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  • Dr. Wise; Laboratory Grown Bladder

    Dr. Oz talked about this on Oprah the other day. This sounds great for all of us that will be needing this surgery. I wonder how hard it will be to qualify as a candidate for the surgery? Have you heard much about this?

    www.wfirm.org

    Wake Forest Physician Reports First Human Recipients of Laboratory-Grown Organs
    --------------------------------------------------------------------------------

    WINSTON-SALEM, N.C. -- The first human recipients of laboratory-grown organs were reported today by Anthony Atala, M.D., director of the Institute for Regenerative Medicine at Wake Forest University School of Medicine. In The Lancet, Atala describes long-term success in children and teenagers who received bladders grown from their own cells.

    “This is one small step in our ability to go forward in replacing damaged tissues and organs,” said Atala, who is now working to grow 20 different tissues and organs, including blood vessels and hearts, in the laboratory.

    The engineered bladders were grown from the patients’ own cells, so there is no risk of rejection. Scientists hope that laboratory-grown organs can one day help solve the shortage of donated organs available for transplantation. Atala reported that the bladders showed improved function over time -- with some patients being followed for more than seven years.

    The study involved patients from 4 to 19 years old who had poor bladder function because of a congenital birth defect that causes incomplete closure of the spine. Their bladders were not pliable and the high pressures could be transmitted to their kidneys, possibly leading to kidney damage. They had urinary leakage, as frequently as every 30 minutes.

    The main goal of the surgery was to reduce pressures inside the bladder to preserve the kidneys. In addition, urinary incontinence, which was a problem before the surgery, improved in all patients.

    “It is rewarding when you can see the improved quality of life in these patients,” said Atala.

    The patients were candidates for a procedure to repair the non-functioning bladder tissue with tissue from the intestines. This 100-year-old procedure is also used to “build” bladders for patients with bladder cancer. But because the intestine is designed to absorb nutrients and a bladder is designed to excrete, patients who have the procedure are prone to such problems as osteoporosis, increased risk of cancer and kidney stone formation.

    Atala had been working since 1990 to build bladders from patients’ own cells and in 1999 implanted the first organ in a patient. His current report discusses the long-term results with seven children who had the surgery.

    “We wanted to go slowly and carefully and make sure we did it the right way,” said Atala. “This is a small, limited experience, but it has enough follow-up to show us that tissue engineering is a viable tool that will allow us to tackle problems of similar magnitude.”

    The report involves children who were treated at Boston Children’s Hospital when Atala was director of the Tissue Engineering and Cellular Therapeutics at Harvard Medical School. In 2004, Atala’s program moved to Wake Forest.

    The process for growing each patient’s organ began with a biopsy to get samples of muscle cells and the cells that line the bladder walls. These cells were grown in a culture in the laboratory until there were enough cells to place onto a specially constructed biodegradable mold, or scaffold, shaped like a bladder.

    The cells continued to grow. Then, seven or eight weeks after the biopsy, the engineered bladders were sutured to patients’ original bladders during surgery. The scaffold was designed to degrade as the bladder tissue integrated with the body. Testing showed that the engineered bladders functioned as well as bladders that are repaired with intestine tissue, but with none of the ill effects.

    “We have shown that regenerative medicine techniques can be used to generate functional bladders that are durable,” said Atala. “This suggests that regenerative medicine may one day be a solution to the shortage of donor organs in this country for those needing transplants.”

    Atala said the approach needs further study before it can be widely used. Additional clinical trials of the bladders are scheduled to begin later this year.
    Last edited by sreneet; 03-30-2009, 04:06 PM.
    Renee

  • #2
    This is already being used at a few research centers for bladder augmentations in people with SCI (instead of using bowel or stomach). It of course does not restore normal bladder function (it doesn't fix the neurologic bladder function), but it should be a much less traumatic way to do this surgery.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

    Comment


    • #3
      Bill has a stage 4 pressure ulcer on his left ischium that we have been treating (seems like) forever. I have been trying to get our doc to look at trying this treatment and it looks like my determination has paid off. The surgeon who is doing Bill's debridement is going to try the porcine cellular mesh - http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum ... which I believe is related to this research .
      We're trying to avoid another flap surgery if possible ..... seeing Dr.Oz on Oprah with the guy who's finger tip grew back really got me excited about the possibilities.

