Adult stem cell therapy of female stress urinary incontinence

OBJECTIVES: To investigate the efficacy of transurethral ultrasound (TUUS)-guided injections of autologous myoblasts and fibroblasts in women with incontinence. METHODS: Between January and June 2005, 20 female patients suffering from stress urinary incontinence (SUI) were included. Skeletal muscle biopsies were taken from the left arm to obtain cultures from autologous fibroblasts and myoblasts. By TUUS guidance the fibroblasts were injected into the urethral submucosa and the myoblasts were injected into the rhabdosphincter. A defined incontinence score, quality-of-life score and urodynamic, electromyographic, and laboratory parameters, as well as morphology and function of urethra and rhabdosphincter were evaluated before and up to 2 yr after therapy. RESULTS: Eighteen of 20 patients were cured 1 yr after injection of autologous stem cells and in 2 patients SUI was improved. Two years after therapy 16 of the 18 patients presented as cured, 2 others were improved, and 2 were lost to follow-up. Incontinence and quality-of-life scores were significantly improved postoperatively. The thickness of urethra and rhabdosphincter as well as activity and contractility of the rhabdosphincter were also statistically significantly increased after therapy. CONCLUSIONS: Clinical results demonstrate that SUI can be treated effectively with autologous stem cells. The present data support the conclusion that this therapeutic concept represents an elegant and minimally invasive treatment modality to treat SUI.     

A randomized controlled trial of urodynamic investigations prior to conservative treatment of urinary incontinence in the female

Sixty patients complaining of frequency, urgency, nocturia, urge incontinence and stress incontinence were randomly allocated to either undergo conservative treatment by way of combined physiotherapy and bladder retraining as an inpatient without prior urodynamics, or to have urodynamic investigations and treatment tailored to the urodynamic diagnosis. The assessment period was 3 months and assessment was made pre- and posttreatment by urinary diary, pad testing and subjective questionnaire. There was a significant improvement posttreatment for each parameter studied, with the exception of pad testing. There was no significant difference between the two groups for any parameter. Two-thirds of patients were cured to the extent that they did not require further treatment, and again there was no difference between the two groups. We conclude that patients attending for the first time with an uncomplicated story of urinary incontinence can be effectively treated conservatively without prior urodynamics.EDITORIAL COMMENT: The treatment of urinary incontinence based on symptoms rather than urodynamic diagnosis has long been used by physicians, although the validity and success of this approach has been questioned. Dr Ramsay and associates attempt to address this issue of conservative management of urinary incontinence prior to urodynamic evaluation. The study design is clean cut, although the number of patients enrolled is small and the treatment regimen initially requires hospitalization. With more and more emphasis being placed on managed care, empiric therapy based on symptoms rather than the results of expensive urodynamic testing may become the standard approach to female urinary incontinence. Large randomized studies looking at clearly defined outcome measures will be necessary to support this approach.     

Long-term subjective continence status and use of alternative treatments by women with stress urinary incontinence after collagen injection therapy

This study examined subjective continence status and use of subsequent alternative therapeutic procedures at long-term follow-up after collagen injection for stress incontinence (SI) in women. Seventy women who underwent collagen injection for SI were identified by retrospective chart review and surveyed by mail questionnaire for subjective continence status, daily pad usage pre- and post-treatment, and use of anticholinergics and alternative procedures. Questionnaire responders’ versus non-responders’ mean age, follow-up, and pad usage were compared. Thirty-three women (47%) responded on questionnaires. Of the 33, 50% were dry or subjectively improved at long-term follow-up and 91% had not chosen an alternative invasive treatment after collagen injection. Chart review showed responders were not significantly different from non-responders in mean age (65.9 vs. 69.2 years), pad usage (0.6 vs. 0.8 pads/day), or follow-up (4.5 vs. 4.3 years). Collagen injection, a minimally invasive treatment for SI, appears to benefit a significant number of women.     

组织工程技术在下尿路疾病修复与重建中的应用

组织工程技术对下尿路疾病的修复与重建,如泌尿生殖器先天性畸形、尿道狭窄、膀胱先天性与获得性缺陷,提供了一个新的途径,且在近几年的实验与临床研究中有较大的发展。本文介绍组织工程技术在泌尿外科中开展的一些新进展。     

女性压力性尿失禁患者在不同膀胱容量下漏尿点压的对照研究

目的:探讨女性压力性尿失禁患者在不同膀胱灌注量下漏尿点压的差异。方法:回顾性分析2016年1月至2018年12月本院收治的12例女性压力性尿失禁患者,在术前行尿动力检查时分别给予膀胱灌注200、250、300、350 mL时,测出腹压漏尿点压及咳嗽漏尿点压并分别进行比较。结果:不同膀胱容量下同时测得的腹压漏尿点压及咳嗽...     

