Muscle-Derived Cells for Treatment of Iatrogenic Sphincter Damage and Urinary Incontinence in Men

Abstract

Introduction. Aim of this study was to assess the safety and efficacy of injection of autologous muscle-derived cells into the urinary sphincter for treatment of postprostatectomy urinary incontinence in men and to characterize the injected cells prior to transplantation. Methods. 222 male patients with stress urinary incontinence and sphincter damage after uroloical procedures were treated with transurethral injection of autologous muscle-derived cells. The transplanted cells were investigated after cultivation and prior to application by immunocytochemistry using different markers of myogenic differentiation. Feasibility and functionality assessment was achieved with a follow-up of at least 12 months. Results. Follow-up was at least 12 months. Of the 222 treated patients, 120 responded to therapy of whom 26 patients (12%) were continent, and 94 patients (42%) showed improvement. In 102 (46%) patients, the therapy was ineffective. Clinical improvement was observed on average 4.7 months after transplantation and continued in all improved patients. The cells injected into the sphincter were at least ~50% of myogenic origin and representative for early stages of muscle cell differentiation. Conclusions. Transurethral injection of muscle-derived cells into the damaged urethral sphincter of male patients is a safe procedure. Transplanted cells represent different phases of myogenic differentiation.

Autologous muscle‐derived cells for the treatment of female stress urinary incontinence: A 2‐year follow‐up of a polish investigation

“…An 8‐month follow‐up and an update at 2 years after the procedure demonstrated the safety of the biopsy of a muscle sample and of the injection procedure. Our results add further evidence to other published short‐term trials regarding the safety of injecting MDCs as a therapy for SUI …”

“…The success rate reached 75%, with 50% of patients cured and a further 25% with improvement. Previous reports of using autologous myoblasts for UI demonstrated 13% to 43% of patients achieving total continence and 13.6% to 49% achieving improvement, after the injection of 0.21–128 × 10 6 myogenic cells . Thus, the 50% success rate for total continence reported here, despite the considerably low number (0.6–25 × 10 6 ) of infused MDCs, represents one of the best results for the use of cell therapy for SUI patients to date.…”

“…To date, an optimal technique that would permit an easier and more effective means of injection MDCs has not yet been described. The different means of injection that have been reported include trans‐ or periurethral injection into the bladder neck, the external sphincter, or the submucosa . Experience gained through the use of stem cells in the treatment of myocardial infarction demonstrates possibility to administer MDCs around the urethral sphincter at a precise depth in a repeatable manner using an injecting device .…”

“…Recent report demonstrated 13% cured and the highest improvement—79%; observed 6 weeks after injection of autologous myoblasts combined with electrostimulation . The application of autologous myoblasts for 222 men with iatrogenic sphincter damage and UI yielded 12% cured with 42% improved patients . Hershorn et al demonstrated that the improvement in quality of life and stress leaks tended to depend upon the number of transplanted cells.…”

Stem Cell Therapy: Current Applications and Potential for Urology

“…The largest study was conducted in 222 men with postprostatectomy urinary incontinence. Of the subjects, 54 % responded to MSC therapy while only 12 % of this number ultimately became continent [70]. In a recent study of 5 patients with SUI, transurethral injections of autologous adipose stem cells combined with bovine gel and saline resulted in a negative cough test in only 1 subject when bladder was saline-filled to a 500-ml capacity.…”