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.