Stress urinary incontinence in women: Current and emerging therapeutic options

Abstract

Surgical management of stress urinary incontinence (SUI) is most commonly achieved by midurethral synthetic sling (MUS) insertion as a first-line surgical option. A great deal of research continues to evolve new management strategies to reach an optimal balance of high efficacy and minimal adverse events. This expert opinion review provides a brief and comprehensive discussion of recent advances and ongoing research in the management of SUI, with an emphasis on single-incision mini-slings, vaginal laser treatment, and cell-based therapy. It is based on data obtained from numerous published meta-analyses and original studies identified through literature search. Single-incision mini-slings appear equally effective initially compared with standard MUS (retropubic or transobturator) for the treatment of female SUI; however, this efficacy lacks durability evidence beyond one-year followup. There is a lack of sufficient clinical evidence to currently confirm long-term safety and effectiveness of cell-therapy and non-ablative vaginal laser therapy, besides suggestion of apparent initial safety. There are still significant challenges to overcome before widespread clinical practice of the latter two modalities. Future research should be aimed at identifying groups of patients who might benefit from these minimally invasive therapeutic options.

Applicability of regenerative medicine and tissue engineering for the treatment of stress urinary incontinence in female patients

“…In this regard, several concerns need to be addressed and standardized in future translational studies, such as cell isolation and in vitro culture, amount of cells to restore the sphincter functionality, number of injection, time for intervention, and so forth. In addition, the clinical outcomes also depend on good laboratory practice and a high‐qualified team of professionals . The concept of acute injury repair with cells and chronic injury with regenerative pharmacology rather than cells needs to be explored.…”

“…In addition, the clinical outcomes also depend on good laboratory practice and a high-qualified team of professionals. 42 The concept of acute injury repair with cells and chronic injury with regenerative pharmacology rather than cells needs to be explored. Unrestricted growth of cells and malignant potential remains a theoretical concern.…”

Which molecular targets do we need to focus on to improve lower urinary tract dysfunction? ICI‐RS 2017

“…This does not seem to be the case, based on the limited efficacy of current treatment options recently reviewed by the ICI. It is obvious that structural factors cannot be treated pharmacologically, and drug treatment is not even mentioned as a treatment option in a recent review of SUI treatment in women . Stem cell treatment of SUI is an interesting avenue, but treatment efficacy seems limited .…”

Female urinary incontinence: is laser treatment effective? a systematic review

“…3,4 There is a wide range of therapeutic options for UI, both medical and surgical, but new and minimally invasive methods have recently been introduced to optimize efficacy and overcome the complications and morbidity of standard therapies. 1,5 Laser therapy has a therapeutic role in various medical conditions and most recently has gained interest as a promising treatment for UI, particularly SUI, the most prevalent type of UI. 1,6 In this field, two distinct lasers have been used: microablative fractional CO 2laser (CO 2 -laser) and non-ablative photothermal Erbium: YAG-laser (Er:YAG-laser).…”

“…6 Even though there is currently a reasonable number of studies about vaginal CO 2 -laser and Er:YAGlaser treatments, there are no reviews focusing on both kinds of laser as an approach to any type of female UI (SUI, UUI and MUI). 5,7,12 The aim of the present study is to identify the effectiveness and safety of both CO 2 -laser and Er:YAG-laser as therapy for female urinary incontinence by reviewing literature.…”