STEM CELLS IN THE TREATMENT OF URINARY STRESS INCONTINENCE – A VISION OF FUTURE?
Abstract
Background. For one third of all women urinary incontinence is a health problem. Different strategies of treatment have been used, namely surgical, medical and physiotherapy. To this armamentarium a new method – adult stem cells therapy – has been added.
Methods. The source of adult autologues multipotent stem cells consists of muscle-derived stem cells, adipose-derived stem cells and mesenchymed bone marrow cells. In facilities for stem cells with processing and in the presence of specific inducing factors, muscle derived stem cells can be differentiated to striated or smooth muscles. Clinical work is based on animal models that with immunohistochemical analysis demonstrated new skeletal-muscle fiber formation at the site of injection of stem cells. In stress urinary incontinence (SUI) autologues bioptic material is obtained by using a musle needle biopsy device. From the biopsy speciment with dissociation muscle-derived stem cells are isolated and injected under local anaesthesia in the middle urethra and/or external urethral sphincter. Initial results of SUI treatment with adult muscle-derived stem cells suggest that perspectives of this method are encouraging.
Conclusions. Stem cell therapy is promising to become minimally invasive method for reconstruction of the muscles and connective tissue of urethra and external urethral sphincter.
Downloads
References
Kerr Cl, Gerhart JD, Elliot AM, Donovan PJ. Embryonic germ
cells: when germ cells become stem cells? Semin Reprod Med
; 24: 304–13.
Pesce M, Scholer HR. Oct-4-control of totipotency and germ-lowe
determination. Mol Reprod Dev 2000; 55: 452–7.
Surani MA. Nuclear reprogramming by human embryonic stem
cells. Cell 2005; 9: 653–4.
Rosenthal N. Prometeus‘s vulture and the stem-cell promise. N
Engl J Med 2003; 17: 267–74.
Perillo A, Bonanno G, Pierelli L, Rutella S, Scambia G, Mancuso S,
et al. Stem cells in gynecology and obstetrics. Panminerva Med
; 46: 49–59.
Moise KJ. Umbilical cord stem cells. Obstet Gynecol 2005; 106:
–407.
Johnson J, Canning J, Kaneko T, Pru JK, Tiully JL. Germline stem
cells and follicular renewal in the postnatal mammalia ovary.
Nature 2004; 428: 145–50.
Bukovsky A. Can ovarian infertility be treated with bone marrow
or ovary derived germ cells? Reprod Biol Endocrinol 2005; 3:
–8.
Virant-Klun I, Zech N, Rožman P, Vogler A. Putative stem cells
with an embryonic character isolated from the ovarian surface
epithelium of women with no naturally present follicles and
oocytes. Differentiation 2008; 76: 843–56.
Taylor HS. Endometrial cells derived from donor stem cells in
bone marrow transplantant recipients. JAMA 2004; 292: 81–5.
Radley SC, Chapple CR, Bryan NP, Clarke DE, Craig DA, et al. Effects
of methoxamine on maximum urethral pressure in women
with genuine stress incontinence: a placebo-controlled, double
blind crossover study. Neurourol Urodyn 2001; 20: 43–52.
Kiilholma PJ, Chancellor MB, Markinen J, Hirsch IH, Klemi PJ, et
al. Complications of Teflon injection for stress urinary incontinence
. Neurourol Urodyn 1993; 12: 131–7.
Bent AE, Tutrone RI, Mc Lennan MT. Treatment of intrinsic
sphincter deficiency using autologous ear chondocytes as a
bulking agent. Neurourol Urodyn 2001; 20: 157–65.
Ward KL, Hiltn P. A prospective multicenter randomized trial
of tension-free vaginal top and colposuspension for primary
urodynamic stress incontinence: two year follow-up. Am J Obstet
Gynecol 2004; 190: 324–31.
Cannon TW, Lee JY, Somogyi, Pruchnic R, Smith CP, Huard J, et
al. Improved sphincter contractily after allogenic muscle-derived
progenitor cell injection into the denervated rat urethra. Urology
; 62: 958–63.
Zeng X, Jack G, Zhang R et al. Fibroblasts and adipose derived
stem cells in the treatment of stress urinary incontinence: comparison
of functional outcomes. J Urol 2007; 177: 554 (abstract
.
Pittenger MF, Mackay AM, Beck SC, Jaiswal RK, Douglas R, Mosca
JD, et al. Multilineage potential of adult human mesenchymal
stem cells. Science 1999; 284: 143–7.
Furuta A, Carr LK, Yoshimura N, Chancellor HB. Advances in the
understanding of stress urinary incontinence and the promise
of stem-cell therapy. Rev Urol 2007; 9: 106–12.
Yokoyama T, Pruchnic R, Lee JY, Chuang YC, Jumon H, Yoshimura
N, et al. Autologous primary muscle-derived cells transfer into
the lower urinary tract. Tissue Eng 2001; 7: 395–404.
Chancellor MB, Yokohama T, Tirney S, Mattes CE, Ozawa H,
Yoshimura N, et al. Preliminary results of myoblast injection into
the urethra and bladder wall: a possible method for treatment
of stress urinary incontinence and impaired detrusor contractibility.
Neurourol Urodyn 2000; 19: 279–87.
Strasser H, Marksteiner R, Margreiter E et al. transurethral ultrasound
guided stem cell therapy of urinary incontinence. J Urol
; 175: 291.
Carr LK, Steele D, Steele S et al. Single institution clinical trial of
muscle-derived cell injection to treat stress urinary incontinence.
J Urol 2006; 175: 414.
Hijaz A, Daneshgari F, Sievert KD, Damaser MS. Animal models of
female stress urinary incontinence. J Urol 2008; 179: 2103–10.
Rodriguez LV, Alfonso Z, Zhang R, Leung J, Wu B, Ignarro LJ, et
al. Clonogenic multipotent stem cells in human adipose tissue
differentiate into functional smooth muscle cells . Proc Natl Acad
Sci USA 2006; 103: 12167–72.
Furuta A, Jankowski RJ, Pruchnic R, Yoshimura N, Chancellor
MB, et al. The promise of stem cell therapy to restore urethral
sphincter function. Curr Urol Rep 2007; 8: 373–8.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
