Tissue engineering for the lower urinary tract: A review of a state of the art approach

Objectives: Tissue engineering (TE) has become synonymous with physiological and functional reconstructive approaches in medicine. Although the goals of TE are ambitious and have not yet been attained, significant milestones have been achieved and future possibilities are great. To examine these possibilities with a special emphasis on the lower urinary tract, we provide a review of the development of TE techniques and a high-level overview of related regulatory and legal issues. Methods: Current trends in the field of TE, including the use of stem cells, scaffold optimization, and acellular tissue and growth factors, were reviewed and critically assessed through a comprehensive literature review using the PubMed database. Because of the rapid development of new TE approaches, recent abstracts from international urology conventions were included. A review of 2007 European Medicines Agency and Commission for Advanced Therapies legal regulations was also performed. Results: Although several clinical TE approaches have been developed, most lack objective validation. A variety of TE techniques are currently under development or investigation, but thus far, no one approach is clearly superior on the basis of significant long-term studies. A medical product based on TE and stem cells can be successfully developed only with careful consideration of legal and ethical regulations. Conclusions: TE holds the promise for a tremendous impact on reconstructive urology. However, research must be focused and intensified for the full potential clinical benefits to be made widely available. Because the product development is affected by legal regulations, consensus must be achieved. (c) 2007 Published by Elsevier B.V. on behalf of European Association of Urology.