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Wu Z, Tang Z, Zheng Z, Tan S. A novel trauma induced urethral stricture in rat model. Sci Rep 2024; 14:6325. [PMID: 38491041 PMCID: PMC10943079 DOI: 10.1038/s41598-024-55408-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/22/2024] [Indexed: 03/18/2024] Open
Abstract
Urethral stricture (US) is a longstanding disease, while there has not existed a suitable animal model to mimic the condition. We aimed to establish a trauma-induced US animal model to simulate this clinical scenario. A total of 30 rats were equally distributed into two groups, sham and US group. All rats were anesthetized with isoflurane and undergone cystostomy. In the US group, a 2 mm incision was made in the urethra and sutured to induce US. The sham group only make a skin incision on the ventral side of the anterior urethra. 4 weeks later, ultrasound and cystourethrography were performed to evaluate the degree of urethral stricture, pathological examinations were carried out to evaluate the degree of fibrosis. Urodynamic evaluation and mechanical tissue testing were performed to evaluate the bladder function and urethral tissue stiffness. The results showed that the urethral mucosa was disrupted and urethral lumen was stenosed in the US group. Additionally, the US group showed elevated bladder pressure, prolonged micturition intervals and increased tissue stiffness. In conclusion, the rat urethral stricture model induced by trauma provides a closer representation of the real clinical scenario. This model will significantly contribute to advancing research on the mechanisms underlying traumatic urethral stricture.
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Affiliation(s)
- Ziqiang Wu
- Department of Urology, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, Changsha, People's Republic of China
| | - Zhengyan Tang
- Department of Urology, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, Changsha, People's Republic of China
| | - Zhihuan Zheng
- Department of Urology, Xiangya Hospital of Central South University, Changsha, People's Republic of China.
- Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, Changsha, People's Republic of China.
| | - Shuo Tan
- Department of Urology, Third Xiangya Hospital of Central South University, Changsha, People's Republic of China.
- Provincial Laboratory for Diagnosis and Treatment of Genitourinary System Disease, Changsha, People's Republic of China.
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Gundogdu G, Nguyen T, Eijansantos M, Chaudhuri A, Barham D, Gelman J, Mauney JR. Development of male and female models of long urethral strictures in swine. Surg Open Sci 2023; 16:205-214. [PMID: 38035225 PMCID: PMC10687041 DOI: 10.1016/j.sopen.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/01/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023] Open
Abstract
Background Preclinical animal models which mimic the dimensions of long urethral strictures (>2 cm in length) encountered in the clinic are necessary to evaluate prospective graft designs for urethroplasty. The purpose of this study was to develop both male and female porcine models of long urethral strictures (∼4 cm in length) and characterize histological and functional outcomes of iatrogenic stricture formation between genders. Methods Focal, partial thickness urethral injuries were created over 5-6 cm long segments in male and female swine (N = 4 per gender) via electrocoagulation and the degree of stricture formation was monitored for up to 6 weeks by urethroscopy and retrograde urethrography. Animals were sacrificed following stricture confirmation and histological, immunohistochemical, and histomorphometric analyses were performed on strictured and uninjured control urethral segments to profile wound healing responses. Results Urethral stricture formation was detected in all female swine by 2 weeks and 100 % of male swine at 3.2 ± 1.8 weeks, post-operatively. The mean length of urethral strictures in both male and female swine was ∼4 cm. Substantial variations in the degree of stricture severity between sexes were observed with males exhibiting significant urethral stenosis and loss of α-smooth muscle actin+ smooth muscle bundles in comparison to controls, while females primarily displayed defects in pan-cytokeratin+ epithelia as well as functional urethral obstruction. Conclusions Electrocoagulation injury is sufficient to produce long urethral strictures in male and female swine and the degree of stricture severity and nature of urethral obstruction was observed to be dependent on gender. Animal Protocol: AUP-19-150. Key message Novel male and female models of long urethral strictures in swine were created to characterize histological and functional outcomes of iatrogenic stricture formation between genders.
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Affiliation(s)
- Gokhan Gundogdu
- Department of Urology, University of California, Irvine, Orange, CA 92868, USA
| | - Travis Nguyen
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA 92617, USA
| | - Mando Eijansantos
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA 92617, USA
| | - Ambika Chaudhuri
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA 92617, USA
| | - David Barham
- Department of Urology, University of California, Irvine, Orange, CA 92868, USA
| | - Joel Gelman
- Department of Urology, University of California, Irvine, Orange, CA 92868, USA
| | - Joshua R. Mauney
- Department of Urology, University of California, Irvine, Orange, CA 92868, USA
- Department of Biomedical Engineering, University of California, Irvine, Irvine, CA 92617, USA
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Ha JY, Lee MS. Interventional urethral balloon dilatation before endoscopic visual internal urethrotomy for post-traumatic bulbous urethral stricture: A case report. World J Clin Cases 2022; 10:12787-12792. [PMID: 36579103 PMCID: PMC9791538 DOI: 10.12998/wjcc.v10.i34.12787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/22/2022] [Accepted: 11/07/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND While several treatment options are available for pediatric urethral strictures, the appropriate treatment must be based on several factors. Although endoscopic visual internal urethrotomy (EVIU) could be a first-line treatment option for short pediatric urethral strictures, it is not feasible if the urethroscope cannot pass through the stricture point. Herein, we present a pediatric case of severe post-traumatic bulbous urethral stricture that was successfully treated by EVIU after securing the urethral route via interventional balloon dilatation.
CASE SUMMARY A 12-year-old boy presented at our outpatient clinic with the inability to urinate. He had sustained a straddle injury three months prior. The post-void residual urine volume was 644 mL, and retrograde urethrography confirmed severe stricture of the bulbous urethra. EVIU was planned; however, the first attempt to treat the stricture failed because the urethroscope could not pass through the stricture point. The urethral route was subsequently secured via balloon dilatation of the stricture, which was performed in collaboration with specialists from the department of interventional radiology. The urethroscope was then able to pass, and the repeat EVIU was successful.
CONCLUSION Interventional urethral balloon dilatation before EVIU may help secure the urethral route in the treatment of pediatric urethral strictures.
