1. Writing a Systematic Review
a good start of a PhD-project
Marije Sloff
PhD-student Experimental Urology
Tissue Engineering

2. Introduction
• Experimental Urology – internship 2009
• Polymer Chemistry – internship 2011
• Targeted Drug Delivery
• Hyaluronan

3. PhD-project
• “Developing an artificial stoma for urinary diversion in
patients with extensive bladder disease”.
• Patients
• Bladder cancer
•73.000 new patients/2012 in US
•Muscle-invasive tumors
• Congenital malformations
•Spina bifida or bladder exstrophy
•Neurogenic/dyfunctional bladder

4. Urinary Diversion (1/2)

5. Urinary Diversion (2/2)
• Urinary Diversion
• Golden standard is Bricker ileal conduit
• Bowel surgery
• Placing Urostomy

6. Problems
In 28-81% of the cases complications will occur, due to:
• Intestinal surgery (1-5%)
• Leakage/rupture of the anastomosis
• Obstruction
• Fistula formation
• Infections
• Unsuitability of tissue
• Necrosis
• Stenosis
• Obstruction
• Deformations

7. Tissue engineering
• Aims to restore or replace diseased, affected or non-
functional tissues.
• In vitro and In vivo
• Synthetic/biological materials
• W/ or w/o cell technology
• Scaffold
• Temporal support
• Promotes tissue regeneration
• Replacement

8. Artificial Urostomy (1/2)
• Structural protein Collagen
• (slow) Biodegradable Vypro® II
synthetic polymer mesh
• Porcine model
•Conclusion: A tubular construct can be
used for urinary diversion (although
improvement is needed)

9. Artificial Urostomy (2/2)
• Problems
• Skin contraction
• Immunological reaction
• Tissue regeneration
• Improvement
• Material
• Animal model
• Porcine model
• Predictive value?

10. Systematic Review
• “What is the current evidence for the efficacy of
tissue-engineered constructs for urinary diversion in
animal models?”
• PICO
Patient: Urinary diversion in animal models
Intervention: Tissue-engineered construct
Comparison: Classical method using GI tissue
Outcome: Survival/ regeneration/ inflammation/
integration/ functionality

11. Search Strategy (in progress)
Based on Leenaars et al (2012) 45: 24-31.

12. Inclusion/Exclusion
Used in Systematic Review

13. Why start a PhD with systematic Review?
• To prevent unneccessary (animal) experimentation
• To collect information about materials/methods/models
• To generate a detailed overview of all relevant literature
• To learn how to make a comprehensive search strategy

14. Experienced difficulties
• Commercial side of my research
• Unpublished information
• Negative results
• When to stop/continue
• Slow proces

15. Conclusions
• Benefits and difficulties
• Do the benefits outweigh the difficulties?
• Time and effort
• Useful information
• Extensive overview
• Full-time focus at beginning of a project
• Use for grant application

16. Acknowledgements
Department of Urology SYRCLE
Prof. Dr. Wout Feitz Prof. Dr. Merel Ritskes-Hoitinga
Dr. Egbert Oosterwijk Dr. Rob de Vries
Dr. Paul Geutjes