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Tissue engineering and cell therapies for neurogenic bladder augmentation and urinary continence restoration
Published in Jacques Corcos, David Ginsberg, Gilles Karsenty, Textbook of the Neurogenic Bladder, 2015
Another important issue is whether myotubes derived from transplanted MPCs improve urethral muscle tone. In humans, the urethral rhabdosphincter is a unique muscle that participates in urinary continence by developing tonic contractions, thereby maintaining a resting urethral tone. Classically, this activity is mediated by type I myofibers, which are slow-twitch, tonic, aerobic fibers that can sustain long periods of contraction.69,73 Type II myofibers, in contrast, are fast-twitch, chiefly anaerobic fibers that develop strong contractions but fatigue rapidly. Therefore, it was important to determine whether the phenotype of myotubes derived from transplanted MPCs is consistent with sphincter-like muscle activity.
Minimally Invasive Technologies in the Treatment of Renal and Prostate Cancer
Published in Anthony R. Mundy, John M. Fitzpatrick, David E. Neal, Nicholas J. R. George, The Scientific Basis of Urology, 2010
Hashim U. Ahmed, Caroline Moore, Manit Arya, Mark Emberton
Focal therapy involves treatment directed only at the cancer focus and a margin of tissue surrounding the cancer (73, 74). Most treatment related side effects are due to injury to the immediate surroundings of the prostate and not due to treatment of the prostate per se. Damage to prostate capsule, pelvic nerves/ganglia, bladder neck, bladder, seminal vesicles, rhabdosphincter, Denonvilliers fascia, and rectum cause erectile dysfunction, ejaculatory dysfunction, stress-related urinary incontinence, urge-related urinary incontinence, reduced bladder functional capacity, urethral or bladder neck strictures and bowel dysfunction (75, 76).
Complications of Open Prostate Surgery
Published in Kevin R. Loughlin, Complications of Urologic Surgery and Practice, 2007
Stephen S. Connolly, John M. Fitzpatrick
Incontinence is not uncommon in the age category of men undergoing prostatectomy, and continence status prior to any prostatectomy should always be recorded. Persistent incontinence following open prostatectomy is uncommon and at worst an infrequent complication. Careful resection of apical tissue remains the principal operative means of avoiding damage to the rhabdosphincter and during open surgery, sharp incision of apical tissue under direct vision may reduce risk of damage. Significant bladder overactivity may precede TURP and men with preoperative incontinence or features raising a doubt over the presence of obstruction should have preoperative urodynamic analyses of urodynamics to clarify the issue. All men with persistent problematic postprostatectomy incontinence should be evaluated by urodynamic analyses and endoscopic examination of their lower urinary tract.
Advances in stem cell therapy for male stress urinary incontinence
Published in Expert Opinion on Biological Therapy, 2019
Fabrizio Gallo, Gaetano Ninotta, Maurizio Schenone, Pierluigi Cortese, Claudio Giberti
Very few studies are reported in literature using ASCs for the treatment of SUI in human patients (Table 2) [70–78]. Even fewer papers have been published concerning male SUI [71–73,77,78]. The first experience with stem cell therapy was reported by Mitterberger et al. in 2007 in 119 women. One year after the injection of myoblasts and fibroblasts, ultrasound evaluation showed an increase of thickness of the rhabdosphincter and an improvement of its contractility at the urodynamic test [70]. Based on this data, the same group treated, using the same technique, 63 male patients with SUI after radical prostatectomy. A significant postoperative improvement of incontinence and quality of life scores as well as thickness and contractility of the rhabdosphincter with no severe side effects were reassessed at one year of follow up. In particular, 41 patients (65%) were continent and 17 (27%) showed improvement while 5 (8%) did not show any improvement. Preoperative strictures, scars and fibrotic areas in the membranous urethra, prior injection of bulking agents or internal urethrotomy as well as radiation therapy negatively influenced the success rates. These data strongly supported the experimental findings that the ultrasound-guided injection of MDSCs leads to regeneration of the urethral submucosa and the rhabdosphincter and not only to passive obstruction on the lower urinary tract [71].
Stem cell applications in regenerative medicine for stress urinary incontinence: A review of effectiveness based on clinical trials
Published in Arab Journal of Urology, 2020
Bara Barakat, Knut Franke, Samer Schakaki, Sameh Hijazi, Viktoria Hasselhof, Thomas-Alexander Vögeli
As shown in Table 2, most clinical studies have been conducted with autologous MDSCs. Treatment with autologous MDSCs requires an optimal lengthy isolation/cultivation work process prior to injection. In all published UI clinical studies, autologous MDSCs were injected either transurethrally or periurethrally directly into the rhabdosphincter, but the number of transplanted cells varied greatly. The different cell doses used are due to the lack of a clear understanding of stem cell-based therapy. However, it is indisputable that the concept of regenerative medicine leads to regeneration of the damaged rhabdosphincter with improvement in function of the external (striated muscle) and internal (smooth muscle) sphincters, as well as the blood circulation of the urethral sphincter.
Role of sparing of puboprostatic ligaments on continence recovery after radical prostatectomy: a randomized controlled trial
Published in Scandinavian Journal of Urology, 2021
Akram Assem, Tamer Abou Youssif, Seif M. Hamdy, Ahmad M. Beltagy, Ali Serdar Gozen
Several studies assessed the potential preoperative predictors of urinary continence (UC) recovery after RP. According to the literature, two main anatomical components are responsible for male UC: the sphincteric and the supportive system [7]. The sphincteric mechanism includes the rhabdosphincter, assisted by the internal sphincter at the bladder neck [7]. Sparing the supportive system, including the endopelvic fascia, the Denonvilliers fascia, the puboprostatic ligaments (PPLs), the levator ani muscles and the arcus tendinous fascia may help in achieving the UC in patients after RP [8–10].