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Affiliation(s)
- Ji Yong Ha
- Department of Urology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, South Korea
| | - Mu Sook Lee
- Department of Radiology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu 42601, South Korea
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Doersch KM, Barnett D, Chase A, Johnston D, Gabrielsen JS. The contribution of the immune system to genitourinary fibrosis. Exp Biol Med (Maywood) 2022; 247:765-778. [PMID: 35531654 PMCID: PMC9134766 DOI: 10.1177/15353702221090872] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023] Open
Abstract
Fibrotic diseases of the genitourinary tract are devastating and incompletely understood pathologies. These diseases include urethral and ureteral strictures, retroperitoneal fibrosis, and Peyronie's disease. They can contribute to obstructive uropathy and sexual dysfunction. Poor understanding of the pathophysiology of these diseases severely limits our ability to prevent and treat them. Genitourinary fibrotic diseases likely represent related pathologies that share common underlying mechanisms involving wound healing in response to injury. These diseases share the common feature of extracellular matrix abnormalities-such as collagen deposition, transforming growth factor-β accumulation, and dysregulation of collagen maturation-leading to abnormal tissue stiffness. Given the association of many of these diseases with autoimmunity, a systemic pro-inflammatory state likely contributes to their associated fibrogenesis. Herein, we explore the immunologic contribution to fibrogenesis in several fibrotic diseases of the genitourinary system. Better understanding how the immune system contributes to fibrosis in these diseases may improve prevention and therapeutic strategies and elucidate the functions of immunologic contributors to fibrosis in general.
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Affiliation(s)
- Karen M Doersch
- Department of Urology, University of
Rochester Medical Center, Rochester, NY 14642, USA
| | - Daniel Barnett
- Department of Pediatrics, University of
Toledo, Toledo, OH 43614, USA
| | - Abbie Chase
- Department of Urology, University of
Rochester Medical Center, Rochester, NY 14642, USA
| | - Daniel Johnston
- Department of Urology, University of
Rochester Medical Center, Rochester, NY 14642, USA
| | - J Scott Gabrielsen
- Department of Urology, University of
Rochester Medical Center, Rochester, NY 14642, USA
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Xie J, Shen K, Zheng H, Yao Y, Chen Y, Gao C. Grafting of CAG peptides and (polyethylene glycol) on unsaturated polyurethane films to promote selective adhesion and migration of urethral epithelial cells. J Mater Chem B 2021; 9:6201-6211. [PMID: 34312649 DOI: 10.1039/d1tb00547b] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Selective adhesion and migration of urethral epithelial cells (HUCs) over fibroblasts (FIBs) are very important in the reconstruction of the urethral epithelial layer and prevention of ureteral scarring and stenosis. In this study, unsaturated polyurethane (PPFU-CO-SS) films were co-grafted with a cell-resisting poly(ethylene glycol) (PEG) layer and HUC-selective Cys-Ala-Gly (CAG) peptides, whose physicochemical changes were confirmed by X-ray photon spectroscopy, fluorescence spectroscopy and water contact angle measurements. The adhesion and activation of platelets on the PEG/CAG grafted surface were significantly reduced compared to those on the PPFU-CO-SS, resulting in a similar status as that on a PEG-grafted surface. The HUC-selective material could obviously promote the adhesion and migration of HUCs. The ratio of the urethral epithelial cells to fibroblasts on the PEG/CAG grafted surface was nearly 3-fold that on the unmodified PPFU-CO-SS in a co-culture competitive environment. The urethral epithelial cells cultured on the PEG/CAG grafted surface also had the highest migration rate, which was 2.24-fold compared to that on the PPFU-CO-SS control.
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Affiliation(s)
- Jieqi Xie
- Department of Polymer Science and Engineering, MOE Key Laboratory of Macromolecular Synthesis and Functionalization, Zhejiang University, Hangzhou 310027, China.
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Vasyutin I, Butnaru D, Lyundup A, Timashev P, Vinarov A, Kuznetsov S, Atala A, Zhang Y. Frontiers in urethra regeneration: current state and future perspective. Biomed Mater 2021; 16. [PMID: 32503009 DOI: 10.1088/1748-605x/ab99d2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 06/05/2020] [Indexed: 12/13/2022]
Abstract
Despite the positive achievements attained, the treatment of male urethral strictures and hypospadiases still remains a challenge, particularly in cases of severe urethral defects. Complications and the need for additional interventions in such cases are common. Also, shortage of autologous tissue for graft harvesting and significant morbidity in the location of harvesting present problems and often lead to staged treatment. Tissue engineering provides a promising alternative to the current sources of grafts for urethroplasty. Since the first experiments in urethral substitution with tissue engineered grafts, this topic in regenerative medicine has grown remarkably, as many different types of tissue-engineered grafts and approaches in graft design have been suggested and testedin vivo. However, there have been only a few clinical trials of tissue-engineered grafts in urethral substitution, involving hardly more than a hundred patients overall. This indicates that the topic is still in its inception, and the search for the best graft design is continuing. The current review focuses on the state of the art in urethral regeneration with tissue engineering technology. It gives a comprehensive overview of the components of the tissue-engineered graft and an overview of the steps in graft development. Different cell sources, types of scaffolds, assembling approaches, options for vascularization enhancement and preclinical models are considered.
