EURURO Vol. 72 No. 4

594 656

Platinum Priority – Review – Reconstructive Urology
Editorial by Karl-Dietrich Sievert on pp. 607–609 of this issue
Tissue Engineering of the Urethra: A Systematic Review and
Meta-analysis of Preclinical and Clinical Studies
Luuk R.M. Versteegden , Paul K.J.D. de Jonge y, Joanna IntHout Toin H. van Kuppevelt
Egbert Oosterwijk Wout F.J. Feitz Rob B.M. de Vries Willeke F. Daamen
a Department of Biochemistry, Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands; b Department of
Urology, Radboud Institute for Molecular Life Sciences, Radboud university medical center, Nijmegen, The Netherlands; c Department for Health Evidence,
Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands; dRadboudumc Amalia Children’s Hospital, Radboud
university medical center, Nijmegen, The Netherlands; e SYRCLE (SYstematic Review Centre for Laboratory Animal Experimentation), Department for Health
Evidence (section HTA), Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
available at
journal homepage:
Article info
Article history:
Accepted March 17, 2017
Associate Editor:
Christian Gratzke
Keywords:
Urethra
Reconstructive surgery
Tissue engineering
Systematic review
Meta-analysis
Clinical studies
Preclinical studies
Please visit
to read and
answer questions on-line.
The EU-ACME credits will
then be attributed
automatically.
Abstract
Context: Urethra repair by tissue engineering has been extensively studied in laboratory
animals and patients, but is not routinely used in clinical practice.
Objective: To systematically investigate preclinical and clinical evidence of the efficacy
of tissue engineering for urethra repair in order to stimulate translation of preclinical
studies to the clinic.
Evidence acquisition: A systematic search strategy was applied in PubMed and EMBASE.
Studies were independently screened for relevance by two reviewers, resulting in
80 preclinical and 23 clinical studies of which 63 and 13 were selected for meta-analysis
to assess side effects, functionality, and study completion. Analyses for preclinical and
clinical studies were performed separately. Full circumferential and inlay procedures
were assessed independently. Evaluated parameters included seeding of cells and type
of biomaterial.
Evidence synthesis: Meta-analysis revealed that cell seeding significantly reduced the
probability of encountering side effects in preclinical studies. Remarkably though, cells
were only sparsely used in the clinic (4/23 studies) and showed no significant reduction
of side effects. ln 21 out of 23 clinical studies, decellularized templates were used, while
in preclinical studies other biomaterials showed promising outcomes as well. No direct
comparison to current clinical practice could be made due to the limited number of
randomized controlled studies.
Conclusions: Due to a lack of controlled (pre)clinical studies, the efficacy of tissue
engineering for urethra repair could not be determined. Meta-analysis outcome mea-
sures were similar to current treatment options described in literature. Surprisingly, it
appeared that favorable preclinical results, that is inclusion of cells, were not translated
to the clinic. Improved (pre)clinical study designs may enhance clinical translation.
Patient summary: We reviewed all available literature on urethral tissue engineering to
assess the efficacy in preclinical and clinical studies. We show that improvements to
(pre)clinical study design is required to improve clinical translation of tissue engineering
technologies.
# 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.
y These authors contributed equally to the study results.
* Corresponding author. Post Office Box 9101, 6500 HB Nijmegen, The Netherlands.
Tel. +31 24 36 10557; Fax: +31 24 35 40339.
E-mail address: (W.F. Daamen).
0302-2838/# 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.