小儿神经源性膀胱与上尿路损害

目的：探讨脊髓发育不良致神经源性膀胱造成上尿路损害的尿动力学危险因素,方法：对32例脊髓发育不良患儿行尿动力学和影像学检查。结果：18例（56％）有肾和输尿管积水,其中4例伴IV－V级膀胱输尿管返液,19例逼尿肌漏尿点压力大于等于40cmH2O(1cmH2O=0.098kPa)且膀胱顺应性小于等于40ml/cmH2O的患儿中,17例合并上尿路损害,13例逼尿肌漏尿点压力＜40cmH2O且膀胱顺应性＞40ml/c mH2O的患儿中,仅1例有双侧输尿管扩张,差别有非常显著性意义（P＜0．001）,结论：对脊髓发育不良致神经源性膀胱的患儿应行尿动力学检查,了解逼尿肌漏尿点压力和膀胱顺应性,确定与上尿路损害有关的危险因素,有助于避免上尿路进一步损害。     

Initial experience with the modified vaginal wall sling in the treatment of female stress urinary incontinence

From March 1995 to March 1996 24 women aged 29–73 years with stress urinary incontinence underwent a modified vaginal wall sling procedure following videourodynamic evaluation. Of these 24, 2 had stress urinary loss due to urethral hypermobility (UH), 3 had intrinsic sphincter deficiency (ISD) and 19 had both UH and ISD. Thirteen (54%) had preoperative urge incontinence, 13 (54%) had associated pelvic floor weakness, including cystocele, and 12 (50%) had had previous pelvic surgery and bladder neck suspension. Twenty-two patients were evaluable for a mean follow-up of 14 months (range 9–21 months). Stress urinary incontinence was resolved in all patients (100%). Of the patients with preoperative urge symptoms, 58% reported resolution but in 42% the urge symptoms remained unresolved. One new patient developed urge and occasional urge incontinence. Out of 22 patients 20 (90.9%) are totally continent; 2 (9.1%) are incontinent and both have documented detrusor instability and occasionally wear pads. The vaginal wall sling is an ideal procedure for the treatment of the various forms of stress urinary incontinence in women. In our series the early results indicate excellent patient acceptability and continence. Long-term follow-up will determine the durability of the procedure. EDITORIAL COMMENT: This is an observational study of a technique that is only slightly different from that previously described by Raz. The authors appear to have fairly good success, but the study is limited by the lack of uniform follow-up evaluations and the relatively short follow-up time. Further studies with longer follow-up and more comprehensive postoperative testing will be necessary before this procedure can be recommended.     

Comparison of leak point pressure methods in an animal model of stress urinary incontinence

We compared three different methods of testing leak point pressure (LPP) in rats with or without the pudendal nerves and nerves to the iliococcygeus/pubococcygeus muscles transected: (1) sneeze induced with a whisker in the nostril (sneeze LPP), (2) manually increased abdominal pressure (Crede LPP), and (3) increased intravesical pressure using the vertical tilt table method (vertical tilt table LPP). In sham rats, passive intravesical pressure rises in Crede and vertical tilt table methods induced active urethral closure mechanisms that contributed to high LPPs (41.4 and 35.5 cmH₂O, respectively), which were significantly reduced by nerve transection. During sneezing, leakage was observed in nerve-transected rats, but not in sham rats, indicating that sneezing can activate an additional urethral closure mechanism. Measuring LPP during sneezing or passive intravesical pressure rises in the vertical tilt table and Crede method seems to be useful for assessing the continence mechanisms under different stress conditions in rats.     

Sub-urethral slings for treatment of stress urinary incontinence

Sling surgery is considered to be the gold standard for the treatment of incontinence resulting from internal sphincter deficiency. A century of experience is reviewed and evolving new concepts and techniques are presented.     

