Papel de las células madre en el tratamiento de la incontinencia urinaria / The role of stem cells in the treatment of urinary incontinence

Objetivo: valorar el estado actual del tratamiento de la incontinencia urinaria en estudios de experimentación animal y clínica. Revisión: en el mundo hay más de 200 millones de mujeres con incontinencia urinaria, circunstancia que limita la calidad de vida. La incontinencia urinaria de esfuerzo es el tipo de incontinencia más frecuente. En los últimos años se ha propuesto el tratamiento con células madre habiendo sido objeto de trabajos de experimentación animal y clínicos. Se realiza una revisión crítica de las ventajas e inconvenientes de la utilización de células autólogas procedentes de medula ósea, tejido graso, muscular y de cordón umbilical. Se valoran las vías de administración y la metodología utilizada, proponiendo nuevas formas de administración y de los trabajos clínicos, mecanismos de acción y potenciales efectos secundarios. Por último se analizan los dispares resultados clínicos que oscilan entre el 88,9% y el 13,2%. Conclusión: el tratamiento de la incontinencia urinaria con células madre en el futuro podría colaborar a mejorar la calidad de vida de estas pacientes (AU)

Objective: Study the actual status of the urinary incontinence treatment with stem cells on animal and clinical experience. Review: More than 200 million people worldwide, affected with urinary incontinence with reduced quality of life. Stress urinary incontinence has been reported as the most common type of urinary incontinence. Stem cell for the regenerative repair of the stress urinary incontinence has been proposed during the last years, many experimental studies on animal models and some in clinical. This is a critical review of advantages and disadvantages of autologous cells use from bone marrow, fat tissue, muscle and umbilical cord. Administration ways and procedures are described and methology of administration with new ways of treatments are proposed. Study designs are discussed in terms of action mechanisms and possible disadvantages. Finally, discordant results ranging from 88.9% to 13.2% improvement rates are discussed. Conclusion: Urinary stress incontinence treatment with stem cells in the future could improve the quality of life of this kind of patients (AU)

Effect of vaginal spheres and pelvic floor muscle training in women with urinary incontinence: a randomized, controlled trial.

AIMS: To compare the efficacy and safety of Kegel exercises performed with or without, vaginal spheres as treatment for women with urinary incontinence. METHODS: Multicentre parallel-group, open, randomized controlled trial. Women were allocated to either a pelvic floor muscle-training program consisting of Kegel exercises performed twice daily, 5 days/week at home, over 6 months with vaginal spheres, or to the same program without spheres. The primary endpoint was women's report of urinary incontinence at 6 months using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF). Secondary outcome measures were the 1 hr pad-test, King's Health Questionnaire (KHQ) and a five-point Likert scale for subjective evaluation. Adherence was measured with the Morisky-Green test. RESULTS: Thirty-seven women were randomized to the spheres group and 33 to the control group. The primary endpoint was evaluated in 65 women (35 in the spheres group vs. 30 controls). ICIQ-UI-SF results improved significantly at 1-month follow-up in the spheres group (P < 0.01) and at 6 months in the controls. The 1 hr pad-test improved in the spheres group but not in the control group. No significant differences were found in the KHQ results or in the subjective evaluation of efficacy and safety. Adherence was higher in the spheres group but differences were not significant. Mild transient side effects were reported in four patients in the spheres group and one in the control group. CONCLUSIONS: Both treatments improved urinary incontinence but women who performed the exercises with vaginal spheres showed an earlier improvement. Vaginal spheres were well tolerated and safe.

Fecal incontinence in men: causes and clinical and manometric features.

AIM: To determine the causes and characteristics of fecal incontinence in men and to compare these features with those presented by a group of women with the same problem. METHODS: We analyzed the medical history, clinical and manometric data from 119 men with fecal incontinence studied in our unit and compared these data with those obtained from 645 women studied for the same problem. Response to treatment was evaluated after 6 mo of follow-up. RESULTS: Fifteen percent of patients studied in our unit for fecal incontinence were male. Men took longer than women before asking for medical help. Ano-rectal surgery was the most common risk factor for men related to fecal incontinence. Chronic diarrhea was present in more than 40% of patients in both groups. Decreased resting and external anal sphincter pressures were more frequent in women. No significant differences existed between the sexes regarding rectal sensitivity and recto-anal inhibitory reflex. In 17.8% of men, all presenting soiling, manometric findings did not justify fecal incontinence. Response to treatment was good in both groups, as 80.4% of patients improved and fecal incontinence disappeared in 13.2% of them. CONCLUSION: In our series, it was common that men waited longer in seeking medical help for fecal incontinence. Ano-rectal surgery was the major cause of this problem. Chronic diarrhea was a predisposing factor in both sexes. Manometric differences between groups were limited to an increased frequency of hypotony of the external anal sphincter in women. Fecal incontinence was controllable in most patients.