Researchers, including one of Indian-origin, have made significant progress in developing techniques for robotic bladder transplantation in humans through a series of pre-clinical studies. While transplantation is an established treatment for many organ failures, urinary bladder transplantation has never been performed in humans due to the technical challenges involved. Patients with terminal bladder conditions typically undergo bladder removal surgery followed by a diversion procedure using the patient’s own bowel tissue. These procedures have high success rates but carry risks of short and long-term complications.
The team of researchers, led by Inderbir Gill, conducted experiments on pigs and human cadavers to develop the technique of robotic bladder transplantation. They also performed the procedure on beating-heart, deceased donors who had been declared brain-dead. The techniques developed in animal and cadaver models were successfully applied to the beating-heart donors, with operative times decreasing with experience. Three out of four attempts resulted in successful transplants, with good blood flow to the transplanted bladder.
The robotic approach was found to facilitate bladder removal surgery due to its superior technical access and blood vessel control. Based on these findings, the researchers are now preparing for the initial feasibility clinical trial of human bladder transplantation. However, there are still many unanswered questions, including the long-term functioning of the transplanted bladder, the need for lifelong immunosuppressive therapy, and patient acceptance of bladder transplant versus standard urinary diversion procedures.
These findings provide important first steps towards the development and refinement of bladder transplantation as a viable treatment option in select patients. Further research is needed to address the remaining challenges and assess the long-term outcomes of this procedure.
– The Journal of Urology