Recently, a very interesting and promising article was published in Lancet, a very respectable medical journal. The article describes a new possibility for the treatment of stress incontinence in women, but may be able to be translated over to men eventually.
The article describes a study in which cells taken from a woman are prepared and then injected into her urethra to help improve urinary continence. This technique is currently in practice for the treatment of intrinsic sphincter deficiency, a situation where the urethra is not strong enough to hold back urine when there is increased pressure in the bladder, from activity, laughing, sneezing coughing. This is different from hypermobility, where the urethra moves up and down and is treated with a sling surgery. Men experience stress incontinence mostly after they have had their prostate removed for cancer.
Although this method for treating incontinence is currently in use, technically, the only materials available right now include collagen and several other synthetic materials. These materials are injected under the top layer of tissue in the urethra to bulk it up and help hold back urine. All of the current bulking agents are good, but not great, and I find the results in different people to be rather variable.
Collagen is made from an animal protein and people need to have a skin test prior to its use in order to check for an allergy to the material. Collagen is a biologic material and over time, becomes reabsorbed by the body and the procedure usually needs to be repeated. Sometimes is needs to be repeated every three to six months, and some people only need it yearly. The other materials are not as readily absorbed, but I find they often need to be repeated over time as well.
This new method that was described in the Lancet article talks about using a patient’s own cells, which would eliminate the risk of allergy. Also, the type of cells described are myoblasts and fibroblasts. In theory, these cells would not disappear and would maintain the continence mechanism long-term. This study only covers 12 months, but the preliminary results are very promising.
The article also mentions improving the strength of the sphincter muscle itself, and our current materials have no effect on the sphincter muscle directly. Since the disorder that this technique describes is for a dysfunctional sphincter, this finding is quite exciting!
Obviously, larger and longer studies are necessary before this have wide spread use in the United States, but I am looking forward to what is yet to come.