      Obieone
      Last edited by Obieone; 03-30-2009, 12:25 PM.
      ~ Be the change you wish to see in the world ~ Mahatma Gandi


      " calling all Angels ...... calling all Angels ....walk me through this one .. don't leave me alone .... calling all Angels .... calling all Angels .... we're tryin' and we're hopin' cause we're not sure how ....... this .... goes ..."
      Jane Siberry

      Comment


      • #4
        Obieone, we have been using porcine intestinal matrix dressing (Oasis) for pressure ulcers for at least 5 years. It is not magic, and would not necessarily replace flap surgery, esp. if it is for a stage III or IV wound, but we do use it if the person is not a surgical candidate, and sometimes have even had wounds close, although they are unlikely to be able to tolerate weight bearing such as you can do after a flap.

        (KLD)
        The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

        Comment


        • #5
          it's weird, I had "life threatening" stage IV pressure sores and I had oasis wound matrix applied at a doctors office a few times and my Mom does excellent wound care and now I think they're all pretty much closed. My Mom also applied some substance to them every morning.
          I will e-mail this to her so she can explain more in-depth
          "That's not smog! It's SMUG!! " - randy marsh, southpark

          "what???? , you don't 'all' wear a poop sac?.... DAMNIT BONNIE, YOU LIED TO ME ABOUT THE POOP SAC!!!! "


          2010 SCINet Clinical Trial Support Squad Member
          Please join me and donate a dollar a day at http://justadollarplease.org and copy and paste this message to the bottom of your signature

          Comment


          • #6
            Yes Anthony's Dr. told us about the oasis wound matrix back in about 2004 after coming home from the hospital with horrible wounds. I did not put anything else on with the matrix. It worked wonders. It jump started the healing process right away. All his wounds are healed now and have been since about 2006. We found out that wounds tend to get stagnant to any treatment after a while of use and you have to change treatments occassionally. Toward the end when they were almost healed we used Promogran a foam type substance you put on with dry gauze and paper tape and leave on for a couple of days and repeat and this healed them up nicely.

            http://www.healthpoint.com/divisions/tm/prodOASIS.cfm
            Cindy Waters
            mom to Anthony, right c5, left c4 (24yo)
            injury march 2003

            Comment


            • #7
              Hope that can help something and sorry for highjacking this thread, the conversation like morphed
              "That's not smog! It's SMUG!! " - randy marsh, southpark

              "what???? , you don't 'all' wear a poop sac?.... DAMNIT BONNIE, YOU LIED TO ME ABOUT THE POOP SAC!!!! "


              2010 SCINet Clinical Trial Support Squad Member
              Please join me and donate a dollar a day at http://justadollarplease.org and copy and paste this message to the bottom of your signature

              Comment


              • #8
                Originally posted by sreneet View Post
                Dr. Oz talked about this on Oprah the other day. This sounds great for all of us that will be needing this surgery. I wonder how hard it will be to qualify as a candidate for the surgery? Have you heard much about this?

                www.wfirm.org

                Wake Forest Physician Reports First Human Recipients of Laboratory-Grown Organs
                --------------------------------------------------------------------------------

                WINSTON-SALEM, N.C. -- The first human recipients of laboratory-grown organs were reported today by Anthony Atala, M.D., director of the Institute for Regenerative Medicine at Wake Forest University School of Medicine. In The Lancet, Atala describes long-term success in children and teenagers who received bladders grown from their own cells.

