladder tissue after cystectomy for bladder cancer but also due to the need to augment bladders with small capacity and the need to repair bladder exstrophy, a birth defect in which the bladder grows outside the abdominal wall. Current state-of-the-art technologies are restricted to the use of autologous tissues to create a neobladder and primary closure. These approaches come at the expense of several complications such as metabolic disorders, bladder perforation, stone formation, infections, hematuria-dysuria syndrome, and potential development of cancer due to metaplasia. Obviously this affects the quality of life of patients. Here we will discuss the function and the composition of native bladder tissue and bladder tissue engineering, material design and techniques for bladder tissue engineering, and the role of stem cells for tissue engineering; review animal studies and clinical trials; and discuss future possibilities.
Robotic-assisted surgery for the treatment of urologic cancers: recent advances
Published in Expert Review of Medical Devices, 2020
Ugo Falagario, Alessandro Veccia, Samuel Weprin, Emanuel V. Albuquerque, William C. Nahas, Giuseppe Carrieri, Vito Pansadoro, Lance J. Hampton, Francesco Porpiglia, Riccardo Autorino
Radical cystectomy (RC) represents the ‘gold standard’ treatment of muscle-invasive as well as of high-risk non-muscle invasive bladder cancer [69]. The surgical technique for RARC was firstly described by Menon et al. in 2003 [70], and it has been under scrutiny for many years because of unclear advantages and concerns related to the oncological outcomes. Few retrospective single-center studies showed long term follow-up of patients who underwent RARC with a 5-year DFS and OS ranging from 58% to 67% and from 50% to 54%, respectively [71–74].
Design of experiment for optimization of 3D printing parameters of base plate structures in colostomy bag for newborns
Published in Journal of Industrial and Production Engineering, 2021
Chia Hung Yeh, Chia Man Chou, Chien Pang Lin
According to the American Cancer Society, approximately 15% of patients with colorectal cancer must undergo colostomy surgery to prolong their survival [1]. The appearance of patients who undergo surgical enterostomy is no different from that of the average person. However, in everyday life, when the intestines are excreted, it is not possible to discharge the excrement through the anus after surgery. Therefore, it is necessary to provide assistance through an auxiliary bag. In this regard, an improper ostomy bag is likely to cause leakage of the excrement, thus causing allergies or damage to the surrounding skin [2]. These problems deeply affect the patient’s physical condition and quality of life and cause changes in the patient’s body. The individual’s psychological and social impact is more physiological than injury-based. A colostomy can be in the small intestine of the upper gastrointestinal tract or in the colon of the lower gastrointestinal tract. The type of enterostomy also varies depending on the location of the lesion and the location of the operation. The distinction is as follows: (1) Permanent stoma: surgical removal of the anus and rectum, pulling the end of the sigmoid colon or descending the colon out of the left abdomen to make a stoma to defecate, as shown in Figure 1. The patient must both learn the use of stoma products and stoma lavage during hospitalization. Among them, stoma lavage is implemented after surgery, which requires enema training to maintain regular bowel habits. (2) Temporary stoma: If there are traumas around the anus, severe anal abscess, or an acute intestinal obstruction caused by disease when a patient undergoes large intestine surgery, those with the three conditions mentioned above will have the abdominal wall of the transverse colon pulled out to create a temporary colon stoma. When the patient recovers, the transverse colon is returned to the abdominal cavity. (3) Urostomy, also known as an artificial bladder: Patients with bladder cancer need to undergo a total cystectomy because of the disease. An opening is made in the right lower abdomen to drain the urine.
Constructing artificial urinary conduits: current capabilities and future potential
Published in Expert Review of Medical Devices, 2019
Jan Adamowicz, Shane V. Van Breda, Tomasz Kloskowski, Kajetan Juszczak, Marta Pokrywczynska, Tomasz Drewa
Radical cystectomy remains a gold standard for the treatment of high grade or invasive bladder cancer and needs to be followed by advanced orthotopic reconstruction to attain a satisfactory quality of life [3]. Overall, radical cystectomy has a five-year cancer-specific survival rate of 48–69%. Nevertheless, following cystectomy with urinary diversion, the early complication rate is estimated to be 50–70%, with a 25% likelihood of being readmission, a 20% chance of ICU admission, and a 3% risk of perioperative death [4]. A common dilemma in patients that qualify for cystectomy is deciding on the type of urinary diversion. Traditionally, active young patients are candidates for continent urinary diversion by orthotopic ileal neobladder, whereas IC is the preferred method in elderly patients [5]. Despite this decision-making pathway, data indicates that IC was the most commonly performed urinary diversion in all patients. Published reports demonstrated that IC was applied in 80% of the cystectomy cases [6]. With a relatively long life expectancy after bladder cancer resection, the patients’ quality of life is becoming a crucial factor in determining the choice of urinary diversion method. Under these circumstances, it is interesting that the number of performed orthotopic neobladders is steadily decreasing and IC has become a dominant type of urinary diversion. The answer might be related to the disappointing functional results after continent urinary diversion. The daytime incontinence rates can reach up to 20%, and nightly incontinence rates can be significantly higher [7]. Moreover, the proper function of a neobladder is dependent on active postoperative management that might be difficult to comply in underfunded health-care systems. IC is considered the ‘“standard”’ urinary diversion for bladder cancer patients undergoing radical cystectomy. Since clinical introduction in 1950 by Bricker, IC has been recognized as being cost-effective, guarantying low-pressure urine outflow and adequate quality of life in long-term [8]. In fact, Bricker ileal conduit is in the only technique used in urological surgery to perform a urinary conduit. However, IC is not an ideal solution as the procedure still requires entero-enterostomy to restore bowel continuity. This step is the source of related complications that might prolong recovery time. Postoperative anastomosis insufficiency leading to ileus, digestive fistula, concomitant peritonitis, and sepsis occurred in 18% of the patients and required timely re-intervention in half of the cases [9]. Pycha et al. presented a comparison of different incontinent urinary diversions, and IC was linked to the highest number of diversion-related complications [10].