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Affiliation(s)
- Igor Vasyutin
- Sechenov University, 8-2 Trubetskaya str., Moscow 119991, Russia
| | - Denis Butnaru
- Sechenov University, 8-2 Trubetskaya str., Moscow 119991, Russia
| | - Alexey Lyundup
- Sechenov University, 8-2 Trubetskaya str., Moscow 119991, Russia
| | - Peter Timashev
- Sechenov University, 8-2 Trubetskaya str., Moscow 119991, Russia
| | - Andrey Vinarov
- Sechenov University, 8-2 Trubetskaya str., Moscow 119991, Russia
| | - Sergey Kuznetsov
- Sechenov University, 8-2 Trubetskaya str., Moscow 119991, Russia
| | - Anthony Atala
- Wake Forest Institute for Regenerative Medicine, 391 Technology Way NE, Winston-Salem, NC 27101, United States of America
| | - Yuanyuan Zhang
- Sechenov University, 8-2 Trubetskaya str., Moscow 119991, Russia.,Wake Forest Institute for Regenerative Medicine, 391 Technology Way NE, Winston-Salem, NC 27101, United States of America
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Sievert KD, Daum L, Maurer S, Toomey P, Vaegler M, Aufderklamm S, Amend B. Urethroplasty performed with an autologous urothelium-vegetated collagen fleece to treat urethral stricture in the minipig model. World J Urol 2019; 38:2123-2131. [PMID: 31502031 DOI: 10.1007/s00345-019-02888-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/23/2019] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Tissue-engineered materials in urethral reconstructive surgeries are a promising field for innovative therapy. Collagen matrices increase stability of cell-based implants and can promote viability and proliferation of urothelial cells. In this study, a collagen type I-based cell carrier (CCC) with stratified multi-layer autologous urothelium was used for urethroplasty after induction of urethral stricture in eight minipigs. MATERIALS AND METHODS Minipigs underwent surgical procedures to induce urethral stricture by thermocoagulation. Simultaneously, bladder tissue was harvested. Urothelial cells were expanded, labeled with PKH26 and seeded onto CCC in high density. 3 weeks after strictures were induced and verified by urethrography, minipigs underwent urethroplasty using the seeded CCC. Two animals were euthanized after 1, 2, 4, and 24 weeks. Urethras were histologically examined for integration and survival of seeded CCC. In vivo phenotype of multi-layered urothelium matrix constructs was characterized via immunofluorescence staining with pancytokeratin, CK20, p63, E-cadherin and ZO-1. RESULTS Seeded CCCs showed excellent stability and suturability after manipulation and application. Transplanted cells were detected using positive PKH26 fluorescence up to 6 months after labeling. Urothelium matrix implants integrated well into the host tissue without sign of inflammation. Animals showed no sign of rejection or stricture recurrence (urethrography) at any time during experimental period. Immunofluorescence analysis confirmed epithelial phenotype, junction formation and differentiation after 2 weeks. CONCLUSION CCC can be suitable for urologic reconstructive surgeries and represents a promising option for clinical application. Longer follow-up results are required to exclude re-occurrence of stricture reformation.
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Affiliation(s)
- Karl-Dietrich Sievert
- Laboratory of Tissue Engineering, Department of Urology, Eberhard-Karls-University, Tübingen, Germany. .,Department of Urology, Eberhard-Karls-University, Tübingen, Germany. .,Department of Urology, Klinikum Lippe, Röntgenstrasse 18, 32756, Detmold, Germany. .,Department of Urology, University Clinic of Vienna, Vienna, Austria.
| | - L Daum
- Laboratory of Tissue Engineering, Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - S Maurer
- Laboratory of Tissue Engineering, Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - P Toomey
- Laboratory of Tissue Engineering, Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - M Vaegler
- Laboratory of Tissue Engineering, Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - S Aufderklamm
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - B Amend
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
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The effect of platelet-rich plasma injection on post-internal urethrotomy stricture recurrence. World J Urol 2018; 37:1959-1964. [DOI: 10.1007/s00345-018-2597-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/04/2018] [Indexed: 12/12/2022] Open
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Prihadi JC, Sugandi S, Siregar NC, Soejono G, Harahap A. Imbalance in extracellular matrix degradation in urethral stricture. Res Rep Urol 2018; 10:227-232. [PMID: 30538969 PMCID: PMC6251351 DOI: 10.2147/rru.s178904] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Extracellular matrix degradation may play an important role in the etiology of urethral stricture. MMP1 and TIMP1 are involved in extracellular matrix degradation. The aim of this study was to investigate the roles of MMP1, TIMP1, and MMP1:TIMP1 ratio at the remodeling phase of urethral stricture in an animal model. METHODS This research was carried out in collaboration between the Bogor Institute of Agriculture, Universitas Indonesia, and the Eijkman Institute Indonesia. This was an experimental in vivo study in adult male New Zealand rabbits, divided into two groups: a urethral stricture group and a control group. Euthanasia was performed in four rabbits of each group on days 7, 14, 21, 28, and 56. Urethral stricture was confirmed with an 8 F urethral catheter. Several laboratory examinations were done, including H&E and Masson trichrome staining, immunohistochemistry, and ELISA, to determine levels of MMP1 and TIMP1. Percentages of total collagen and collagen type 1 were counted with ImageJ 1.46q software. A general linear model was used for statistic analysis. RESULTS We found that the level of MMP1 was lower, TIMP1 higher, and MMP1:TIMP1 ratio lower in the urethral stricture group than the control group. There was a correlation between MMP1 level with total collagen percentage (r=0.561, P=0.010) and no correlation between TIMP1 and total collagen (r=0.307, P=0.188). CONCLUSION Imbalance in extracellular matrix degradation was marked by decreased MMP1 level and MMP1:TIMP1 ratio and increased TIMP1 level. This results showed that urethral stricture is not only caused by collagen decomposition, but also by the imbalance of extracellular matrix degradation.
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Affiliation(s)
- Johannes C Prihadi
- Department of Surgery, Faculty of Medicine, Atma Jaya Catholic University, Jakarta, Indonesia,
| | - Suwandi Sugandi
- Department of Urology, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia
| | - Nuryati C Siregar
- Department of Pathological Anatomy, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Gunanti Soejono
- Faculty of Veterinary Medicine, Bogor Institute of Agriculture, Bogor, Indonesia
| | - Alida Harahap
- Department of Clinical Pathology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Yang Q, Wang J, Liu F, Ma W, Hu H, Ran C, Li F, Pan Q. A Novel Rabbit Model for Benign Biliary Stricture Formation and the Effects of Medication Infusions on Stricture Formation. Dig Dis Sci 2018; 63:2653-2661. [PMID: 29767392 DOI: 10.1007/s10620-018-5118-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/08/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Benign biliary stricture (BBS) is highly refractory. Currently, there is no effective strategy for prevention of BBS recurrence. The aim of this study is to establish a novel BBS rabbit model and to investigate the efficacy of biliary infusion with anti-proliferative medications for treating BBS. METHOD A BBS model was established via surgical injury and biliary infection. The biliary infusion tube was inserted into the common bile duct via the stump of cystic duct after cholecystectomy. Biliary infusions with Rapamycin, Pirfenidone and Fasudil were performed daily during the 4 weeks following the surgery. The wall thickness and luminal area of the bile duct were assessed. RESULTS All rabbits formed BBS after surgery. The mortality rate was 13% (8/60) and tube withdrawal rate was 4% (2/48). The thickness of the bile duct wall was significantly reduced; whereas the luminal area of the bile duct was dramatically enlarged in the Rapamycin or the Pirfenidone treated group, compared to the saline treated group. Furthermore, the local treatment significantly decreased the levels of proliferation makers, including PCNA, Collagen I and fibrogenic mediators, including ACTA2 and TGF-beta. CONCLUSION We have established a novel animal model for BBS formation. We have further demonstrated that biliary infusion with Rapamycin or Pirfenidone limits the biliary strictures through inhibiting the proliferation of the bile duct wall in this model. This may represent a new avenue for preventing biliary restenosis.