                “This is one small step in our ability to go forward in replacing damaged tissues and organs,” said Atala, who is now working to grow 20 different tissues and organs, including blood vessels and hearts, in the laboratory.

                The engineered bladders were grown from the patients’ own cells, so there is no risk of rejection. Scientists hope that laboratory-grown organs can one day help solve the shortage of donated organs available for transplantation. Atala reported that the bladders showed improved function over time -- with some patients being followed for more than seven years.

                The study involved patients from 4 to 19 years old who had poor bladder function because of a congenital birth defect that causes incomplete closure of the spine. Their bladders were not pliable and the high pressures could be transmitted to their kidneys, possibly leading to kidney damage. They had urinary leakage, as frequently as every 30 minutes.

                The main goal of the surgery was to reduce pressures inside the bladder to preserve the kidneys. In addition, urinary incontinence, which was a problem before the surgery, improved in all patients.

                “It is rewarding when you can see the improved quality of life in these patients,” said Atala.

                The patients were candidates for a procedure to repair the non-functioning bladder tissue with tissue from the intestines. This 100-year-old procedure is also used to “build” bladders for patients with bladder cancer. But because the intestine is designed to absorb nutrients and a bladder is designed to excrete, patients who have the procedure are prone to such problems as osteoporosis, increased risk of cancer and kidney stone formation.

                Atala had been working since 1990 to build bladders from patients’ own cells and in 1999 implanted the first organ in a patient. His current report discusses the long-term results with seven children who had the surgery.

                “We wanted to go slowly and carefully and make sure we did it the right way,” said Atala. “This is a small, limited experience, but it has enough follow-up to show us that tissue engineering is a viable tool that will allow us to tackle problems of similar magnitude.”

                The report involves children who were treated at Boston Children’s Hospital when Atala was director of the Tissue Engineering and Cellular Therapeutics at Harvard Medical School. In 2004, Atala’s program moved to Wake Forest.

                The process for growing each patient’s organ began with a biopsy to get samples of muscle cells and the cells that line the bladder walls. These cells were grown in a culture in the laboratory until there were enough cells to place onto a specially constructed biodegradable mold, or scaffold, shaped like a bladder.

                The cells continued to grow. Then, seven or eight weeks after the biopsy, the engineered bladders were sutured to patients’ original bladders during surgery. The scaffold was designed to degrade as the bladder tissue integrated with the body. Testing showed that the engineered bladders functioned as well as bladders that are repaired with intestine tissue, but with none of the ill effects.

                “We have shown that regenerative medicine techniques can be used to generate functional bladders that are durable,” said Atala. “This suggests that regenerative medicine may one day be a solution to the shortage of donor organs in this country for those needing transplants.”

                Atala said the approach needs further study before it can be widely used. Additional clinical trials of the bladders are scheduled to begin later this year.
                Renee, this is a relatively old story (i.e. Dr. Atala has been working on this for over a decade and the data from this study came from when he was working in Boston before he moved to Wake Forest in 2004). What he has been able to do is to grow something similar to a bladder wall in the laboratory, using the patient's own cells, and then transplanted the cells into the patients. I don't think that it restored control of the bladder. It is similar to what is done when the bladder is augmented with intestine. For example, at the present, when doctors use intestine to augment the bladder when they do a Mitrofanoff, they cut a piece of intestine to do so. The piece of intestine (or in the case of Atala's study, a piece of this tissue) is sewn so that it becomes part of the wall of the bladder, the bladder can no longer contract as well, thereby reducing the pressures that are produced within the bladder during episodes of bladder spasticity. This increases the volume of the bladder and reduces medications required for bladder spasticity. Sorry for this long explanation. If you don't understand, let me try again.

                Wise.

                Comment


                • #9
                  So what happens to all of us Foley catheter users in the future, those of us that can only hold 100-200 CC in our tiny bladders?
                  A good friend is someone who will come to bail you out of jail. A TRUE friend is the guy sitting next to you behind the same set of bars saying, "boy we sure f*cked up this time huh?"

