Stem cell hope for urinary incontinence

Women’s own bodies may hold the key to their recovery from incontinence, researchers say. In a small study presented November 29 at the Radiological Society of North America annual meeting in Chicago, Austrian researchers successfully used their patients’ own stem cells to treat urinary incontinence.
The therapy is a potentially long-lasting one, with patients remaining continent one year after treatment.

Although the technique needs to be studied in more women and for longer periods of time, Dr Joe Littlejohn, a clinical instructor of urology at Columbia University College of Physicians and Surgeons in New York City, called the results “very promising.”

Stem cells are unspecialised cells that eventually grow into the myriad specific cells the body needs for specific functions.

Stress incontinence, the form of incontinence treated in this study, affects almost 15 million people worldwide, most of them women. Often the condition is a result of childbirth or ageing. It occurs when problems with the urethra or the sphincter muscles that help open and close the urethra cause urine leakage. Current therapies range from pelvic floor exercises to collagen injections to surgery, Littlejohn said.

These researchers built on preliminary studies already conducted, which used adult muscles derived from stem cells to reconstruct the lower urinary tract.
For this particular study, the authors removed stem cells from the arms of 20 females, aged 36 to 84, who were experiencing stress incontinence. The stem cells were cultured, producing tens of millions of new cells, then injected into the wall of the urethra and into the sphincter muscle.

“The good thing about this new procedure is it’s less invasive and the stem cells are harvested from the patient’s own body, so you don’t have to worry about rejection,” Littlejohn said. The cells also stayed where they had been injected and, when enough muscle had been formed, stopped growing.

All the women in the study experienced enhanced muscle mass and contractility of the sphincter and a thicker urethra. The procedure, which was done on an outpatient basis, took 15 to 20 minutes to complete. At one year after the initial procedure, 18 of the 20 participants remained continent.
The researchers are still following the participants with the longest follow-up, who were treated as far back as October 2002. “We still have good results,” study author Dr Ferdinand Frauscher said.

Frauscher, head of uroradiology at University Hospital in Innsbruck, Austria, said his team has plans to start using this technique at other centres. “Next year we will start in three centres in Austria, two in Germany, one in Switzerland and one in the Netherlands,” he said. “We are also planning to perform this in the USA.”

To become widely available, centres would need to be able to perform ultrasounds to help determine where to place the stem cells as well as a lab for stem cells to be cultured.

Frauscher said the procedure has also been tried in a few men after prostate surgery. “It should work well, especially after radical prostatectomy, because the sphincter is one of the most important muscles for maintaining continence,” he said. “However, if there are large video porno gratis, this might be a limitation.”

Frauscher is a consultant for InnovaCell, which produces the stem cells. Two other authors of the study are owners of the company.

My dexa scan experience

I lie down on a bed, wearing a knee-length, fleecy gown and underpants. The room in the radiology centre is warm enough, though the day outside is cold. Not knowing what to expect, I wonder what the bone density scan, for which I’ve paid $80, will involve.

I had assumed that all I would have to do was take off my shoe, and put my foot into some sort of bone density measuring device. But there are, in fact, several types of density tests, and I am being given the one that is the most relevant for a pre-menopausal woman like me checking for signs of osteoporosis.

I had tried to side step the referral process and make a scan appointment myself, but these radiology people like a doctor involved in case there’s a need for follow-up treatment. So I phoned my GP’s practice and he faxed a referral to the radiology centre I had selected – it was near home.

Luckily the type of scan I had is reputedly the most accurate indicator of bone mass – the DEXA scan, which stands for dual-energy x-ray absorptiometry.

The young radiographer who had earlier directed me into the changing room appears again and shows in into the room where I will have the scan. I scuttle in before anyone can see me looking like a half naked bag lady!

From here on it is a dream, really: the most painless and least invasive medical procedure I have ever had. I almost fall asleep.

I do have to ask questions, but they are answered adequately. The scan uses very low radiation, so the radiographer can be in the same room without wearing protective clothing.

She asks my weight (there are scales in the room if you need them) and height. My age is on the referral form.

The DEXA scanner is different from x-ray and ultrasound machines. You lie on you back the whole time, and a long, thin metal arm reaches across the bed, about 0.5m above your body.

First, the spine picture. The radiographer asks you to lift your legs so she can put a large, square cushion under your knees, which keeps your thighs up, almost at right angles to the bed.

Operated from a desk in the corner of the room, the machine arm then slowly slides the length of the bed above your torso, making a bit of a racket as it moves.