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Affiliation(s)
- Qin Yang
- Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
- Department of Gastroenterology and Hepatology, Postgraduate School Molecular Medicine, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
| | - Junke Wang
- Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Fei Liu
- Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Wenjie Ma
- Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Haijie Hu
- Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Congdun Ran
- Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Fuyu Li
- Department of Hepatobiliary Surgery, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan Province, China.
| | - Qiuwei Pan
- Department of Gastroenterology and Hepatology, Postgraduate School Molecular Medicine, Erasmus MC-University Medical Center, Rotterdam, The Netherlands
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Rapamycin Inhibits the Growth and Collagen Production of Fibroblasts Derived from Human Urethral Scar Tissue. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7851327. [PMID: 29850566 PMCID: PMC5932518 DOI: 10.1155/2018/7851327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/15/2018] [Accepted: 03/01/2018] [Indexed: 11/17/2022]
Abstract
Rapamycin can inhibit fibroblast proliferation, collagen accumulation, and urethral stricture in rabbits. Transforming growth factor-beta-1 (TGF-β1) signaling, with downstream recruitment of Smad2, is known to promote fibrosis. This in vitro study examined the effects of rapamycin on fibroblasts derived from human urethral scar tissue (FHUS) and investigated the possible mechanism with respect to regulation of TGF-β1 signaling. FHUS were cultured from urethral scar tissues collected from four patients with urethral stricture. The cells were exposed to different concentrations of rapamycin (0, 10, 20, 40, 80, or 160 ng/ml) for 24 or 48 hours. Cell growth was assessed by the MTT assay. Collagen content was measured based on hydroxyproline levels. The mRNA expressions of Smad2, eIF-4E, and alpha-1 chains of collagen types I and III (Col1α1 and Col3α1) were determined by semiquantitative reverse-transcription PCR. The protein expressions of Smad2, phospho-Smad2, and eIF-4E were evaluated by western blot. Rapamycin caused a concentration-dependent inhibition of FHUS growth at 24 and 48 hours (P < 0.01). Rapamycin decreased total collagen content (P < 0.01), collagen content per 105 cells (P < 0.05), and mRNA expressions of Col1α1 and Col3α1 (P < 0.05) in a concentration-dependent manner. Rapamycin elicited concentration-dependent reductions in the mRNA (P < 0.05) and protein (P < 0.01) expressions of Smad2 and eIF-4E. The two highest concentrations of rapamycin also enhanced phospho-Smad2 levels (P < 0.01). In conclusion, the present study confirmed that rapamycin may reduce the growth and collagen production of FHUS, possibly through inhibition of TGF-β1 signaling.
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Hua X, Xu Y, Liu G, Sun L, Zhang H, Pan Q, Liu D, Li B. An Experimental Model of Anterior Urethral Stricture in Rabbits With Local Injections of Bleomycin. Urology 2018; 116:230.e9-230.e15. [PMID: 29545036 DOI: 10.1016/j.urology.2017.12.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 12/26/2017] [Accepted: 12/27/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To develop an experimental model of anterior urethral stricture in rabbits using a bleomycin (BLM) injection technique. MATERIALS AND METHODS Thirty adult male New Zealand rabbits were randomly divided into 4 groups. In group 1 (BLM group), BLM was injected into the urethral submucosal tissue every other day through a catheter for 6 weeks at the 3-, 6-, 9-, and 12-o'clock positions of the urethra in 12 rabbits. In group 2 (phosphate-buffered saline [PBS] group), PBS was injected instead of BLM in 6 rabbits. In group 3 (stricture control group), an 8 × 20 mm urethral defect was created in 6 rabbits. In group 4 (normal group), 6 normal rabbits were included. All rabbits in the PBS group and stricture control group, as well as 6 rabbits in the BLM group, were sacrificed at 6 weeks. The remaining 6 rabbits in the BLM group were sacrificed at 10 weeks. Urethrography was performed in all rabbits before sacrifice, and the urethra was harvested for histologic analysis. RESULTS All rabbits in the BLM group showed mild urethral stricture at 4 weeks and significant urethral stricture at 6 weeks, without spontaneous resolution of the stricture at 10 weeks. No urethral stricture was observed in the PBS group at 4 and 6 weeks. Histologic examination confirmed the presence of fibrosis in the BLM group without spontaneous improvement. CONCLUSION BLM injection can induce an experimental model of anterior urethral stricture in rabbits. This simple, highly efficient, reproducible method can be carried out in any laboratory.
