AUA: Autologous Cell Transplants Show Promise for Stress Urinary Incontinence

By Charles Bankhead
ORLANDO, 28 may 2008-- For stress urinary incontinence, the use of transplanted autologous muscle-derived cells has led to significant and durable symptom improvement, investigators reported here.
Of 177 patients followed for up to two years, fewer than 10% of women and 30% of men required absorbent pads, Hannes Strasser, M.D., of the Medical University of Innsbruck in Austria, said at the American Urological Association meeting.
"The procedure is safe and minimally invasive," said Dr. Strasser. "Ultrasonography-guided injection of autologous cells has been very effective and also very precise, which is of utmost importance."
Since April 2004, Dr. Strasser and colleagues have used cell transplantation to treat 65 men and 112 women, starting with removal of a small amount of muscle from the patient's upper arm. Myoblasts and fibroblasts are grown in culture for six to eight weeks. The fibroblasts are mixed with a small amount of collagen, which serves as a carrier and prevents cell migration.
Guided by transurethral ultrasound, the fibroblasts are injected into the urethral submucosa to treat atrophy, and the myoblasts are injected into the rhabdosphincter to effect reconstruction.
Follow-up examinations revealed thickening of the urethra and rhabdosphincter and increased contractility of the rhabdosphincter.
At baseline the women used an average of six pads daily, which decreased to one pad at two years. Dr. Strasser reported that 62.5% of the women required no pads, 28.4% used a single pad daily for precautionary reasons, and 9.1% still required multiple pads because of persistent urinary incontinence.
Most of the men had urinary incontinence secondary to treatment of prostate cancer. On average the men required about five pads daily before treatment, decreasing to 1.59 at two years. Dr. Strasser said 27.9% of the men had regained complete continence, 43.6% used a single pad daily as a precaution, and 28.5% had persistent urinary incontinence.
There were no severe treatment side effects or complications. One patient who had undergone multiple surgical procedures and radiation therapy had a bladder perforation. No patient had signs of obstruction, scars or strictures, or bulking of injected cells.
Longer follow-up is needed to confirm the safety and efficacy of the procedure, Dr. Strasser said, and a multicenter trial is needed to demonstrate replicability.
"This is not a wonder therapy that works in every incontinent patient," Dr. Strasser cautioned. "It cannot be used in patients with hypermobility or in patients with prolapse. It works very well in patients with intrinsic sphincter insufficiency."
Dr. Strasser disclosed that he has an ownership stake in Innovacell Biotechnologie GmbH.
Primary source: Journal of UrologySource reference:Strasser H, et al "Transurethral ultrasound guided injection oif autologous myo- and fibroblasts in treatment of incontinence in men: 2 year data" J Urol 2008; 179(suppl):483. Abstract 1413. Additional source: Journal of UrologySource reference: Strasser H, et al "Transsurethral ultrasound guided application of autologous myo- and fibroblasts in treatment of incontinence in women: 2 year data" J Urol 2008; 179(suppl):534. Abstract 1561.