A Foreseeable Tissue Engineering Approach to Overcome the Neurogenic Bladder-Related Detrusor/Urethral Rhabdosphincter Dyssynergia

I have read, with high interest, the Jednak’s review article “The evolution of bladder augmentation: from creating reservoir to reconstituting an organ” (1), where the literature regarding this subject has been carefully taken into consideration. Particularly, about the tissue engineeringbased augmentation cystoplasty, the attention has been focused on the results reached by Atala and his group in patients suffering from end-stage myelomeningoceleinduced poorly compliant/high pressure bladder (2). Nevertheless, such tissue engineered arrangement remains functionally conditioned by spinal cord neuropathy-due detrusor/urethral rhabdosphincter dyssynergia. Hence, in my opinion, it would be suitable, for these patients, to implant, after total cystectomy together with removal of the urethral rhabdosphincter, a tissue engineered neobladder–rhabdosphincter complex – quite not influenced by spinal cord neuropathy effects – provided with inside neobladder wall embedded tension micro-electro-sensors (correlatively to intra-neobladder pressure) with microloop antenna to send, beyond a properly adjustable wall tension value threshold, modulated wireless e-m signals toward a rhabdosphincterial receiver– converter micro-electro device to promote, in turn, by suitable e-m field generation, the rhabdosphincter relaxation simultaneously with the neobladder contraction. What should be quite reversible following the micturition-due intra-neobladder pressure drop below the arranged levels. Bright advances in the scaffold fabrication, emerging from recent progress in the field of both nanotechnology and material science research – from different “smart” synthetic polymers to silk fibroin-based biomaterials – besides in stem-cell biology, could make feasible a suitable setting of micro-electro-sensors inside the mentioned bladder/rhabdosphincter tissue engineered complex (3–5).