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Affiliation(s)
- Xiaoliang Hua
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yujie Xu
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Gang Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Lin Sun
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Hao Zhang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Qiufeng Pan
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Di Liu
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Bing Li
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Protective effect of platelet‐rich plasma on urethral injury model of male rats. Neurourol Urodyn 2017; 37:1286-1293. [DOI: 10.1002/nau.23460] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 11/10/2017] [Indexed: 01/15/2023]
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Siqueira OHK, Oliveira KJ, Carvalho ACG, da Nóbrega ACL, Medeiros RF, Felix-Patrício B, Áscoli FO, Olej B. Effect of tamoxifen on fibrosis, collagen content and transforming growth factor-β1, -β2 and -β3 expression in common bile duct anastomosis of pigs. Int J Exp Pathol 2017; 98:269-277. [PMID: 29205609 DOI: 10.1111/iep.12250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 09/01/2017] [Indexed: 12/14/2022] Open
Abstract
End-to-end anastomosis in the treatment for bile duct injury during laparoscopic cholecystectomy has been associated with stricture formation. The aim of this study was to experimentally investigate the effect of oral tamoxifen (tmx) treatment on fibrosis, collagen content and transforming growth factor-β1, -β2 and -β3 expression in common bile duct anastomosis of pigs. Twenty-six pigs were divided into three groups [sham (n = 8), control (n = 9) and tmx (n = 9)]. The common bile ducts were transected and anastomosed in the control and tmx groups. Tmx (40 mg/day) was administered orally to the tmx group, and the animals were euthanized after 60 days. Fibrosis was analysed by Masson's trichrome staining. Picrosirius red was used to quantify the total collagen content and collagen type I/III ratio. mRNA expression of transforming growth factor (TGF)-β1, -β2 and -β3 was quantified using real-time polymerase chain reaction (qRT-PCR). The control and study groups exhibited higher fibrosis than the sham group, and the study group showed lower fibrosis than the control group (P = 0.011). The control and tmx groups had higher total collagen content than the sham group (P = 0.003). The collagen type I/III ratio was higher in the control group than in the sham and tmx groups (P = 0.015). There were no significant differences in the mRNA expression of TGF-β1, -β2 and -β3 among the groups (P > 0.05). Tmx decreased fibrosis and prevented the change in collagen type I/III ratio caused by the procedure.
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Affiliation(s)
| | - Karen Jesus Oliveira
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | | | | | - Renata Frauches Medeiros
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Bruno Felix-Patrício
- Department of Natural Science, Fluminense Federal University, Rio das Ostras, Rio de Janeiro, Brazil
| | - Fábio Otero Áscoli
- Department of Physiology and Pharmacology, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
| | - Beni Olej
- Department of Clinical Medicine, Fluminense Federal University, Niterói, Rio de Janeiro, Brazil
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Establishing and monitoring of urethral sphincter deficiency in a large animal model. World J Urol 2017; 35:1977-1986. [PMID: 28940030 DOI: 10.1007/s00345-017-2088-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/06/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Different methods for induction and monitoring of urethral sphincter deficiency were explored in a large animal model. METHODS Sphincter deficiency was established in female pigs by dilatation and cauterization, and amount and frequencies of voiding were monitored and explored by pad test. Sphincteric closure pressures were recorded prior to and immediately after treatment of each animal, and on day 21 by two techniques: standard urethral pressure profilometry (s-UPP) and high-definition urethral pressure profilometry (HD-UPP). Tissue samples of the urethrae were analyzed by histochemistry (AZAN- and Sirius Red staining) and by immunohistochemistry detecting desmin and fast-myosin to depict muscular tissues. RESULTS After 3 weeks of observation animals treated by dilatation plus electrocautery presented with sphincter deficiency: measurements by both, s-UPP and HD-UPP demonstrated the maximal closure pressure reduced to baseline levels and a diminished area under the curve. Histological analyses documented, that dilatation yielded a pitted connective tissue and cauterization lead to muscle damage. Animals treated by either dilatation only or proximal injury only recovered within 3 weeks. By pad test no significant differences between untreated and treated animals or between the differently treated groups were recorded. CONCLUSION Significant urethral sphincter deficiency can be induced in female pigs by a combination of urethral dilatation and distal electrocautery. Sphincter deficiency can be measured by standard and high-definition urethral pressure profilometry. It was maintained over 21 days after induction and correlated with visible changes in the tissue structure of the distal urethra.
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Zhou S, Yang R, Zou Q, Zhang K, Yin T, Zhao W, Shapter JG, Gao G, Fu Q. Fabrication of Tissue-Engineered Bionic Urethra Using Cell Sheet Technology and Labeling By Ultrasmall Superparamagnetic Iron Oxide for Full-Thickness Urethral Reconstruction. Theranostics 2017; 7:2509-2523. [PMID: 28744331 PMCID: PMC5525753 DOI: 10.7150/thno.18833] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 04/21/2017] [Indexed: 01/18/2023] Open
Abstract
Urethral strictures remain a reconstructive challenge, due to less than satisfactory outcomes and high incidence of stricture recurrence. An “ideal” urethral reconstruction should establish similar architecture and function as the original urethral wall. We fabricated a novel tissue-engineered bionic urethras using cell sheet technology and report their viability in a canine model. Small amounts of oral and adipose tissues were harvested, and adipose-derived stem cells, oral mucosal epithelial cells, and oral mucosal fibroblasts were isolated and used to prepare cell sheets. The cell sheets were hierarchically tubularized to form 3-layer tissue-engineered urethras and labeled by ultrasmall super-paramagnetic iron oxide (USPIO). The constructed tissue-engineered urethras were transplanted subcutaneously for 3 weeks to promote the revascularization and biomechanical strength of the implant. Then, 2 cm length of the tubularized penile urethra was replaced by tissue-engineered bionic urethra. At 3 months of urethral replacement, USPIO-labeled tissue-engineered bionic urethra can be effectively detected by MRI at the transplant site. Histologically, the retrieved bionic urethras still displayed 3 layers, including an epithelial layer, a fibrous layer, and a myoblast layer. Three weeks after subcutaneous transplantation, immunofluorescence analysis showed the density of blood vessels in bionic urethra was significantly increased following the initial establishment of the constructs and was further up-regulated at 3 months after urethral replacement and was close to normal level in urethral tissue. Our study is the first to experimentally demonstrate 3-layer tissue-engineered urethras can be established using cell sheet technology and can promote the regeneration of structural and functional urethras similar to normal urethra.
