Doctors call stem cells 'cure' for incontinence
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Doctors call stem cells 'cure' for incontinence
By John Fauber
MILWAUKEE JOURNAL SENTINEL
MILWAUKEE - Doctors say they were able to cure urinary incontinence in the vast majority of patients who were treated with injections of their own stem cells.
The finding, which was presented Sunday, is the latest accomplishment in a promising area of research: using adult stem cells derived from patients' own muscle tissue to treat a troubling condition that affects more than 15 million Americans.
The researchers described the treatment as a cure, meaning the patients did not need to wear absorbent pads after they were treated.
"It's highly effective and it's much more effective than we previously thought," said Hannes Strasser, lead author of the study. "If somebody had told me it would have worked so well four years ago, I would not have believed it."
Some of the first patients to undergo the technique remained continent four years after the treatment, said Strasser, an associate professor of urology at the Medical University of Innsbruck, in Austria.
The results presented Sunday involved 186 men and women ages 36 to 85. The study involved about twice as many women as men.
One year after the treatment, 153 of those treated did not need to wear pads, Strasser said.
In addition to curing the incontinence, the patients also had a dramatically improved quality of life, he said.
There were no side effects, although a later patient, one of 270 who now have undergone the therapy, suffered a perforation of the urethra during the treatment.
The research was presented at the American Urological Association annual meeting in Atlanta.
"It's a great idea," said Elliott Silbar, a urologist with Aurora St. Luke's Medical Center who attended the presentation. "They are trying to replace healthy cells into an area with unhealthy tissue. Theoretically, it makes a lot of sense."
What's still needed, Silbar said, are studies involving head-to-head comparisons between the adult stem cell treatment and other types of injectable urinary incontinence treatments.
One potential advantage to the stem cell treatment is the possibility that it only may need to be done once while other injectable therapies require retreatment, he said.
Strasser said the stem cell treatment costs about $16,000.
The treatment involves harvesting muscle cells taken as biopsy from the patient's upper arm. Those cells are grown in a laboratory for seven weeks and a small amount of collagen is mixed in.
"What's nice is they are using the patient's own cells," said Silbar, who was not a part of the study. "You are not going to have any problem with rejection or diseases. It's totally biocompatible."
What is not known is whether the new cells become functioning muscle, as is theorized, or whether the injections are just providing bulk, as is the case with other treatments, Silbar said.
The extracted cells become both myoblasts, or muscle cells, and fibroblasts, a type of connective tissue cell.
The fibroblasts were injected into the urethra, the canal that carries urine out of the bladder. The myoblasts were injected into the rhabdosphincter, a ring of muscle around the urethra that acts as a valve.
The treatment did not involve the use of embryonic stem cells, which generally are derived from five-day-old embryos.
The research has created a buzz at the meeting, said Michael Guralnick, an assistant professor of urology at the Medical College of Wisconsin.
"It almost sounds too good to be true," said Guralnick, who also attended the presentation.
One advantage to the treatment is that patient's own muscle cells can become a potential permanent rebuilding source of the sphincter muscle, Guralnick said.
He said the cure rate cited by researchers of more than 80 percent is about twice that for other injectable treatments.
Guralnick said the treatment still needs to be subjected to more rigorous scientific testing. And, he said, it's likely to be a few years before it is available in the United States.
"This could really be a better alternative, but it's still in its infancy," he said.
The injections were done using a technique known as transurethral ultrasound.
"We can inject both types of cells very precisely," Strasser said.
Imaging showed that the thickness of the urethra and rhabdosphincter were increased and the contracting ability of the rhabdosphincter was improved, he said.
"It's much stronger," Strasser said.
Other research presented Sunday indicated that the prevalence of urinary incontinence may be 50 percent greater than previously thought -- affecting up to 17 percent of men over the age of 60 and 38 percent of women.
"People are walking around (with incontinence) and not even asking their doctors about it," said Jennifer Anger, a urologist with the UCLA Medical Center. "Prevalence is high in men and very high in women."
Urinary incontinence can be caused by a variety of conditions including childbirth, prostate surgery, diabetes, stroke, multiple sclerosis and Parkinson's disease.
Many of those in the study had the most common type of urine leakage, known as stress incontinence.
It occurs when urine is lost as the result of pressure on the lower abdomen from activities such as sneezing, coughing and exercise. |
