Muscle-derived cells for treatment of iatrogenic sphincter damage and urinary incontinence in men.

INTRODUCTION: Aim of this study was to assess the safety and efficacy of injection of autologous muscle-derived cells into the urinary sphincter for treatment of postprostatectomy urinary incontinence in men and to characterize the injected cells prior to transplantation. METHODS: 222 male patients with stress urinary incontinence and sphincter damage after uroloical procedures were treated with transurethral injection of autologous muscle-derived cells. The transplanted cells were investigated after cultivation and prior to application by immunocytochemistry using different markers of myogenic differentiation. Feasibility and functionality assessment was achieved with a follow-up of at least 12 months. RESULTS: Follow-up was at least 12 months. Of the 222 treated patients, 120 responded to therapy of whom 26 patients (12%) were continent, and 94 patients (42%) showed improvement. In 102 (46%) patients, the therapy was ineffective. Clinical improvement was observed on average 4.7 months after transplantation and continued in all improved patients. The cells injected into the sphincter were at least ~50% of myogenic origin and representative for early stages of muscle cell differentiation. CONCLUSIONS: Transurethral injection of muscle-derived cells into the damaged urethral sphincter of male patients is a safe procedure. Transplanted cells represent different phases of myogenic differentiation.

[Operative treatment of female urinary incontinence with particular consideration of sexuality according to anatomical findings]. / Operative Therapie der weiblichen Harninkontinenz unter Berücksichtigung sexualitätsrelevanter Strukturen.

An evaluation of surgical treatment modalities for urinary incontinence shows that loop plasties are easy to use and with good short-term results with regard to achievement of urinary continence. However, in the light of reports of serious complications and the lack of long-term results, this indication must be reconsidered. In the framework of prolapse surgery Burch's colposuspension with sarcopexy and, possibly, rectopexy represents the standard therapy. Laparoscopic procedures are currently being evaluated. Experimental concepts such as, for example, tissue engineering for the reconstruction of a damaged sphincter apparatus or the use of hyaluronic acid as a bulking agent are potential procedures for the treatment of stress incontinence that need investigation, especially since these methods will probably not have visible negative impacts of the female patient's sexual function. What we need is an interdisciplinary project like that currently practiced in the German Centre for Pelvic Surgery. Objectives are the preservation and reattainment for female sexuality in the course of operations to achieve urinary continence and other pelvic interventions.