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Aufderklamm S, Vaegler M, Kelp A, Maurer S, Gustafsson L, Mundhenk J, Busch S, Daum L, Stenzl A, Amend B, Sievert KD. Collagen cell carriers seeded with human urothelial cells for urethral reconstructive surgery: first results in a xenograft minipig model. World J Urol 2016; 35:1125-1132. [PMID: 27783146 DOI: 10.1007/s00345-016-1959-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 10/16/2016] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Urethral strictures are a common disease of the lower urinary tract in men. At present, the use of buccal mucosa is the method of choice for long or recurrent strictures. However, autologous tissue-engineered grafts are still under investigation for reconstructive urological surgery. The aim of this pilot study was to evaluate the use of human urothelial cells (HUC) seeded on bovine collagen type I-based cell carriers (CCC) in an animal model and to evaluate short-term outcome of the surgical procedure. METHODS Four male Göttingen minipigs were used with immunosuppression (cyclosporine A) for this pilot xenograft study. HUC obtained from human benign ureteral tissue were stained by PKH26 and seeded on a collagen cell carrier (CCC). Seven weeks after urethral stricture induction and protective vesicostomy, cell-seeded CCC was implanted in the urethra with HUC luminal and antiluminal, respectively. After two weeks animals were euthanized, urethrography and histological assessment were performed. RESULTS Surgery was technically feasible in all minipigs. Stricture was radiologically established 7 weeks after induction. CCC was visible after two weeks and showed good integration without signs of inflammation or rejection. In the final urethrography, no remaining stricture could be detected. Near porcine urothelium, PKH26-positive areas were found even if partially detached from CCC. Although diminished, immunofluorescence with pankeratin, CK20, E-cadherin and ZO-1 showed intact urothelium in several areas on and nearby CCC. CONCLUSION Finally, this study demonstrates that the HUC-seeded CCC used as a xenograft in minipigs is technically feasible and shows promising results for further studies.
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Affiliation(s)
- Stefan Aufderklamm
- Department of Urology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Martin Vaegler
- Experimental and Clinical Research Center (ECRC), University Clinic Charité, Berlin, Germany
| | - Alexandra Kelp
- Department of Urology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Sabine Maurer
- Department of Urology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Leon Gustafsson
- Department of Urology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Jens Mundhenk
- Department of Urology, Diakonie Hospital Stuttgart, Stuttgart, Germany
| | | | - Lisa Daum
- Animal Doctor Facility, Neustadt/Aisch, Germany
| | - Arnulf Stenzl
- Department of Urology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Bastian Amend
- Department of Urology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Karl-Dietrich Sievert
- Department of Urology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
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Castiglione F, Dewulf K, Hakim L, Weyne E, Montorsi F, Russo A, Boeri L, Bivalacqua TJ, De Ridder D, Joniau S, Albersen M, Hedlund P. Adipose-derived Stem Cells Counteract Urethral Stricture Formation in Rats. Eur Urol 2016; 70:1032-1041. [PMID: 27156445 DOI: 10.1016/j.eururo.2016.04.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 04/20/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND A medical treatment for urethral stricture (US) is not yet available. OBJECTIVE To evaluate if local injection of human adipose tissue-derived stem cells (hADSC) prevents urethral fibrosis in a rat model of US. DESIGN, SETTING, AND PARTICIPANTS Male rats were divided into three groups: sham, US, and hADSC (n=12 each). Sham rats received a vehicle injection in the urethral wall. US and hADSCs were incised and injected with the fibrosis-inducer transforming growth factor-β1 in the urethral wall. INTERVENTION One day later, hADSCs were injected in the urethral wall of hADSC rats whereas sham and US rats were injected with the vehicle. After 4 wk, the rats underwent cystometries and tissues were then harvested for functional and molecular analyses. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Cystometry, microultrasound, histochemistry, organ bath studies, reverse transcription polymerase chain reaction, and western blot. RESULTS AND LIMITATIONS US rats exhibited 49-51% shorter micturition intervals, 35-51% smaller micturition volumes and bladder capacity, 33-62% higher threshold pressures and flow pressures, and 35-37% lower bladder filling compliance compared with hADSC-treated rats and sham rats (p<0.05). By ultrasound, US rats had hyperechogenic and thick urethral walls with narrowed lumen compared with sham rats, whereas hADSC rats displayed less extensive urethral changes. Isolated detrusor from US rats exhibited 34-55% smaller contractions than detrusor from sham rats (p<0.05). Corresponding values were 11-35% for isolated detrusors from hADSC rats. Collagen and elastin protein expression were increased in the penile urethras of US rats compared with sham and hADSC groups (p<0.05). Endothelial and inducible nitric oxide synthase expressions were higher (p<0.05) in the hADSC group. Compared with US rats, hADSC rats demonstrated decreased expression of several fibrosis-related genes. Administration of hADSCs was performed at an early stage of US development, which we consider a limitation of the study. CONCLUSIONS Local injection of hADSCs prevents stricture formation and urodynamic complications in a new rat model for US. PATIENT SUMMARY Stem cell therapy is effective for preventing urethral stricture in an experimental setting.
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Affiliation(s)
- Fabio Castiglione
- Laboratory for Experimental Urology, Organ Systems, Department of Development and Regeneration, University of Leuven, Leuven, Belgium; Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Karel Dewulf
- Laboratory for Experimental Urology, Organ Systems, Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Lukman Hakim
- Laboratory for Experimental Urology, Organ Systems, Department of Development and Regeneration, University of Leuven, Leuven, Belgium; Department of Urology, Airlangga University/Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Emmanuel Weyne
- Laboratory for Experimental Urology, Organ Systems, Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Russo
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luca Boeri
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute, Department of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Dirk De Ridder
- Laboratory for Experimental Urology, Organ Systems, Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Steven Joniau
- Laboratory for Experimental Urology, Organ Systems, Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Maarten Albersen
- Laboratory for Experimental Urology, Organ Systems, Department of Development and Regeneration, University of Leuven, Leuven, Belgium.
