Use of Reconstructed Small Intestine Submucosa for Urinary Tract Replacement

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Abstract
We used reconstructed SIS (ReSIS), a photocrosslinked biomaterial, to create grafts in various shapes and sizes. Sheets of ReSIS were placed in 14 swine to repair bladder defects, and ReSIS tubes were placed in six swine to replace a segment of excised ureter. Histologic analysis of the bladder repair revealed transitional urothelial cells lining the ReSIS by 1 week. After 2 weeks, fibroblasts and mononuclear cells had infiltrated the ReSIS, neovascularization had occurred, and the urothelial lining was more complex, containing multiple cell layers. After 4 weeks, a definite submucosa was present and the ReSIS was starting to degrade. An initial muscular regeneration was demonstrated at 12 weeks. No foreign body reaction, calcification, or sedimentation was noted in any animal. The ureteral implants showed identical histologic changes, without obstruction or leakage of the replaced segment. The ReSIS allowed rapid urothelial regeneration, ingrowth of new blood vessels, and the orderly deposition and organization of new collagen. Our study demonstrates that the photocrosslinking technique used to create larger sheets and tubes of this biomaterial (ReSIS) does not detract from the positive attributes of the SIS and should improve its usefulness in accomplishing larger bladder augmentations and ureter replacements.