Karl-Dietrich Sievert

Cystectomy causes immunosuppression in bladder cancer.

Bladder cancer is the fourth most common cancer among men and the sixth most common non-cutaneous cancer overall, with 54,200 new cases and 12,000 deaths in 1999 (NCI website). Local treatment may be successful, but tumors commonly reoccur. Tumor invasion into the muscle layer of the bladder wall usually requires total bladder removal. Without metastasis, cystectomy with urinary diversion is the only possible cure for these patients, although the risk for postoperative metastasis development is considerably high.

Chapter 16:Regeneration of the Lower Urinary Tract: Clinical Applications and Future Outlook

Due to the absence of transplantable organ resources and the reconstructive urological demand, researchers have been called to action in order advance tissue engineering and stem cell research. As the archetype of pluripotent cells, human embryonic stem cells (hESCs) and inducible stem cells (iPS) are still far from any clinical application, whereas new and interestingly adult sources of stem cells are coming into focus. Such urological reconstructive approaches such as adult myoblasts for an autologous therapy option of stress urinary incontinence and the recently advances in pluripotent adult human germline stem cells (haGSCs) have a potentially suitable application in male reconstructive medicine. Further and comparable progress must be made in the female approach. Despite its histological complexity, there has been a huge progression in the development of renal tissue formation. Even the feasibility of engineering the entire pendular penile corporal bodies in a rabbit model could be shown. The further development of suitable surgical harvesting and implantation techniques allow sufficient and functional graft survival. Urological TE should be positioned as “a young field” that promises to influence urological treatment in the “near future”.