Regenerative approaches for managing percutaneous nephrostomy complications: stem cell and tissue engineering strategies

Abstract

Introduction: Percutaneous nephrostomy (PCN) is a crucial intervention for urinary tract decompression in obstructive uropathy, malignancy, and infection. However, it carries significant risks, including hemorrhage, infection, and catheter dysfunction. Moderate hematuria occurs in 50% of cases, while severe bleeding requiring transfusion is reported in 1–4% of patients. Long-term catheter-related complications, such as occlusion and dislodgement, affect nearly 50% of patients, often leading to recurrent infections and renal impairment. Given these risks, regenerative medicine approaches, including stem cell therapy and tissue engineering, are being explored as alternative solutions. Materials and Methods: Experimental studies demonstrate that mesenchymal stem cells (MSCs) migrate to injured bladder and renal tissues, reducing fibrosis and promoting tissue repair. In animal models, MSC administration improves vascularization, decreases hypoxia, and enhances bladder compliance. Additionally, acellular matrices and biomaterial scaffolds provide structural support, facilitating cell adhesion, migration, and differentiation. These scaffolds can be functionalized with growth factors to further enhance regenerative processes. Results: Research indicates that MSC-based therapy reduces fibrosis and enhances bladder function in urinary obstruction. Tissue-engineered constructs incorporating MSCs and biomimetic scaffolds promote urothelial regeneration, smooth muscle reconstruction, and reduced catheter dependency. The use of bioactive scaffolds improves biocompatibility, minimizes inflammatory responses, and mitigates complications such as infections and occlusions. Conclusion: Stem cell therapy and biomaterial-based scaffolds offer promising strategies for addressing PCN-associated complications. Further studies should focus on refining cell delivery methods, optimizing scaffold design, and validating their clinical efficacy. The integration of regenerative therapies into standard PCN management may reduce the morbidity associated with catheter-based interventions and improve long-term patient outcomes.