                  Comment


                  • #10
                    Rick, if you want to change bladder management methods to intermittent cath, then an augmentation could be done. This procedure (which is often NOT combined with a Mitrofanoff in spite of what Dr. Young said above) has been available for 20 years. It uses your own bowel (or stomach) or in some studies, the scaffold grown bladder tissue from your own body to make your bladder larger and have less pressure. It does not restore neurologic function and control though, so emptying must then be done by intermittent cath.

                    By the way, most people with long term indwelling catheters and a SCI have much less capacity than 100-200 cc. 30-50 cc. is much more common, even for those who have used anticholergic medications to try to prevent this. This is generally not a problem as long as the catheter is kept in place and does not clog up.

                    (KLD)
                    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                    Comment


                    • #11
                      Dr. Wise; Thanks for the response. I understand what you are saying. I have used an indwelling foley for 24 years. I am at the point of needing an augmentation because of the increased risk of cancer and erosion of the uretha if I don't do something.

                      After reading the article the following things sounded like reasons the laboratory grown bladder would be a better type of augmentation.

                      "But because the intestine is designed to absorb nutrients and a bladder is designed to excrete, patients who have the procedure are prone to such problems as osteoporosis, increased risk of cancer and kidney stone formation."

                      "The engineered bladders were sutured to patients’ original bladders during surgery. The scaffold was designed to degrade as the bladder tissue integrated with the body. Testing showed that the engineered bladders functioned as well as bladders that are repaired with intestine tissue, but with none of the ill effects."

                      After reading the following do you interpret it to mean the laboratory grown bladder would not contract causing spasms like our bladder does now?

                      "The main goal of the surgery was to reduce pressures inside the bladder to preserve the kidneys. In addition, urinary incontinence, which was a problem before the surgery, improved in all patients."

                      I am attaching the video clip of Dr. Oz speaking with Dr. Atala.

                      http://www.oprah.com/media/20090305b...generate-video
                      Renee

                      Comment


                      • #12
                        Originally posted by sreneet View Post
                        Dr. Wise; Thanks for the response. I understand what you are saying. I have used an indwelling foley for 24 years. I am at the point of needing an augmentation because of the increased risk of cancer and erosion of the uretha if I don't do something.

                        After reading the article the following things sounded like reasons the laboratory grown bladder would be a better type of augmentation.

                        "But because the intestine is designed to absorb nutrients and a bladder is designed to excrete, patients who have the procedure are prone to such problems as osteoporosis, increased risk of cancer and kidney stone formation."

                        "The engineered bladders were sutured to patients’ original bladders during surgery. The scaffold was designed to degrade as the bladder tissue integrated with the body. Testing showed that the engineered bladders functioned as well as bladders that are repaired with intestine tissue, but with none of the ill effects."

                        After reading the following do you interpret it to mean the laboratory grown bladder would not contract causing spasms like our bladder does now?

                        "The main goal of the surgery was to reduce pressures inside the bladder to preserve the kidneys. In addition, urinary incontinence, which was a problem before the surgery, improved in all patients."

                        I am attaching the video clip of Dr. Oz speaking with Dr. Atala.

                        http://www.oprah.com/media/20090305b...generate-video
                        sreneet,

                        I looked up the risk of bladder cancer after enteric augmentation of the bladder. Husmann, et al. (2008) reported an incidence of 4.5% in 153 patients over >10 year period. Austin (2008) likewise suggested that bladder cancer is relatively common amongst patients who had received the operation as young children. The cancers may develop in the intestinal patch (Elphick, et al. 2008) or the gastric patch (Vemulakonda, et al., 2008; Castellan, et al., 2007). In my opinion, this risk is high and, if the laboratory grown bladder has a lower risk, it would be worthwhile.

                        Wise.



