**3.2 Small intestinal submucosal (SIS) graft**

SIS xenograft is an acellular, nonimmunogenic, biodegradable, biocompatible, collagen matrix manufactured from porcine small intestinal submucosa, which could induce native tissue regeneration in various organs.

### **3.2.1 Clinical applications of SIS**

SIS graft has gained popularity in the field of urogynecology and reconstructive surgery. Promising results have been reported with the use of SIS as a bladder and urethral substitute material in animals **(Kropp, 1998a; Kropp et al, 1998b; Chen, Yoo and Atala, 1999).** Also, SIS has been used in humans undergoing urogenital procedures such as cystoplasties, ureteral reconstructions, penile chordee, and even urethral reconstruction for hypospadias and strictures **(Dedecker et al, 2005; Atala et al, 1999; Le Roux, 2005; Kassaby et al, 2003; Sharma and Secrest, 2003; Liatsikos et al, 2001).** In the field of urinary incontinence, SIS has been used with encouraging results in treatment of postprostatectomy incontinence **(Jones et al, 2005a),** neuropathic incontinence **(Misseri et al, 2005),** and SUI **(Wiedemann and Otto, 2004; Rutner et al, 2003; Jones et al, 2005b; Farahat et al, 2009).** Practical concerns regarding the use of the SIS implant in clinical practice: The first practical concern is related to the graft biocompatibility and how the tissue would react to the implant. The second practical concern is related to the biomechanical properties of the SIS sling and its suitability for curing SUI **(Farahat et al, 2009).**
