Clinical challenges in tissue-engineered urethral reconstruction

Urologic patients often present with congenital and/or acquired tissue and organ dysfunctions requiring surgical reconstruction to re-establish normal genitourinary system function. The field has made tremendous use of limited resources, developing creative and effective ways to reconstruct or replace inadequate tissues. Urethral reconstruction continues to be a challenging area of expertise for urologists. Whilst for some conditions, only one or a few procedures are recognized as standard of treatment, over 300 techniques are known for urethral stricture and hypospadias repair. This diversity illustrates the complexity of these conditions and indicates the lack of a gold standard procedure. In addition to the surgeon’s skills, successful outcomes of any procedure depend on the availability of appropriate tissues. A wide variety of tissues, such as (vascularized) skin grafts, and bladder and buccal mucosa, have been used in urethral repair. However, all of these substitutes have limitations compared to autologous urethral tissue, which can lead to complications (e.g., stricture formation, graft failure). Furthermore, the amount of tissue that can be harvested from a donor site is limited, which can be problematic, especially in the case of long defects. To overcome these difficulties, alternative methods for urethral reconstruction have been explored.