| | - Petter Hedlund
- Department of Clinical and Experimental Pharmacology, Lund University, Sweden; Division of Drug Research, Department of Medical and Health Sciences, Linköping University, Sweden
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Atala A, Danilevskiy M, Lyundup A, Glybochko P, Butnaru D, Vinarov A, Yoo JJ. The potential role of tissue-engineered urethral substitution: clinical and preclinical studies. J Tissue Eng Regen Med 2015; 11:3-19. [PMID: 26631921 DOI: 10.1002/term.2112] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 10/01/2015] [Accepted: 10/15/2015] [Indexed: 01/10/2023]
Abstract
Urethral strictures and anomalies remain among the difficult problems in urology, with urethroplasty procedures being the most effective treatment options. The two major types of urethroplasty are anastomotic urethroplasty and widening the urethral lumen using flaps or grafts (i.e. substitution urethroplasty). However, no ideal material for the latter has been found so far. Designing and selecting such a material is a necessary and challenging endeavour, driving the need for further bioengineered urethral tissue research. This article reviews currently available studies on the potentialities of tissue engineering in urethral reconstruction, in particular those describing the use of both acellular and recellularized tissue-engineered constructs in animal and human models. Possible future developments in this field are also discussed. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Anthony Atala
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mikhail Danilevskiy
- Research Institute of Uronephrology and Reproductive Health, I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Alexey Lyundup
- Research Institute of Molecular Medicine, I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Petr Glybochko
- I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Denis Butnaru
- Research Institute of Uronephrology and Reproductive Health, I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Andrey Vinarov
- Research Institute of Uronephrology and Reproductive Health, I. M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - James J Yoo
- Wake Forest Institute for Regenerative Medicine, Wake Forest University, Winston-Salem, NC, USA
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Nguyen TH, Rhee YH, Ahn JC, Kang HW. Circumferential irradiation for interstitial coagulation of urethral stricture. OPTICS EXPRESS 2015; 23:20829-40. [PMID: 26367936 DOI: 10.1364/oe.23.020829] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
An optical diffuser was developed to achieve radially uniform light irradiation by micro-machining helical patterns on the fiber surface for endoscopically treating urethral stricture. Spatial emission from the diffuser was evaluated by goniometric measurements. A computational model was developed to predict spatio-temporal heat distribution during the interstitial coagulation. The fabricated diffuser yielded circumferential light distribution with slightly concentrated energy at the proximal end. Both simulation and tissue testing demonstrated approximately 1-mm coagulation thickness at 6 W for 10 sec with 1470 nm. The proposed optical diffuser may be a feasible tool to treat the urethral stricture in a uniform manner.
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21
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Tissue engineering in urothelium regeneration. Adv Drug Deliv Rev 2015; 82-83:64-8. [PMID: 25477302 DOI: 10.1016/j.addr.2014.11.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/04/2014] [Accepted: 11/24/2014] [Indexed: 12/12/2022]
Abstract
The development of therapeutic treatments to regenerate urothelium, manufacture tissue equivalents or neourethras for in-vivo application is a significant challenge in the field of tissue engineering. Many studies have focused on urethral defects that, in most cases, inadequately address current therapies. This article reviews the primary tissue engineering strategies aimed at the clinical requirements for urothelium regeneration while concentrating on promising investigations in the use of grafts, cellular preparations, as well as seeded or unseeded natural and synthetic materials. Despite significant progress being made in the development of scaffolds and matrices, buccal mucosa transplants have not been replaced. Recently, graft tissues appear to have an advantage over the use of matrices. These therapies depend on cell isolation and propagation in vitro that require, not only substantial laboratory resources, but also subsequent surgical implant procedures. The choice of the correct cell source is crucial when determining an in-vivo application because of the risks of tissue changes and abnormalities that may result in donor site morbidity. Addressing an appropriately-designed animal model and relevant regulatory issues is of fundamental importance for the principal investigators when a therapy using cellular components has been developed for clinical use.
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22
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Chun SY, Kim BS, Kwon SY, Park SI, Song PH, Yoo ES, Kim BW, Kwon TG, Kim HT. Urethroplasty using autologous urethral tissue-embedded acellular porcine bladder submucosa matrix grafts for the management of long-segment urethral stricture in a rabbit model. J Korean Med Sci 2015; 30:301-7. [PMID: 25729254 PMCID: PMC4330486 DOI: 10.3346/jkms.2015.30.3.301] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 10/30/2014] [Indexed: 11/20/2022] Open
Abstract
We conducted this study to evaluate the combined effect of acellular bladder submucosa matrix (BSM) and autologous urethral tissue for the treatment of long segment urethral stricture in a rabbit model. To prepare the BSM, porcine bladder submucosa was processed, decellularized, configured into a sheet-like shape, and sterilized. Twenty rabbits were randomized to normal control, urethral stricture, urethroplasty using BSM only or BSM/autologous urethral tissue (n=5 per group). Retrograde urethrography was performed at 4, 8, and 12 weeks postoperatively, and the grafted specimens were harvested at week 12 to evaluate urethral reconstruction through histopathologic and immunohistochemical analysis. The mean urethral width of the control, stricture, BSM, and BSM/autologous urethral tissue groups at week 12 was 10.3±0.80, 3.8±1.35, 8.8±0.84, and 9.1±1.14 mm, respectively. The histopathologic study revealed that the BSM/autologous urethral tissue graft had a normal area of urethral lumen, compact muscular layers, complete epithelialization, and progressive infiltration by vessels in the regenerated urethra. In contrast, the BSM grafts revealed keratinized epithelium, abundant collagenized fibrous connective tissue, and were devoid of bundles of circular smooth muscle. Nontransected ventral onlay-augmented urethroplasty using an acellular BSM scaffold combined with an autologous urethral tissue graft represents a feasible procedure for urethral reconstruction.
