Corpus cavernosum and tunica albuginea reconstruction by tissue engineering: towards functional erectile structures regeneration

Background: Current treatments for penile erectile structures reconstruction are limited and remain a great challenge in clinical practice. Tissue engineering techniques using different seed cells and scaffolds to construct a neo-tissue open promising avenues for penile erectile structures repair and replacement and show great promise in the restoration of: structure, mechanical property, and function which matches the original tissue.

Methods: A comprehensive literature review was conducted by accessing the NCBI PubMed, Cochrane, and Google Scholar databases from January 1, 1990, to January, 1, 2022 using the search terms "Tissue engineering, Corpus cavernosum (CC), Tunica albuginea (TA), Acellular Matrix, Penile Reconstruction". Articles were screened and assessed by two independent reviewers to determine whether those met the inclusion criteria, and a total of 19 articles were being selected and included in the data analysis.

Results: Tissue engineered cell-seeded scaffold can reconstruct a similar structure to native TA and CC and showed good histocompatibility with no immunological rejection. The results of the evaluation of morphological feature, intracavernosal pressure, and erectile-related nitric oxide (NO) expression were strongly proofs that the tissue engineered graft can significantly improve the penile erectile and ejaculatory function. In addition, increasing the purity of seed cells, improving the mechanical properties of the scaffold, providing appropriate induction for stem cells, and optimizing cell delivery systems are potential approaches to improve reconstructive outcomes. Currently, a larger animal model, comparable in size to the human penis, is needed to test the feasibility of the engineered grafts.

Conclusion: Our review summarized the research in tissue engineering of CC and TA. It showed great promise in reconstructing the functional structures and restoring the erection and ejaculatory function. With continuous advancement in the field, tissue-engineered penile erectile structures hold substantial potential to enhance clinical outcomes for patients.