                        References

                        1. Husmann DA and Rathbun SR (2008). Long-term follow up of enteric bladder augmentations: the risk for malignancy. J Pediatr Urol. 4: 381-5; discussion 386. Department of Urology, Mayo Clinic, Rochester MN 55905, USA. OBJECTIVE: To determine the risk of bladder cancer following enteric bladder augmentation. MATERIALS AND METHODS: Patients followed for care after an enteric bladder augmentation have been entered into a registry; individuals followed for a minimum of 10 years were evaluated. RESULTS: The study criteria were met by 153 patients. Indications for bladder augmentation were neurogenic bladder in 97, exstrophy in 38 and posterior urethral valves in 18. There was a median follow-up interval of 27 years (range 10-53). A total of seven cases of malignancy developed. Median time to tumor development following augmentation was 32 years (range 22-52). Two patients with neurogenic bladder developed transitional cell carcinoma; both were heavy smokers (>50 pack per year history). Two patients with a history of posterior urethral valves and renal transplantation developed adenocarcinoma of the enteric augment. Three patients with bladder exstrophy developed multifocal adenocarcinoma of the augmented bladder. Two patients remain alive, 5 and 6 years following radical cystoprostatectomy; five died of cancer-specific causes. CONCLUSIONS: Malignancy following enteric bladder augmentation arose in 4.5% (7/153) of our patients and was associated with coexisting carcinogenic stimuli (prolonged tobacco/chronic immunosuppressive exposure), or alternatively with the inherent risk of malignancy existing with bladder exstrophy.

                        2. Austin JC (2008). Long-term risks of bladder augmentation in pediatric patients. Curr Opin Urol. 18: 408-12. Department of Urology, University of Iowa, Iowa City 52242-1089, USA. chris-austin@uiowa.edu. PURPOSE OF REVIEW: Bladder augmentation is still a commonly performed reconstructive procedure for pediatric patients with severe bladder dysfunction. Recent developments in the long-term risks associated with this procedure are reviewed. RECENT FINDINGS: There are metabolic changes in these patients after incorporation of bowel into the urinary tract. Linear growth and bone mineral density are more affected by the primary disorder rather than bladder augmentation. There is a high rate of reoperation in patients after bladder augmentation for perforation, bladder stones, and bowel obstruction. Bladder cancer has been reported in patients after bladder augmentation but also in patients without augmentation. SUMMARY: Bladder augmentation is associated with a number of potential long-term risks, including a high risk of needing further surgery and development of serious complications such as bowel obstruction or bladder perforation. Bladder stones continue to be common in patients after bladder augmentation. Multiple cases of bladder cancer have been reported recently in young adults with a history of bladder augmentation in childhood and reinforce the need for lifelong follow up for these patients. Future studies will hopefully define the benefits and role of cancer surveillance for these patients.

                        3. Elphick DA, Tophill PR, Suvarna SK and Riley SA (2008). Flat adenomas in a colonic bladder augmentation patch: cystoscopic removal using an endoscopic mucosal resection technique. Urology. 72: 230 e1-3. Department of Gastroenterology, Northern General Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom. david.elphick@sth.nhs.uk. Bladder augmentation using colonic patches is being increasingly performed and a substantial risk of neoplasia in such patches has been reported. We present the case of a 62-year-old man who developed a large flat adenoma in the colonic mucosa of an augmented bladder. The adenoma was indigo-carmine dye sprayed and completely resected via a cystoscope using an endoscopic mucosal resection technique. We discuss how methods used at colonoscopy to detect and remove early neoplastic lesions may readily be employed during colonic patch surveillance at cystoscopy.

