Researchers at the Keck School of Medicine, University of Southern California, have taken important first steps towards developing techniques for robotic bladder transplantation in humans. These pre-clinical studies, outlined in the Journal of Urology, lay the groundwork for future clinical trials.
The research team, led by Dr. Inderbir S. Gill, successfully performed bladder auto-transplantation in heart-beating, brain-dead human research donors. This is a necessary preparatory step towards clinical bladder transplantation in living patients. The procedure presents significant challenges due to the complex anatomy of the blood vessels in the deep pelvis.
Patients with terminal bladder conditions often require a cystectomy, the removal of the bladder. This is followed by a diversion procedure using a segment of the patient’s own bowel tissue. Although successful, these procedures carry a risk of complications. Bladder transplantation could offer a viable alternative treatment option for selected patients.
The team conducted pre-clinical studies using three models: living animal, human cadaver, and beating-heart donors. They successfully applied techniques developed in the animal and cadaver models to beating-heart donors. Surgical times for robotic auto-transplantation decreased with experience, from 10.5 to 4.7 hours.
The success rate for robotic auto-transplantation in beating-heart donors was 75%. Good blood flow was achieved in the transplanted bladder, and one donor maintained on life support for 12 hours confirmed the continued viability of the transplanted organ.
Compared to traditional open surgery, the robotic approach offers better access to the deep pelvis and increased control over blood vessels during surgical procedures. The researchers are preparing for an initial feasibility clinical trial of human bladder transplantation.
There are still many unanswered questions surrounding this procedure, including long-term functioning of the transplanted bladder, the need for lifelong immunosuppressive therapy, and patient acceptance of bladder transplant versus standard urinary diversion procedures.
This groundbreaking research brings us closer to a future where bladder transplantation could be a viable treatment option for selected patients. Further studies and clinical trials are needed to address the remaining challenges and ensure the success and safety of this procedure.
– Journal of Urology (2023). DOI: 10.1097/JU.0000000000003620