Which injectable to use in the treatment of intrinsic sphincter deficiency?

Goudelocke, Colin

doi:10.1097/mou.0b013e32833a4420

Cited by 9 publications

(3 citation statements)

References 16 publications

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“…[14][15][16][17] In these cases, improvement of urinary continence requires increased urethral closure pressure. Injection of a bulking agent, such as collagen, into the periurethral tissue, [18][19][20][21] and surgical implantation of a device, such as artificial urinary sphincter, 22,23 have been widely accepted as treatments for the intrinsic sphincter deficiencyrelated SUI. For the majority of patients, the benefits of these treatments are not enough because the continence rate sharply decreases with time, 24,25 or the injection or implantation of these materials can cause severe side effects, such as inflammation, foreign giant cell responses, abscesses, erosions, and voiding dysfunction.…”

mentioning

confidence: 99%

Implantation of Autologous Bone-Marrow-Derived Cells Reconstructs Functional Urethral Sphincters in Rabbits

Imamura

Ishizuka

Kinebuchi

et al. 2011

Tissue Engineering Part A

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The purpose of this study was to determine if implantation of autologous bone-marrow-derived cells has the potential to treat stress urinary incontinence caused by intrinsic sphincter deficiency. Bone marrow cells harvested from femurs of New Zealand White rabbits were cultured for 10 days. Seven days before implantation, the urethral sphincters located at the internal urethral orifice were cryo-injured by spraying liquid nitrogen for 15 s. The cultured autologous bone-marrow-derived cells were implanted 7 days after cryo-injury. For controls, cell-free solutions were injected. At 7 and 14 days after implantation, leak point pressures were determined and the urethral sphincters were examined by immunohistochemistry. At 7 and 14 days, the cell-implanted regions contained numerous striated and smooth muscle-like cells expressing myoglobin and smooth muscle actin, respectively. The proportions of myoglobin-and smooth muscle actin-expressing areas in both the 7-and 14-day cell-implanted regions were significantly higher than in controls. By 14 days, these differentiated cells formed contacts with similar cells, creating layered muscle structures. At that time, the leak point pressure of the cellimplanted rabbits was significantly higher than that of the controls. In conclusion, autologous bone-marrowderived cells can reconstruct functional urethral sphincters.

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mentioning

confidence: 99%

Implantation of Autologous Bone-Marrow-Derived Cells Reconstructs Functional Urethral Sphincters in Rabbits

Imamura

Ishizuka

Kinebuchi

et al. 2011

Tissue Engineering Part A

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“…There was a common tendency for the improvement in urinary incontinence to decrease over time in these studies, but no consensus as to the best agent and injection technique could be reached. According to Rovner and Goudelocke [46], "the ideal periurethral injectable agent has not yet been identified although many of the currently used agents have acceptable efficacy in selected populations" [47].…”

Section: Overview Of Ubasmentioning

confidence: 99%

Injectable Bulking Agents for the Treatment of Stress Urinary Incontinence

Lemperle¹,

Lemperle²

2017

SM Gerontol Geriatr Res

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Urethral Bulking Agents (UBAs) are injected locally as a minimally invasive procedure for Stress Urinary Incontinence (SUI) and are beneficial for properly selected patients. Many different materials have been developed and are available, although none so far meet all the requirements of an ideal agent. The first UBA was cross-linked bovine collagen (Contigen ® ), followed by autologous fat injections, solid silicone particles (Macroplastique ® ), microspheres covered with pyrolytic carbon (Durasphere ® ), calcium hydroxyapatite (Coaptite ® ), polyacrylamide hydrogel (Bulkamid ® ), and dextran/HA copolymer (Zuidex ® ). The latest product development is PDMS-U, a silicone gel bulking agent that polymerizes in situ (Urolastic ® ).The ideal urinary bulking agent could consist of permanent microspheres, which immediately elicit a modest foreign body reaction along with the production of fibro-vascular tissue, which encapsulate every single microsphere individually and prevent their migration from the injection site. Polymethylmethacrylate microspheres have a successful history as dermal fillers used world-wide and can be safely injected submucosally at the urinary sphincter under direct vision, rather than peri-urethrally into the muscle like most of the present agents.Overall, short-term clinical results with most of the currently used urinary bulking agents are encouraging; however, longer follow-up results are often disappointing and retreatment is required. Proper patient selection and a safe, biocompatible and non-migrating bulking agent that elicits permanent fibro-vascular tissue formation at the injection site are paramount to successful treatment of stress urinary incontinence.

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“…Under these circumstances, improvement of urinary continence requires increased urethral closure pressure. Injection of a bulking agent, such as collagen, into the periurethral tissue has been widely accepted; 20–23 however, the long‐term benefits are not satisfactory because the continence rate sharply decreases with time 24,25 . Surgical implantation of a device, such as an artificial urinary sphincter, has also been accepted as a treatment for this type of incontinence 26,27 .…”

Section: Introductionmentioning

confidence: 99%

Autologous Bone Marrow‐Derived Cells Regenerate Urethral Sphincters

Imamura

Ishizuka

Nishizawa

2012

LUTS

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Regenerative medicine based on tissue engineering and/or stem cell therapy techniques has the potential to improve irreversibly damaged tissues. Surgical injury to the lower urinary tract can occur as a result of radical prostatectomy or bladder neck surgery. Regeneration of urethral sphincters could be an effective treatment for post-surgical intrinsic sphincter deficiency (ISD)-related urinary incontinence. The replacement, enhancement, and/or recovery the urethral sphincter striated and smooth muscles could increase urethral closure pressure to help patients regain continence. Stem cells from muscle-derived satellite or adipose-derived mesenchymal cells provide temporary improvement in urethral closure pressure but do not reconstruct the muscle layer structures. Our strategy to accomplish regeneration of urethral sphincters is the utilization of autologous bone marrow-derived cells. We have developed a freeze injury model of ISD in rabbits. Freezing of the urinary sphincter causes loss of the majority of striated and smooth muscle cells, and causes a significant decrease in leak point pressure. In this review, we show that the autologous bone marrow-derived cells implanted within the freeze-injured sphincters differentiate into striated or smooth muscle cells. These cells then develop to reconstitute muscle layer structures within the sphincter. Furthermore, the leak point pressure of cell-implanted rabbits is significantly higher than that of cell-free injected controls. We conclude that implantation of autologous bone marrow-derived cells could be an effective treatment for human post-surgical ISD-related urinary incontinence.

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Which injectable to use in the treatment of intrinsic sphincter deficiency?

Abstract: The ideal periurethral injectable agent has not yet been identified though many of the currently used agents have acceptable efficacy in selected populations. There is active research into novel therapies that may prove effective.

Cited by 9 publications

References 16 publications

Implantation of Autologous Bone-Marrow-Derived Cells Reconstructs Functional Urethral Sphincters in Rabbits

Implantation of Autologous Bone-Marrow-Derived Cells Reconstructs Functional Urethral Sphincters in Rabbits

Injectable Bulking Agents for the Treatment of Stress Urinary Incontinence

Autologous Bone Marrow‐Derived Cells Regenerate Urethral Sphincters

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