Colposuspension for urinary stress incontinence in postmenopausal patients

Eighty-seven postmenopausal patients had a colposuspension for urinary stress incontinence. A significant postoperative reduction (p<0.001) of symptoms of frequency, nocturia, urgency and urge incontinence was obtained. The cure rate for urinary incontinence was 77%. Twenty patients were found to be wet postoperatively, 8 due to stress incontinence and 12 due to detrusor instability, 9 of whom had detrusor instability preoperatively.No differences were found pre- and postoperatively in the cystometric and uroflowmetric values or in the urethral pressure profile measurements. The pressure transmission ratios were significantly improved postoperatively.During operation and postoperatively, minor complications occurred in this group of patients. In 5 patients blood transfusion was needed. Urinary tract infection was diagnosed in 21 patients, wound infections in 4 patients and enterocele in 5 patients.Colposuspension for urinary stress incontinence in postmenopausal patients is a safe procedure with a reasonable cure rate indicating that a surgical approach should be adopted in such patients.Editorial Comments: This is an extension of the authors' previously published series in SGO [2] now dealing exclusively with postmenopausal patients. Although they state that their overall cure rate was 77%, in fact the cure rate for stress incontinence was 79/87 or 91%. Adding the patients with detrusor instability gives the lower cure rate of 77%. An important contribution of this article is the documentation of a decrease of symptoms of urgency, frequency and urge incontinence subsequent to a modified Burch colposuspension. In addition they document that the pressure-transmission ratios were less than 100% in all of their failed cases. Further studies are needed in the elderly to document success or failure in this group since we will be faced with an ever increasing elderly population in years to come.     

Innovations in pharmacotherapy for stress urinary incontinence

The purpose of this review article is to highlight new pharmacotherapies on the horizon for the treatment of stress urinary incontinence (SUI). Although behavioral and surgical therapies are currently the mainstay of treating SUI, we believe that medications will take center stage and possibly become first-line therapy. Currently, there are no FDA medications indicated for SUI. However, results are becoming available about an oral medication, duloxetine, which appears to be clinically safe and efficacious for the treatment of SUI. In addition to discussing medications currently under development, we will also discuss exciting pharmacological targets that could be suitable to treat SUI.Abbreviations EUS External urethral sphincter - SPN Sacral parasympathetic nucleus - SUI Stress urinary incontinence     

Ultrasonography in stress urinary incontinence

Evaluation of the urethrovesical junction in stress urinary incontinence is essential. For this reason the Q-tip test, a clinical test with debatable specificity; lateral cystourethrography, a conventional method; and videourethrocystography, a sophisticated method, have been in use. Because ultrasonography is inexpensive, reliable, easy to apply and free of any contrast material and X-ray exposure, it has practically replaced all the former methods in the evaluation of the urethrovesical junction in stress urinary incontinence patients within the last decade.     

口腔黏膜细胞与膀胱黏膜下脱细胞基质复合物构建组织工程化尿道的实验研究

目的 探讨以兔口腔黏膜细胞与同种异体膀胱黏膜下脱细胞基质(BAMG)复合物构建组织工程化尿道的可行性.方法 新西兰雄性兔24只,距尿道外口2.0 cm剥离尿道黏膜(2.0 cm×0.8 cm)后,随机分实验组和对照组,每组12只.切取实验组兔口腔黏膜组织分离细胞,在有灭活的3T3细胞培养皿上进行培养扩增,将培养获得的第2代口腔黏膜细胞种植于BAMG(2.2 cm×1.0 cm)上,植入实验组兔尿道缺损区域;对照组单纯采用无细胞植入的BAMG修复尿道.分别于术后1、2、6个月观察动物排尿情况,行尿道造影,8 F尿管插管确定有无狭窄;随后处死实验兔,取修复段尿道黏膜组织行组织学检查.结果 细胞培养获得的口腔黏膜细胞形态均一,生长良好;组织形态学、扫描电镜观察见口腔黏膜细胞与BAMG具有良好的相容性.实验组兔术后1、2、6个月伤口愈合良好、排尿通畅,无尿瘘发生,组织学和尿道造影检查显示带细胞修复的尿道形态完整、清晰宽敞,无狭窄发生;术后6个月植入的口腔黏膜细胞仍然存在,并明显扩增.对照组兔则出现排尿困难、尿道狭窄,光镜下发现黏膜及黏膜下存在严重的炎症反应.结论 兔口腔黏膜细胞与同种异体BAMG复合后,可成功用于尿道缺损的修复,构建组织工程化尿道.     

压力性尿失禁的细胞治疗

目的综述压力性尿失禁(stress urinary incontinence,SUI)细胞治疗的研究现状及临床应用进展。方法广泛查阅近年来有关SUI细胞治疗的文献并进行综述。结果软骨细胞和成肌细胞因不具有或仅有较差的再生修复能力,限制了二者的临床应用;干细胞因具有较强的自我更新和再生修复能力被认为是治疗SUI的理想种子细胞,已在动物实验及初步临床研究中取得了令人振奋的成果,为SUI细胞治疗可行性奠定了理论基础。结论细胞治疗尤其是干细胞治疗为SUI提供了一种新的治疗手段,其具体作用机制还有待进一步研究。     

