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Developments in stem cell therapy, new minimally invasive sling procedures, and research on botulinum toxin (Botox) therapy for overactive bladder soon will give urologists far more effective treatment for incontinence than they can offer their patients today.
Urologists began to hear about stem cell use in incontinence therapy at the 2004 AUA meeting. This year's meeting brings more research on the use of muscle-derived stem cells from those same scientists, who will present longer-term data and discuss their use of stem cells in other groups of patients, such as for treating incontinence in men after prostate surgery.
Other new approaches are being tried. Researchers from UCLA are using autologous fat as a new source of stem cells for intraurethral injection to treat incontinence. Clearly, stem cell therapies hold promise in the not-too-distant future.
New approach to slings
"It's easier for urologists to do, and it has fewer complications. It may not be as effective, but we don't have long-term data yet," he said.
Although using biomaterials for slings held promise, their use is fading, and synthetic materials are now overwhelmingly used, Dr. Raz said.
"The durability of the biomaterials is in doubt because the body reabsorbs them. The body does not as easily transform a biomaterial into a strong layer of tissue," he explained. "But the synthetic materials create a frame for the patient's own tissue to grow and create a durable and strong support."
At the upcoming AUA meeting, urologists also will hear about new techniques and kits from synthetic materials being used in prolapse surgery.
Data are maturing on the use of botulinum toxin injections for overactive bladder. These techniques could be a boon to both urologists and their patients, Dr. Raz said. Injections can be done in the office under local anesthesia with minimal morbidity and relatively good results.
"If, indeed, it is shown that it is effective, botulinum toxin can be a viable alternative to the use of anticholinergic agents or neuromodulation. At present, the long-term use of botulinum toxin is unknown.
"It's something to try when a patient has had other overactive bladder treatments fail," said Dr. Raz.