LUTS (2015) 7, 63–70 REVIEW ARTICLE Application of Tissue Engineering to Pelvic Organ Prolapse and Stress Urinary Incontinence Christopher R. CHAPPLE, 1* Nadir I. OSMAN, 1,2 Altaf MANGERA, 1,2 Christopher HILLARY, 1,2 Sabiniano ROMAN, 2 Anthony BULLOCK, 2 and Sheila MACNEIL 2 1 Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, UK and 2 Department of Materials and Science Engineering, Kroto Research Institute, University of Sheffield, Sheffield, UK Synthetic or biological materials can be used for the surgical repair of pelvic organ prolapse (POP) or stress urinary incontinence (SUI). While non-degradable synthetic mesh has a low failure rate, it is prone to complications such as infection and erosion, particularly in the urological/gynecological setting when subject to chronic influences of gravity and intermittent, repetitive strain. Biological materials have lower complication rates, although allografts and xenografts have a high risk of failure and the theoretical risk of infection. Autografts are used successfully for the treatment of SUI and are not associated with erosion; however, can lead to morbidity at the donor site. Tissue engineering has thus become the focus of interest in recent years as researchers seek an ideal tissue remodeling material for urogynecological repair. Herein, we review the directions of current and future research in this exciting field. Electrospun poly-L-lactic acid (PLA) and porcine small intestine submucosa (SIS) are two promising scaffold material candidates. Adipose-derived stem cells (ADSCs) appear to be a suitable cell type for scaffold seeding, and cells grown on scaffolds when subjected to repetitive biaxial strain show more appropriate biomechanical properties for clinical implantation. After implantation, an appropriate level of acute inflammation is important to precipitate moderate fibrosis and encourage tissue strength. New research directions include the use of bioactive materials containing compounds that may help facilitate integration of the new tissue. More research with longer follow- up is needed to ascertain the most successful and safe methods and materials for pelvic organ repair and SUI treatment. Key words pelvic organ prolapse, stress urinary incontinensce, tissue engineering 1. INTRODUCTION Regenerative medicine is a rapidly-evolving, multidis- ciplinary field involving physiology, materials science, cell culture, and engineering, 1 and is arguably one of the most intriguing and promising fields of research today. 2,3 The underlying principle with this approach is the replacement or regeneration of human tissues or organs through the implantation of biomaterials – either synthetic or biological restore normal function. 2 The clin- ical application of regenerative medicine extends to the repair of a wide variety of disorders, including skin repair in burn patients, tracheal repair, knee replacement, and pelvic organ repair. 1,4 Two key branches of research are currently being undertaken. The first technique, the regenerative approach, involves the implantation of a biodegradable scaffold that the host can use to remodel and regenerate tissue, taking advantage of the body’s natural ability to regenerate itself. The second technique, aptly called ‘‘tissue engineering’’, involves the establishment of cell cultures, which are seeded onto a biological or synthetic scaffold, creating a composite tissue graft, which is then transplanted back into the host to continue the regeneration process. 1,3 Both techniques have inherent advantages and disadvantages. 3 Tissue engineering has been the focus of much research in the field of pelvic medicine over the past decade and a half, and has the potential to revolutionize the treatment of pelvic organ prolapse and stress urinary incontinence (SUI). 3 Historically, a number of allograft and xenograft tissues have been used for repair of the lower urinary tract and pelvic floor; however, infections and complica- tions are frequent with the use of these tissues, and have necessitated the development of alternative engineered materials and tissues. 4 Currently, there is increasing con- cern over the significant side-effects associated with mesh devices in a small but significant proportion of patients and this has led to international controversy surrounding * Correspondence: Christopher Chapple, MBBS, MD, Department of Urology, The Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK. Tel: +44 (0)114 271 3048; Fax: +44 (0)114 279 7841. Email: c.r.chapple@ sheffield.ac.uk Received 11 February 2015; accepted 16 February 2015 DOI: 10.1111/luts.12098 © 2015 Wiley Publishing Asia Pty Ltd