Autologous muscle transfer for reconstruction of the lower urinary tract.

The recent experimental results of using functioning muscle transfer to the bladder have been shown to be useful for some clinical indications. LDDM proved to be a viable option for the treatment of patients with an acontractile bladder due to traumatic or congenital lower motor neuropathy. A logical development for complete bladder substitution would be to combine the well-vascularized and contractile latissimus dorsi muscle transplant with cultivated and expanded autologous urothelial cells. A scaffolding, such as bioabsorbable polymer, alginate, or small intestinal sumucosa, may be useful to convey the in vitro-created urothelial layer onto the muscle and to avoid osteogenesis. Experimental studies are necessary, however, to rule out whether these materials induce fibrosis, leading to stiffness of the neobladder wall, and thereby reducing contractile function and voiding capability of the transferred muscle.