Reconstructive Urology: The present and the future

Tue, 15 Apr 2014

In a slightly adapted format due to the regretful absence of several speakers, Thematic Session 16 managed to convey a good look at the current state of reconstructive urology, as well as its future. In the words of the Session Chairman, Dr. René Yiou (FR): “The speakers gave a nice overview of each topic, and even I learned a lot. My only regret is that we did not have time for questions or discussion.”

Prof. Wilhelm Aicher (DE) covered the topic of possible stem cell sources for reconstruction of the lower urinary tract, an area that clearly points to the future of reconstructive urology. Prof. Yiou: “Mesenchymal stem cells are useful not just in cases of urinary incontinence, but different new indications like overactive bladder, erectile dysfunction, and Peyronie’s disesase. Aicher gave a nice talk on the issues involved in preparing these cells. They can come from bone marrow and be differentiated into multiple lineages like muscle and bone tissue through paracrine signalling.”

Looking to the future of reconstructive urology also involves reassessing the past. Dr. Fredrik Liedberg (SE) gave a talk that Dr. Yiou deemed “quite provocative”. It questioned the wisdom of abandoning the “Bricker”, in favour of a neobladder. By comparing the patients’ QoL, it can carefully be concluded that the traditional Bricker, which bypasses the lower urinary tract completely might have fewer side-effects than a bladder replacement. Yiou: “Liedberg used data from a Swedish population study, showing we have to discuss the type of urinary diversion we ought to be using.”

The session’s last presentation came from Prof. Willem Oosterlinck (BE). Oosterlinck spoke from experience when he mentioned that in the past, reconstructive surgery was mainly concerned with restoring micturition functionality. In recent years, QoL has become equally important, so it’s important to take this into account when considering the options, for instance between a graft and a flap, or end-to-end vs. graft. He also sympathized with patient discomfort, arguing that limiting the use of catheter by even a few days would make a big difference. “I suggest to you to place a catheter on yourself tonight, if you don’t believe me!” Oosterlinck quipped.

In some impressive pictures, Oosterlinck showed how the oral or lingual mucosa (in one case the entire underside of the patient’s tongue) could serve as a donor. This can be difficult in regions with poor oral hygiene, heavy smokers or chewers of the betel nut. Oosterlinck: “Tissue engineering also shows great promise for unlimited, off-the-shelf availability, but one thing is for sure: it will be extremely expensive!”