Stem cells may restore continence in both sexes

November 1, 2007

Using stem cells to cure stress urinary incontinence has been tested against collagen bulking and in incontinence following prostate surgery, and has come up a winner.

Keypoints:

Innsbruck, Austria-In 2006, urologists at the AUA annual meeting in Atlanta first heard about an innovative technique using stem cells to cure stress urinary incontinence. Now the technique has been tested against collagen bulking and in incontinence following prostate surgery, and has come up a winner.

Dr. Strasser, associate professor of urology at the University of Innsbruck, led the research that pioneered the transurethral, ultrasound-guided techniques to inject autologous myoblasts and fibroblasts into the urethral submucosa and the rhabdosphincter.

The injection device, which has a diameter of only 8F, is mounted on a tripod to provide stability, allowing the cells to be arranged precisely. Fifty to 60 injections of cells in microliter quantities are made: myoblasts into the rhabdosphincter, and fibroblasts, suspended in a small amount of collagen and autologous serum, into the submucosa.

Dr. Strasser noted that it takes about 4 to 6 weeks for the effects to be apparent. He also emphasized that only patients without hypermobility of the urethra and those without prolapse are candidates for the procedure.

Treating SUI in women

In a prospective, randomized trial, 42 women with stress urinary incontinence underwent stem cell therapy and 21 patients received standard treatment with collagen injection. All were followed for 1 year.

The two groups were "absolutely comparable" preoperatively in terms of their incontinence scores, quality of life scores, thickness of the urethra, thickness and contractility of the rhabdosphincter, and urodynamic parameters.

After 1 year, no obstruction was observed in either group. Thirty-eight of the 42 stem cell patients were continent, compared with only two of the 21 collagen patients. Incontinence, quality of life scores, and thickness and contractility of the rhabdosphincter all were significantly better in the stem cell group, as was maximum urethral closure pressure at contraction.

"Even more important," noted Dr. Strasser, "periurethral EMG activity after therapy was statistically significantly higher in the stem cell group: 44.23 seconds versus 35.24 seconds in the collagen group during rest and 56.47 seconds versus 40.57 seconds during contraction. That reflected the improved contractility and the visibly thicker, stronger, better-delineated rhabdosphincter [sometimes barely visible before therapy]."

Dr. Strasser and his colleagues also have followed up male patients who were treated with stem cell therapy for incontinence after laparoscopic or open prostatectomy or transurethral resection of the prostate. Although the injection device is longer for men, the method is principally the same as it is for women, Dr. Strasser told Urology Times.

From 2002 to 2006, 83 men underwent the therapy. Of 30 patients treated between 2002 and 2004, 16 are still continent. No effect was seen in five patients. Further, of 33 men treated in 2005, 19 are still continent and in 10 of 32 patients, continence is markedly improved. Finally, of the 22 men treated in 2006, 16 are still continent and in five of the 22 men, continence has improved.

One patient who had undergone multiple surgeries and radiation therapy incurred perforation of the bladder as an intraoperative complication; no long-term side effects were reported in any other patient.