Andranik G. Vardikian

Monolayer two-dimensional in vitro cell culture systems are unable to fully mimic the native tissue microenvironment, which limits their prognostic value. Threedimensional (3D) culture systems overcome these limitations, ensuring the reproduction of intercellular interactions and tissue architecture characteristic of in vivo models. The most common 3D cell constructs are 3D spheroid models and organoids, the preservation of gene expression in which makes them valuable tools for preclinical research. This work aimed to review the scientific publications on the generation and application of 3D cell cultures in urology and urologic oncology. Analysis of recent publications demonstrates a wide range of applications of these technologies. This review demonstrates that in urologic oncology, patientderived bladder cancer organoids reproduce the molecular profile of tumors, allowing them to be used for testing chemotherapeutic drugs and assessing the cytotoxic activity of T cells. For prostate cancer, 3D cultures are used to evaluate the effectiveness of docetaxel in combination with sildenafil. Kidney cancer organoids reproduce the histological architecture of the original tissues, which facilitates drug screening. In regenerative medicine, 3D spheroid models of bladder smooth muscle cells demonstrate increased deposition of extracellular matrix proteins, which supports their potential for tissue engineering. Thus, 3D cell technologies open up new opportunities for personalized therapy and the development of bioengineered constructs in urology and urologic oncology.

BACKGROUND: Stress urinary incontinence remains a prevalent medical and social issue that significantly reduces women’s quality of life. Despite their high efficacy, synthetic slings are associated with a risk of complications related to limited biocompatibility of materials. Allografts are a promising approach in surgical treatment of stress urinary incontinence because of their high strength, minimal immunogenicity, and reduced risk of postoperative complications. AIM: The work aimed to improve the outcomes of surgical treatment of stress urinary incontinence in women using a combined allogeneic–synthetic suburethral sling. METHODS: The study included 51 female patients with stress urinary incontinence who underwent suburethral loop plasty (TVT-O) using a newly developed combined allogeneic–synthetic sling. The outcomes were evaluated at 1 to 12 months postoperatively using both subjective (validated questionnaires) and objective diagnostic methods (including the cough test, ultrasonography, comprehensive urodynamic studies, and magnetic resonance imaging). RESULTS: The study demonstrated high efficacy and safety of the combined allogeneic–synthetic sling in surgical treatment of stress urinary incontinence. The findings confirmed favorable biomechanical properties of the implant, a significant improvement in patients’ quality of life (ICIQ-SF and PISQ-12 scores), and the absence of erosive complications. Magnetic resonance imaging findings indicated complete biological remodeling of the allogeneic component with the formation of functional connective tissue 12 months postoperatively. CONCLUSION: A combined sling containing a biocompatible allogeneic component (Alloplant) significantly improves surgical treatment outcomes in stress urinary incontinence. Strategic placement of the biological material in the periurethral zone minimizes the risk of rejection and erosive complications, improves functional outcomes (lower risk of dyspareunia and de novo overactive bladder), and promotes physiological tissue remodeling with the formation of a mature connective tissue regenerate within 6–12 months.

Stress urinary incontinence refers to a multifactorial disease characterized by involuntary urination associated with a sudden increase in intra­abdominal pressure. Millions of females around the world suffer from stress incontinence each year. Conservative methods of treatment and physical rehabilitation are considered to be ineffective, thereby driving the need for surgical treatment. Sling surgeries comprise a widely used surgical technique for the treatment of stress urinary incontinence due to their affordability and minimal time investment. Introduction of synthetic polypropylene mesh prostheses in the treatment of stress incontinence made them the most common material. However, the accumulated experience and complications associated with the use of mesh grafts contribute to the recent decline in the popularity of synthetic slings and give rise to the search for and development of alternative materials for the surgical treatment of stress urinary incontinence. Since the need for treatment of urinary incontinence remains high, fascia autograft surgeries have been proposed, even though they require an additional surgical procedure and expose the patient to complications at the donor site of the graft. In addition, surgeons use allografts and xenografts, and regenerative technology is developing in this field. Considering high social significance of this problem, the present paper is aimed at reviewing the scientific literature concerning grafts for the treatment of stress incontinence.

Organs-on-chips (OOC) refer to microfluidic devices used to create biomimetic systems of physiological organs. The system contains engineered or natural miniature tissues grown inside microfluidic chips. Organ-on-a-chip technology enables numerous human pathologies to be reproduced, since classical animal models may fail to adequately predict the therapeutic response in humans. This technology can be an intermediate link in the animal-human research system. Moreover, in cancer studies, OOC simulate the three-dimensional hierarchical complexity of tumors in vivo and the tumor microenvironment, being an efficient and cost-effective solution for tumor growth studies and cancer drug screening. Organs-on-chips represent compact and easy-to-use microphysiological functional units simulating physical and biological processes in human body. This extends the possibility of preclinical studies, such as disease modeling or even the development of diagnostic devices. In this regard, the present study is aimed at reviewing the scientific literature in the field of microfluidic devices intended for use in urology and oncourology.