WebMD Medical News
Louise Chang, MD
June 28, 2007 -- Injections of stem cells and other cells obtained from a
woman's own body can treat stress urinary incontinence with dramatically better
results than conventional collagen injections, according to a new study from
The results, which mimic those from similar research under way in the U.S.,
might also be long-lasting. "The treatment might have a chance to be
permanent," Giacomo Novara, MD, a doctor at the University of Padua in
Italy, tells WebMD in an email interview. Novara wrote a comment accompanying
the study. Both appear in the June 30 issue of The Lancet.
More than 13 million women in the U.S. suffer from stress urinary
incontinence, a condition much more common in women than in men. The condition
develops as the urethral sphincter muscles, which control the flow of urine,
weaken, typically after childbirth or with age. When a person coughs, sneezes,
or laughs, urine can leak.
The Austrian researchers, led by Hannes Strasser, MD, from the Medical
University of Innsbruck, compared the effects of the stem cell injections with
conventional injections of collagen in 63 women with stress urinary
They first performed a small muscle biopsy on the upper arms of the 42 women
assigned to get the stem cell injections. In the laboratory, they retrieved
myoblasts, a type of muscle stem cell, and fibroblasts, cells which form the
structural framework for many body tissues. Both types of cells have been shown
effective in reconstructing the lower urinary tract in animal studies,
according to Strasser.
Next, guided by ultrasound, Strasser's team injected the cells back into the
women's sphincter and surrounding area.
Traditional collagen injections, which don't typically have a high success
rate for incontinence, were given to the other 21 women. Collagen treatments
work by bulking up the area to compress the urethra -- helping to hold
After 12 months, 38 of the 42 women given the stem cell and other cell
injections were completely continent. The other four showed either slight or
substantial improvement. But just two of the 21 who got collagen injections
were continent; seven others showed either slight or substantial
On ultrasound exams after the injections, the thickness of the sphincter had
increased 59% in the women given cell injections but just 9% in the
collagen-treated group. The muscle contractibility rose much more in the cell
group. Increases in the sphincter thickness and muscle contractibility
are thought to help improve symptoms.
Women treated with the injections of cells reported higher quality of life
than the collagen-treated group.
None of the women reported any adverse side effects.
Strasser is a founder and co-owner of the biotechnology company at which the
retrieved cells were prepared, but the company had no role in the research, he
The Austrian study shows "promising results," according to Michael
Chancellor, MD, a professor of urology and director of the neurourology and
urinary incontinence programs at the University of Pittsburgh.
He has been conducting similar research and presented his findings in May
2007 at the annual meeting of the American Urological Association in Anaheim,
In that study, Chancellor and his colleagues injected adult stem cells
derived from the person's own muscle into the weakened sphincter and found
after a year and half that five of the eight women with urinary incontinence
studied got modest improvement; one woman was completely continent. The study
was a safety study, considered preliminary, and done in cooperation with the
University of Toronto and Health Canada.
In his editorial, Novara calls the study results "impressive" and
writes: "If the data are confirmed, this approach is likely to cause a
substantial change in the treatment of female urinary incontinence."
If the research bears out, the new approach "may indeed be a true
breakthrough in the management of incontinence," says Roger R. Dmochowski,
MD, a spokesman for the American Urological Association and director of the
Vanderbilt University Continence Center in Nashville, Tenn. "This
study has surprisingly good data and actually shows not only durability of the
injected tissue but also functionality of that tissue, which is impressive at
this time." But he says more follow-up is needed and other researchers need
to reproduce the results.
Urologists agree that better options are sorely needed for stress
incontinence. Currently, doctors treating women with the condition suggest
pelvic floor exercise or Kegels to strengthen the pelvic floor muscles,
biofeedback to retrain the muscles, or a variety of surgical options. One
procedure involves inserting a mesh-like tape that serves as a kind of sling to
support the urethra and prevent the involuntary leakage of urine.
Similar research on injecting a person's own cells for incontinence
treatment is ongoing not only in the U.S. and Austria but also in several
European centers, according to Novara.
If additional research proceeds on schedule, the cell injection treatment
could be available in the U.S. in less than three years, Chancellor
Dmochowski is less optimistic about the timelines. Look for the new
treatment to be available, he says, "not earlier than three to five years
from now and possibly as long as seven to 10."
SOURCES: Giacomo Novara, MD, department of oncological and surgical sciences
urology clinic, University of Padua, Italy. Michael Chancellor, MD, professor
of urology and director of neurourology and urinary incontinence programs,
University of Pittsburgh. Roger Dmochowski, MD, professor of urology and
director of the Vanderbilt University Continence Center, Nashville, Tenn.
Strasser, H. The Lancet, June 30, 2007; vol 369: pp 2179-2186. Novara,
G. The Lancet, June 30, 2007; vol 369: pp 2139-2140.
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