Transurethral injections of autologous myoblasts and fibroblasts could relieve stress urinary incontinence in women, conclude authors of an article published in The Lancet. And an accompanying comment hails the development as the beginning of a new era in urogynaecology. Myoblasts are a type of muscle stem cell, while fibroblasts are cells which form the structural framework for many tissues in the body. Autologous cells are ones which the patient is the source of. Dr Hannes Strasser, Medical University of Innsbruck, Austria, and colleagues studied 63 women with stress urinary incontinence, of which 42 were given myoblast/fibroblast injections and 21 were given conventional endoscopic injections of collagen. All the women were given incontinence scores from 0-6, based on a 24-hour voiding diary, 24-hour pad test and a patient questionnaire. After 12 months, the contractibility of the rhabdosphincter (the voluntary muscle responsible for contraction of the urethral sphincter) and the thickness of the urethra were analysed.
The researchers found that 38 of the 42 women given the autologous cell injections were completely continent after 12 months, compared with just two of the 21 patients given conventional collagen treatment. The mean thickness of the rhabdosphincter increased by 59% in patients given autologus cell injections, compared to a 9% increase in the collagen-injection group; and the contractibility of the rhabdosphincter increased by 268% in patients given the autologous cell injections, compared with 15% in the collagen-injected group. The change in thickness of the urethra did not differ significantly between the two groups. The authors say their data accord with other results that suggest success rates for injection of bulking agents such as collagen to treat urinary incontinence are poor. They say: “We show that continence improved more in patients injected with autologous myoblasts and fibroblasts than in those injected with collagen.”
They conclude: “Long-term postoperative results and data from multicentre trials with larger numbers of patients are needed to assess whether injection of autologous cells into the rhabdosphincter and the urethra could become a standard treatment for urinary incontinence.” In the accompanying Comment, Dr Giacomo Novara and Dr Walter Artibani, Urology Clinic, University of Padua, Italy, say: “Hannes Strasser and colleagues report a randomised trial that can be seen as the beginning of a new era in urogynaecology.” They conclude: “If the data are confirmed, this approach is likely to cause a substantial change in the treatment of female stress urinary incontinence, and could become one of the most important innovations in urology since the development of extracorporeal shockwave lithotripsy for urinary stone treatment and tension-free vaginal tape for stress urinary incontinence.”
Source: The Lancet.
August 21, 2007
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