                        4. Vemulakonda VM, Lendvay TS, Shnorhavorian M, Joyner BD, Kaplan H, Mitchell ME and Grady RW (2008). Metastatic adenocarcinoma after augmentation gastrocystoplasty. J Urol. 179: 1094-6; discussion 1097. Department of Urology, University of Washington School of Medicine and Division of Pediatric Urology, Children's Hospital and Regional Medical Center, Seattle, Washington 98105, USA. vijaya.vemulakonda@seattlechildrens.org. PURPOSE: Augmentation gastrocystoplasty has been proposed as an alternative to enterocystoplasty because of potential benefits, including decreased risk of mucus production, stone formation and urinary tract infections. Although cancer has rarely been reported in this patient population, it is a well recognized potential risk of all augmentation cystoplasties. To define better the risk of malignancy associated with gastric augmentation and the appropriate surveillance protocol for these patients, we describe our experience in 2 patients with metastatic adenocarcinoma following gastrocystoplasty. MATERIALS AND METHODS: We retrospectively reviewed the charts of all patients who had undergone augmentation gastrocystoplasty between 1990 and 1994. Of the 72 patients identified 2 were diagnosed with a primary malignancy arising from the augmented bladder. Charts were reviewed for medical history, clinical outcomes and pathology. RESULTS: Two patients were identified with a primary bladder malignancy after gastrocystoplasty. Both patients had metastatic disease at initial presentation. Neither patient had a history of gross hematuria, recurrent urinary tract infections or pain before initial presentation. Mean patient age at augmentation was 5.5 years. Mean age at diagnosis of malignancy was 19.5 years, with a mean time from augmentation of 14 years. CONCLUSIONS: Although the risk of bladder cancer is low after gastric augmentation, the effects may be life threatening. Therefore, we advocate routine annual surveillance with cystoscopy, bladder biopsy and upper tract imaging in all patients who have undergone augmentation gastrocystoplasty.

                        5. Castellan M, Gosalbez R, Perez-Brayfield M, Healey P, McDonald R, Labbie A and Lendvay T (2007). Tumor in bladder reservoir after gastrocystoplasty. J Urol. 178: 1771-4; discussion 1774. Division of Pediatric Urology, Miami Children's Hospital, Miami, Florida, USA. PURPOSE: To our knowledge the risk of malignancy in patients with previous bladder augmentation with stomach is unknown. We report 3 cases of gastric adenocarcinoma and 1 of transitional cell carcinoma after augmentation cystoplasty with stomach with long-term followup. MATERIALS AND METHODS: Between August 1989 and August 2002, 119 patients underwent augmentation cystoplasty with stomach at our 2 institutions (University of Miami School of Medicine, and Seattle Children's Hospital and Regional Medical Center). Medical records, urodynamic studies, radiographic imaging and laboratory evaluations were reviewed retrospectively and cases of malignancy were analyzed in detail. RESULTS: Four male patients had carcinoma after augmentation gastrocystoplasty. Preoperative diagnosis was neurogenic bladder in 3 patients and posterior urethral valve in 1. Three patients had gastric adenocarcinoma, while the other had poorly differentiated transitional cell carcinoma. Each case progressed to malignancy more than 10 years after augmentation (11, 12, 14 and 14 years, respectively). CONCLUSIONS: Patients who undergo bladder augmentation with a gastric remnant are at increased risk for malignancy, probably similar to that in patients with enterocystoplasty. Therefore, they require close long-term followup. Patients should be followed annually with ultrasound, and cystoscopy should be performed annually starting 10 years after gastrocystoplasty unless they have abnormal ultrasound, hematuria or another cancer risk factor. Any suspicious lesions should be biopsied, especially at the gastrovesical anastomotic site.

                        Comment


                        • #13
                          Dr. Wise; Thanks for the reply. I was thinking the same thing about the laboratory grown bladder.
                          Renee

                          Comment


                          • #14
                            So what does this mean when they find a repair/cure 4 sci, we still going to have to have catheters/super pubic ways to void? Or will we be able to retrain the bladder & it will learn to expand and be able to hold more? Or is this just way too early to ask this question? Because no one knows how much function or what we will get back in the future.
                            keiffer66

                            Comment


                            • #15
                              You said it. It is to early , wait for the cure and then we will see.

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