Tissue engineering and regenerative medicine in hypospadias management

Over the past 40 years, hypospadias research has focused on the development of novel surgical procedures, including new suture types and uses of autologous tissue harvested from local and distant sites. Although postoperative outcomes have steadily improved over time, complication rates remain extremely high, particularly in cases of severe hypospadias. Even for patients with good outcomes early after surgery, little is known about long-term prognosis due to the paucity of longitudinal follow-up data beyond the adolescent period. Key challenges include persistently high complication rates after hypospadias surgery, dissatisfaction with functional and cosmetic outcomes, and uncertainty regards the long-term behavior of transplanted tissue under the influence of hormonal changes. Consequently, it is now a priority to advance our understanding of the tissues involved and how these are modified by hypospadias surgery. Greater comprehension of tissue characteristics may lead to new methods of promoting wound healing and improving surgical outcomes, while also paving the way for tissue engineering approaches capable of restoring urethral structure and function. The purpose of this chapter is to provide urologists and researchers with an overview of recent advances in tissue engineering and regenerative medicine that have particular relevance to hypospadias research and clinical care. We discuss a range of novel concepts and pilot studies that may indicate future opportunities to enhance urethral function, refine cosmetic outcomes, and improve the quality of life for hypospadias patients. (See Video 9.1).