Autologous muscle precursor cell Transplantation for the treatment of Urinary Incontinence in Children with Classic Bladder Extrophy: One year follow up

Abstract

PURPOSE The application of muscle derived stem cells is an area of active research that may represent an improved alternative for the treatment of urinary incontinence. We investigated the effectiveness of autologous muscle precursor cell transplantation as a treatment option for urinary incontinence due to sphincter incompetence in children with the bladder exstrophy/epispadias complex (BEEC). MATERIAL AND METHODS Twelve patients with BEEC (11 boys and 1 girl) with persistent urinary incontinence entered the study. All patients had undergone staged bladder repair and bladder neck reconstruction and all of them (except 1) had received 1-3 transurethral injections of bulking agents with minimal effects. Muscle precursor cells were isolated from each patient's abdominal skeletal muscle, and cultured before endourethral injection. The effectiveness of treatment was evaluated with particular emphasis on clinical outcome (based on a 24-hour voiding diary), cystometric and urodynamic studies. RESULTS Eight Patients had a mean follow-up of 11.3 (from 8 to 14 months), The remaining 4 cases with less than 6 months follow-up are not presented in this data. There was a significant time-dependent improvement in patients' urinary continence. At the final follow-up, all 7 (88%) boys were socially dry (day-time dryness >3 hours) – including 3 (38%) completely dry. Urodynamic studies revealed an increase in mean bladder capacity (p < 0.001) and leak point pressure (p < 0.001). Six months after injection, all 7 boys (versus 2 cases preoperatively) had normal micturition with demonstrable voiding detrusor contraction in presence of compliant, stable bladders (p < 0.05). These changes were accompanied by an increment in the average maximum urinary flow (p < 0.01). CONCLUSIONS Autologous myoblast transplantation may be a safe, effective and attractive alternative treatment option for structural urinary incontinence, with possible ability for functional regeneration of urethral sphincter.