Transurethral collagen injection for treatment of stress urinary incontinence

Summary Minimally invasive treatment of urinary incontinence has become a subject of major interest in recent years. We examined the use of transurethral collagen injection for incontinence treatment. A total of 48 patients were selectet for this procedure from April 1993 to February 1997 – 26 male patients (19 post-RPX incontinence and 7 post-TUR incontinence) and 22 female patients (all after previous incontinence surgery) were treated by injection of collagen into the continence region. The whole group underwent an average of 1.8 sessions, and a mean collagen injection volume of 14.5 ml was delivered per session. Mean follow-up was 9.2 months. Of the female population, 68.2 % were cured or greatly improved. In the male population only 47.3 % of the post-RPX patients and 6/7 of the post-TUR patients benefited from the procedure. In males, treatment outcome depends on the degree of pretreatment incontinence, because all grade III incontinence patients did worse. Therefore we conclude: transurethral collagen injection is an interesting method in the treatment of urinary incontinence if proper patient selection is assured.      

TENS: A treatment option for bladder dysfunction

To ascertain the mode of action and benefits of transcutaneous electrical nerve stimulation (TENS) in detrusor overactivity, stress incontinence and interstitial cystitis, an English-language literature search using Medline (1984–1995) was undertaken with detrusor instability, incontinence, interstitial cystitis, neuromodulation, transcutaneous electrical nerve stimulation and urodynamics as keywords and the material so identified was reviewed. The mode of action of TENS and optimal stimulation parameters in bladder dysfunction remain unclear. Lack of strict selection criteria and deficient reporting of subjective and objective outcomes precluded full assessment of therapeutic efficacy. A beneficial effect was evident in some studies of detrusor overactivity and interstitial cystitis. A trial of TENS in detrusor overactivity and interstitial cystitis refractory to conventional therapy would seem justified. Continued experimental research and further clinical studies will lead to refinement of the treatment modality.     

Surgical treatment of stress urinary incontinence after radical hysterectomy

Stress urinary incontinence is not infrequent after radical hysterectomy for cervical cancer. Eight women who underwent surgery for correction of stress incontinence after radical hysterectomy were studied with urodynamic techniques before and 1 year after incontinence surgery. Five patients underwent a Marshall-Marchetti-Krantz (MMK) operation, 1 a Burch colposuspension, 1 a sling procedure and 1 an anterior repair. Two patients remained incontinent after an MMK operation, as did the patient who had an anterior repair. The patient who underwent a sling procedure had to practice intermittent selfcatheterization. We conclude that an appropriate operation can cure stress incontinence after radical hysterectomy, but that patients should be selected carefully.     

腺病毒介导单纯疱疹病毒胸苷激酶基因/更昔洛韦系统杀伤膀胱癌细胞的研究

目的：探讨单纯疱疹病毒胸苷激酶基因／更昔洛韦（HSV－tk/GCV)系统杀伤膀胱癌细胞的作用。方法;采用人巨细胞病毒早期蛋白启动子驱动HSV－tk基因重组腺病毒（Ad)载体,体外转染HTB9和Scan BER细胞,MTT法测定杀伤率,PCR检测Ad-tk转染细胞中tk基因及腺病毒E1区基因。结果：GCV对转染的癌细胞有杀伤作用,感染复数（MOI）100时,10mg/L GCV杀伤80％的tk^ 细胞,而对未转染的细胞无杀伤作用。不同MOI的Ad-tk转染两种细胞,其毒性与Ad-tk MOI正相关,MOI100时,15mg/L GCV杀伤100％的细胞,无GCV组未受到抑制。PCR证实Ad-tk转染细胞有tk基因,腺病毒E1区基因阴性。Annexin V法证实杀伤效应与凋亡有关。结论：HSV-tk/GCV系统是一种有效,安全治疗膀胱癌的新方法。     

Surgery for female stress urinary incontinence with transobturator tape

The aim of suburethral transobturator suspension is to cure the women stress urinary incontinence. The concept underlying this apparatus is based on several points: it reproduces the urethral fascia; it complies with Delancey's concept; it consists of a tension-free band through the soft structures of the obturator fossa; it is a perineal surgery. This surgery needs specific devices: a synthetic tape and a specific tool to introduce it, the tunnelling device. Respecting some technical landmarks are mandatory to ensure successful intervention: the vaginal incision must include all the thickness of the vaginal wall; the trans-obturated endpoint must be located at the level of the mid urethra; the tunnelling device must have a close contact with the ischiopubic bone; the finger inside the incision protects the urethra and drives the tunnelling device inside the vaginal incision.