Bladder biomechanics and the use of scaffolds for regenerative medicine in the urinary bladder

Key Points The tissue of the urinary bladder undergoes constant loading and unloading cycles to fulfil its role in normal physiological conditions Insight into bladder biomechanics is important for restoring its functional properties when bladder augmentation is required Biomechanical clinical assessments include whole-organ urodynamics, whereas preclinical assessments that have been used in animal models also include ex vivo tensile tests of bladder tissue Biomechanical qualification of tissue-engineered bladder scaffolds is crucial; however, the biomechanics of scaffolds have been poorly researched compared with their structural appearance and cellular interactions Mathematical and computational modelling based on biomechanical studies can be used to predict the mechanical performance of a tissue-engineered scaffold A comprehensive algorithm is recommended to study engineered scaffolds in order to validate preclinical experiments before clinical use of these materials Clinical conditions that cause poor bladder compliance, reduced capacity, and incontinence can require bladder augmentation or use of regenerative techniques and scaffolds. Replicating an organ that is under frequent mechanical loading and unloading needs particular attention to its biomechanical requirements. In this Review, the authors describe the biomechanics of the bladder and discuss how different scaffolds and techniques can be assessed to determine the best possible approach to bladder augmentation. The urinary bladder is a complex organ with the primary functions of storing urine under low and stable pressure and micturition. Many clinical conditions can cause poor bladder compliance, reduced capacity, and incontinence, requiring bladder augmentation or use of regenerative techniques and scaffolds. To replicate an organ that is under frequent mechanical loading and unloading, special attention towards fulfilling its biomechanical requirements is necessary. Several biological and synthetic scaffolds are available, with various characteristics that qualify them for use in bladder regeneration in vitro and in vivo, including in the treatment of clinical conditions. The biomechanical properties of the native bladder can be investigated using a range of mechanical tests for standardized assessments, as well as mathematical and computational bladder biomechanics. Despite a large body of research into tissue engineering of the bladder wall, some features of the native bladder and the scaf