PhD-project • “Developing an artificial stoma for urinary diversion in patients with extensive bladder disease”. • Patients • Bladder cancer •73.000 new patients/2012 in US •Muscle-invasive tumors • Congenital malformations •Spina bifida or bladder exstrophy •Neurogenic/dyfunctional bladder
Urinary Diversion (2/2) • Urinary Diversion • Golden standard is Bricker ileal conduit • Bowel surgery • Placing Urostomy
ProblemsIn 28-81% of the cases complications will occur, due to:• Intestinal surgery (1-5%) • Leakage/rupture of the anastomosis • Obstruction • Fistula formation • Infections• Unsuitability of tissue • Necrosis • Stenosis • Obstruction • Deformations
Tissue engineering• Aims to restore or replace diseased, affected or non- functional tissues.• In vitro and In vivo • Synthetic/biological materials • W/ or w/o cell technology• Scaffold • Temporal support • Promotes tissue regeneration • Replacement
Artificial Urostomy (1/2)• Structural protein Collagen• (slow) Biodegradable Vypro® IIsynthetic polymer mesh• Porcine model•Conclusion: A tubular construct can beused for urinary diversion (althoughimprovement is needed)
Artificial Urostomy (2/2) • Problems • Skin contraction • Immunological reaction • Tissue regeneration • Improvement • Material • Animal model • Porcine model • Predictive value?
Systematic Review • “What is the current evidence for the efficacy of tissue-engineered constructs for urinary diversion in animal models?” • PICO Patient: Urinary diversion in animal models Intervention: Tissue-engineered construct Comparison: Classical method using GI tissue Outcome: Survival/ regeneration/ inflammation/ integration/ functionality
Search Strategy (in progress) Based on Leenaars et al (2012) 45: 24-31.
Why start a PhD with systematic Review?• To prevent unneccessary (animal) experimentation• To collect information about materials/methods/models• To generate a detailed overview of all relevant literature• To learn how to make a comprehensive search strategy
Experienced difficulties • Commercial side of my research • Unpublished information • Negative results • When to stop/continue • Slow proces
Conclusions • Benefits and difficulties • Do the benefits outweigh the difficulties? • Time and effort • Useful information • Extensive overview • Full-time focus at beginning of a project • Use for grant application
Acknowledgements Department of Urology SYRCLE Prof. Dr. Wout Feitz Prof. Dr. Merel Ritskes-Hoitinga Dr. Egbert Oosterwijk Dr. Rob de Vries Dr. Paul Geutjes