Lab grown bladders

No, it's not a joke.

One of the little discussed problems in medicine is problems in the bladder.

Most of the problems are incontinence (put into perspective: One of the major reasons for nursing home placement is that Grandmom is peeing all over the house). There is a major need for someone to invent a pacemaker for the bladder to keep women and old men dry...

But sometimes the bladder doesn't work due to nerve problems. If you are born with meningomyelocoel, it is not your paralyzed legs that kill you, but your bladder that won't empty, so you get infections galore...ditto for paraplegics from injuries. So your bladder has to be drained twice aday by tube, or you live with the tube, and tubes cause infections. Finally, the bladder gets overdistended and worse than useless, so they do an ileal conduit...

And, of course, injury and cancer can mean that you lose your bladder completely.

So far, there is no good way to replace the bladder. The nearest thing to replace the bladder is to take a loop of intestine and make a pouch... ileal loop (the ilium is part of the small intestine)...that loop or sac of intestine then drains to a bag on your side. It still gets infected, but because it drains better, it doesn't tend to back up into the kidneys to destroy the kidneys from infection...

But in this experiment, the doctors grew new bladders and placed them into patients...no mention in the article about how they manage to work without the input from the missing nerves, however...wouldn't the "new" bladders end up not emptying just like the old ones?

Well, anyway, here is how they grew the new bladder in the laboratory...

They begin by biopsying a small piece of bladder, about half the size of a postage stamp. The tissue has three layers: muscle on the outside, a collagen supporting layer in the center and specialized urothelial cells on the inside to hold the urine.

The team isolates the muscle and urothelial cells and grows them in the lab for about 30 days. The cells involved are not stem cells, but more specialized progenitor cells, which in this case have the capacity to grow only into other bladder cells......
The study's patients all had spina bifida, a birth defect that leads to incomplete closure of the spine. Their bladder tissue is hard, causing high pressures to build up and be transmitted to the kidney, where they cause kidney damage. They also have urinary leakage.

The study sounds good...one ethical problem, however, is that " Atala's team transplanted their synthetic bladders in nine children from 4 to 19 years old..."

This is troubling, since minors cannot grant permission for experimental studies...and ethically since there is an "alternative" (albeit poor) treatment, allowing parents to permit such experimentation in non life and death situations on their child is ethically questionable...especially since young adults that could have been used...either those with meningomyelocoels or who have neurogenic bladders from paraplegia/back injury.