Then you have to move your feet apart while the radiographer places a thin metal plate between your legs, in the knee/thigh area. All done matter-of-factly; she’s done this a thousand times. Then, asking you to relax with your legs out straight, she puts a soft strap around each ankle, and yanks them gently to turn your legs at an angle that apparently “opens out the hip joints” for a good picture of the bones. It’s not as embarrassing as it sounds.

After two more minutes of the machine gliding back and forth above you, you’re getting dressed again. The whole procedure took only 20 minutes.

The scan is evaluated by a doctor (radiologist) later that day. The next day a copy is mailed to my GP, and I also receive one.

But I have to confess that when I see my results they don’t mean much – they look are like in a foreign language, lists of figures and pictures that mean nothing to me, plus a summary sentence that gives T-scores and recommends another scan in two years.

The radiology centre cannot find a staff member to explain the results when I phone, so I surf the net to discover how to interpret them. I decide I’m disease-free, and will have another scan in two years.


Alan blames stereoid treatment for his broken back

The beneficial effects of the osteoporosis drug alendronate (Fosamax) last for at least a decade with no untoward side effects, according to one of the longest controlled trials ever performed on the drug. Once stopped, the drug’s benefits started dissipating, but only gradually. Experts say the research should allay fears that once stopped, the drug’s effects would wear off quickly, leading to bone brittleness and other symptoms of osteoporosis. The results appear in the March 18 issue of the New England Journal of Medicine. Because osteoporosis is a chronic condition that requires long term treatment, it is helpful to have long term data, explains lead author Dr Henry Bone, director of the Michigan Bone and Mineral Clinic and head of endocrinology at St John Hospital and Medical Center, both in Detroit. According to an accompanying report in the journal, osteoporosis is fast becoming an epidemic with the ageing of the world’s population and increasingly westernised lifestyles. A 50-year-old woman in the US now has a 40% lifetime risk of suffering an osteoporotic fracture. Fosamax works by preventing bone resorption, which occurs when bone material is removed from the body naturally without being replaced quickly enough. (Health Scout)

The cure was worse than the complaint for 41-year-old Alan Weaver of Christchurch. Eighteen months after starting prednisone to treat his rheumatoid arthritis his bones had thinned so severely that his back broke during a muscle seizure.

Thinning bones (osteoporosis) is a known side effect of prednisone, but Alan feels he should have been monitored more closely to detect the unusually rapid changes in his bone strength.

Initially he was delighted with the prednisone treatment. As in so many cases, his onset of rheumatoid arthritis four years ago was extremely fast and painful, and the prednisone worked “fantastically well” – at the beginning.

But it wasn’t long before the low dose he had started on was failing to give any relief and he was put on prednisone 20mg for four to five days at a time. When that wasn’t having the desired effect the dose was increased again, with two month breaks between courses. Finally, Alan needed even more prednisone to control his rheumatoid arthritis, and he started taking 80mg for 10 days each month.

Then after 18 months of prednisone treatment he woke up at 3am one morning in terrible pain.

“I could hardly move. My doctor told me to come in after the weekend if it hadn’t improved. When he saw me he sent me straight to the hospital for an X-ray. This showed that a vertebra had crumbled away and I had a compression fracture in my back.”They told me I had the bones of an 80-year-old.

“Two weeks later a further x-ray revealed more crumbling of the vertebrae. Alan’s back was collapsing under its own weight.

“I was really surprised,” he said. “Over the years I’d fallen off roofs and motorbikes and never broken a bone.

“Although his doctors had given him written information which mentioned the possible side effect of bone thinning with prednisone, Alan feels he should have been offered scans to monitor his bone density, and given calcium supplements and other bone building medicines to protect against bone thinning.

He is now taking the bisphosphonate drug Fosamax (alendronate sodium) which helps stop bone loss and rebuilds bone, plus calcium and Vitamin D. He is due for a bone scan in another two to three months, to check his progress. His medicine regime also includes methotrexate, Arava, Losec, folic acid and drugs for his epilepsy. “Altogether I take 116 pills a week. I feel like I’m rattling with them,” said Alan.

Alan Weaver accepts that his days as the manager of a demolition recycling yard are over, but he still intends to remain an active sailor. His yacht is currently being fitted with self tailing winches which require only one hand to operate, a furler to automatically roll up the front sail and an automatic pilot.

Then he intends setting off from Lyttelton for the Marlborough Sounds, and sailing across to Wellington in time to help with the Arthritis New Zealand annual appeal in September. Alan is a great supporter of Arthritis New Zealand, and his boat sports the name of the organisation in its signature orange.

Arthritis seems to run in the Weaver family. Alan’s grandfather developed it late in life, and his 75-year-old father is now almost bedridden with arthritis. “I keep thinking of my father and seeing my own future,” says Alan. “I’m trying to get in as much activity as a can, now while I still can.”