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Towards clinical application of tissue engineering for erectile penile regeneration

Nature Reviews Urology volume 16, pages 734–744 (2019)Cite this article

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Abstract

Penile wounds after traumatic and surgical amputation require reconstruction in the form of autologous tissue transfers. However, currently used techniques are associated with high infection rates, implant erosion and donor site morbidity. The use of tissue-engineered neocorpora provides an alternative treatment option. Contemporary tissue-engineering strategies enable the seeding of a biomaterial scaffold and subsequent implantation to construct a neocorpus. Tissue engineering of penile tissue should focus on two main strategies: first, correcting the volume deficit for structural integrity in order to enable urinary voiding in the standing position and second, achieving erectile function for sexual activity. The functional outcomes of the neocorpus can be addressed by optimizing the use of stem cells and scaffolds, or alternatively, the use of gene therapy. Current research in penile tissue engineering is largely restricted to rodent and rabbit models, but the use of larger animal models should be considered as a better representation of the anatomical and physiological function in humans. The development of a cell-seeded scaffold to achieve and maintain erection continues to be a considerable challenge in humans. However, advances in penile tissue engineering show great promise and, in combination with gene therapy and surgical techniques, have the potential to substantially improve patient outcomes.

Key points

  • Reconstruction of the erectile tissue has a variety of indications, including trauma, surgical amputation, gender affirmation and Peyronie’s disease.

  • Current surgical treatments for penile reconstruction and erectile dysfunction are associated with high complication rates, emphasizing the need for a tissue-engineered approach.

  • The goals of penile tissue engineering are to cosmetically correct volume deficits, to accomplish urinary voiding and to achieve erectile function.

  • To date, most studies investigating tissue engineering for erectile penile regeneration have been preclinical trials in animal models.

  • Contemporary tissue-engineering strategies enable the seeding of a biomaterial scaffold and implantation to construct a neocorpus; the use of induced pluripotent stem cells and 3D-bioprinted scaffolds can provide a patient-specific approach to penile tissue engineering.

  • The use of gene therapy in erectile tissues has only been successfully performed in one human clinical trial; however, it has the potential to enhance neurogenic and vasculogenic regeneration, increasing blood flow, and increasing growth factor delivery to the corpus cavernosum.

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Fig. 1: Anatomy of the penis in humans and animal models.
Fig. 2: The process of tissue engineering neocorpora.

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Article 01 December 2022

Zixuan Zhao, Xinyi Chen, … Hanry Yu

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Authors and Affiliations

  1. Centre for Nanotechnology & Regenerative Medicine, Division of Surgery & Interventional Science, University College London, London, UK

    Tom W. Andrew, Muholan Kanapathy, Log Murugesan & Deepak Kalaskar

  2. Department of Urology, University College London Hospital, London, UK

    Asif Muneer

  3. Wake Forest Institute for Regenerative Medicine, Winston Salem, NC, USA

    Anthony Atala

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T.W.A., M.K., L.M. and D.K. researched data for the article. All authors made substantial contributions to discussions of content and to writing the manuscript. T.W.A., M.K., A.M. D.K. and A.A. reviewed and edited the manuscript before submission.

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Nature Reviews Urology thanks N. Sopko, J.-K. Ryu and the other, anonymous, reviewer(s) for their help with the peer review of this manuscript.

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Andrew, T.W., Kanapathy, M., Murugesan, L. et al. Towards clinical application of tissue engineering for erectile penile regeneration. Nat Rev Urol 16, 734–744 (2019). https://doi.org/10.1038/s41585-019-0246-7

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