Autologous Penile Corpora Cavernosa Replacement using Tissue Engineering Techniques

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Abstract
The availability of engineered tissues would be beneficial to patients undergoing penile reconstruction. We explored the possibility of replacing an entire cross-sectional segment of both corporal bodies with autologous engineered tissues in rabbits, and investigated the structural and functional integrity of the neo-corpora. Acellular corporal collagen matrices were obtained from donor rabbit penis. Autologous corpus cavernosal smooth muscle and endothelial cells were harvested, expanded and seeded on the matrices. An entire cross-sectional segment of protruding rabbit phallus was excised, leaving the urethra intact. A total of 26 matrices, including 18 seeded with cells and 8 without cells, were interposed into the excised corporal space. An additional 4 rabbits that did not undergo surgical intervention served as normal controls. Functional and structural parameters (cavernosography, cavernosometry, mating behavior and sperm ejaculation) were followed for 6 months. Gross examination, and histochemical, immunocytochemical and Western blot analyses were performed at 3 and 6 months after implantation. The experimental corporal bodies demonstrated intact structural integrity on cavernosography and decreased maximal intracavernosal pressures on cavernosometry compared to normal controls. Mating activity in animals with engineered corpora normalized by 3 months postoperatively. The presence of sperm was confirmed during mating and was present in all rabbits with engineered corpora but in only 2 with the matrix alone. Histologically sinusoidal spaces and walls lined with endothelial and smooth muscle cells were observed in the engineered grafts. Each cell type was identified immunocytochemically. Grafts without cells contained fibrotic tissue and calcifications with sparse corporal elements. Western blot analysis of engineered grafts showed nitric oxide synthase activity similar to normal controls. Autologous corpus cavernosal smooth muscle and endothelial cells seeded on collagen matrices can form corpora cavernosa tissue structures in a rabbit model. Engineered corpora cavernosa achieved adequate structural and functional parameters. This technology may be applicable to patients who require additional tissue for phallic reconstruction.