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Affiliation(s)
- So Young Chun
- Joint Institute for Regenerative Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Bum Soo Kim
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Se Yun Kwon
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sung Il Park
- Laboratory Animal Center, Yeungnam University, Daegu, Korea
| | - Phil Hyun Song
- Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Eun Sang Yoo
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Bup Wan Kim
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Tae Gyun Kwon
- Joint Institute for Regenerative Medicine, Kyungpook National University Hospital, Daegu, Korea
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun Tae Kim
- Department of Urology, School of Medicine, Kyungpook National University, Daegu, Korea
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Arenas da Silva LF, Micol L, Tiemessen D, van Kuppevelt TH, Frey P, Oosterwijk E, Geutjes P, Feitz WF. Is There a Need for Smooth Muscle Cell Transplantation in Urethral Reconstruction? Tissue Eng Part A 2014; 20:1542-9. [DOI: 10.1089/ten.tea.2013.0185] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Lionel Micol
- Institute for Bioengineering, School of Life Sciences and School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Dorien Tiemessen
- Department of Urology, Radboud University Nijmegen, Medical Centre, Nijmegen, Netherlands
| | - Toin H. van Kuppevelt
- Department of Biochemistry, Radboud University Nijmegen Medical Centre, NCMLS, Nijmegen, Netherlands
| | - Peter Frey
- Institute for Bioengineering, School of Life Sciences and School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Egbert Oosterwijk
- Department of Urology, Radboud University Nijmegen, Medical Centre, Nijmegen, Netherlands
| | - Paul Geutjes
- Department of Urology, Radboud University Nijmegen, Medical Centre, Nijmegen, Netherlands
| | - Wout F. Feitz
- Institute for Bioengineering, School of Life Sciences and School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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Hu WF, Li CL, Zhang HP, Li TT, Zeng XY. An Experimental Model of Urethral Stricture in Rabbits Using Holmium Laser under Urethroscopic Direct Visualization. Urol Int 2014; 93:108-12. [DOI: 10.1159/000355353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 08/28/2013] [Indexed: 11/19/2022]
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Vaegler M, Amend B, Aicher W, Stenzl A, Sievert KD. [Stem cell therapy and tissue engineering in regenerative urology]. Urologe A 2013; 52:1671-8. [PMID: 24166059 DOI: 10.1007/s00120-013-3328-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND So far there is no clinically established, effective tissue engineering therapy for dysfunction or defects of the lower urinary tract. The concentration of experimental data, initial clinical studies and individual case reports underlines that stem cell treatment for bladder storage and voiding problems, erectile dysfunction and other urothelial defects of the lower urinary tract could close the gap between individualized therapy and potential biomedical applications. RESULTS As a result of fundamental research work over the last decade a characterization of various stem cell populations and evaluation of different urological therapy options could be performed. Thereby, aspects of optimal administration, migration, secretion of bioactive factors and stage of differentiation of stem cells with respect to an improved efficiency of treatment were investigated. Because successful tissue regeneration depends on angiogenesis and innervation, particular attention was paid to these important factors. CONCLUSIONS Various clinical indications for stem cell treatment and tissue reconstruction that may be required after radical prostatectomy, such as stress urinary incontinence, urethral reconstruction and erectile dysfunction have materialized and are currently being verified in preclinical studies and phase I trials.
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Affiliation(s)
- M Vaegler
- Klinik für Urologie, Universitätsklinik Tübingen, Eberhard-Karls-Universität Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Deutschland
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Tritschler S, Roosen A, Füllhase C, Stief CG, Rübben H. Urethral stricture: etiology, investigation and treatments. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:220-6. [PMID: 23596502 DOI: 10.3238/arztebl.2013.0220] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 02/05/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Urethral stricture is a narrowing of the urethra due to scar tissue, which leads to obstructive voiding dysfunction with potentially serious consequences for the entire urinary tract. Its prevalence among men in industrial countries is estimated at 0.9%. It produces obstructive and irritative urinary symptoms and can ultimately impair renal function. Urethral strictures can be caused by diagnostic or therapeutic urological procedures. These procedures are being performed ever more commonly, because the population is aging; thus, urethral strictures will probably become more common as well. METHODS We selectively reviewed pertinent original articles and meta-analyses (1995-2012) on the causes, diagnostic evaluation, and treatment of urethral strictures, which were retrieved by a search in the PubMed database. RESULTS Most of the relevant publications are reports of retrospective studies from single centers. Only a few prospective randomized trials and structured reviews are available. The overall level of the scientific evidence is low. 45% of urethral strictures are iatrogenic, 30% idiopathic, and 20% due to bacterial urethritis. Strictures are diagnosed with a flow test and a retrograde urethrogram. Short bulbar strictures can be treated endoscopically. For recurrent and complex strictures, only open urethral surgery can reliably and permanently remove the infravesical obstruction. CONCLUSION Urethral strictures must be recognized and treated so that their most serious long-term complication, impaired renal function, can be prevented. The clinical utility of urethrotomy is limited by a high recurrence rate.
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Affiliation(s)
- Stefan Tritschler
- Department of Urology, Ludwig-Maximilians-Universität München, Germany.
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Vaegler M, Lenis AT, Daum L, Amend B, Stenzl A, Toomey P, Renninger M, Damaser MS, Sievert KD. Stem cell therapy for voiding and erectile dysfunction. Nat Rev Urol 2012; 9:435-47. [PMID: 22710667 PMCID: PMC3769422 DOI: 10.1038/nrurol.2012.111] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Voiding dysfunction comprises a variety of disorders, including stress urinary incontinence and overactive bladder, and affects millions of men and women worldwide. Erectile dysfunction (ED) also decreases quality of life for millions of men, as well as for their partners. Advanced age and diabetes are common comorbidities that can exacerbate and negatively impact upon the development of these disorders. Therapies that target the pathophysiology of these conditions to halt progression are not currently available. However, stem cell therapy could fill this therapeutic void. Stem cells can reduce inflammation, prevent fibrosis, promote angiogenesis, recruit endogenous progenitor cells, and differentiate to replace damaged cells. Adult multipotent stem cell therapy, in particular, has shown promise in case reports and preclinical animal studies. Stem cells also have a role in urological tissue engineering for ex vivo construction of bladder wall and urethral tissue (using a patient's own cells) prior to transplantation. More recent studies have focused on bioactive factor secretion and homing of stem cells. In the future, clinicians are likely to utilize allogeneic stem cell sources, intravenous systemic delivery, and ex vivo cell enhancement to treat voiding dysfunction and ED.
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Affiliation(s)
- Martin Vaegler
- Department of Urology, University of Tuebingen, Hoppe-Seyler-Strasse 3, D72076 Tuebingen, Germany
| | - Andrew T Lenis
- The Cleveland Clinic, Case Western Reserve University School of Medicine, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Lisa Daum
- Department of Urology, University of Tuebingen, Hoppe-Seyler-Strasse 3, D72076 Tuebingen, Germany
| | - Bastian Amend
- Department of Urology, University of Tuebingen, Hoppe-Seyler-Strasse 3, D72076 Tuebingen, Germany
| | - Arnulf Stenzl
- Department of Urology, University of Tuebingen, Hoppe-Seyler-Strasse 3, D72076 Tuebingen, Germany
| | - Patricia Toomey
- Department of Urology, University of Tuebingen, Hoppe-Seyler-Strasse 3, D72076 Tuebingen, Germany
| | - Markus Renninger
- Department of Urology, University of Tuebingen, Hoppe-Seyler-Strasse 3, D72076 Tuebingen, Germany
| | - Margot S Damaser
- The Cleveland Clinic, Case Western Reserve University School of Medicine, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Karl-Dietrich Sievert
- Department of Urology, University of Tuebingen, Hoppe-Seyler-Strasse 3, D72076 Tuebingen, Germany
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