Abstract
Urinary incontinence (UI) is a major problem in health care and more than 400 million people worldwide suffer from involuntary loss of urine. With an increase in the aging population, UI is likely to become even more prominent over the next decades and the economic burden is substantial. Among the different subtypes of UI, stress urinary incontinence (SUI) is the most prevalent and focus of this review. The main underlying causes for SUI are pregnancy and childbirth, accidents with direct trauma to the pelvis or medical treatments that affect the pelvic floor, such as surgery or irradiation. Conservative approaches for the treatment of SUI are pelvic physiotherapy, behavioral and lifestyle changes, and the use of pessaries. Current surgical treatment options include slings, colposuspensions, bulking agents and artificial urinary sphincters. These treatments have limitations with effectiveness and bear the risk of long-term side effects. Furthermore, surgical options do not treat the underlying pathophysiological causes of SUI. Thus, there is an urgent need for alternative treatments, which are effective, minimally invasive and have only a limited risk for adverse effects. Regenerative medicine is an emerging field, focusing on the repair, replacement or regeneration of human tissues and organs using precursor cells and their components. This article critically reviews recent advances in the therapeutic strategies for the management of SUI and outlines future possibilities and challenges.
Highlights
The involuntary loss of urine remains a major medical issue with approximately 20%of people affected at some point during their lifetime [1,2] and a three-to-one ratio between women and men [3,4]
Patients suffering from urinary incontinence (UI) experience a severely reduced quality of life (QoL) [5,6] and there is an unmet medical need including continuously rising healthcare costs [7,8,9,10]
The choice of a specific therapeutic pathway depends on the clinical severity and objective psychological burden and must be well discussed and selected together with the particular patient adapted to her/his individual needs
Summary
The involuntary loss of urine remains a major medical issue with approximately 20%. of people affected at some point during their lifetime [1,2] and a three-to-one ratio between women and men [3,4]. The involuntary loss of urine remains a major medical issue with approximately 20%. Among different types of UI, this article focuses on stress urinary incontinence (SUI), the most prevalent subtype [1,11]. Continence Society (ICS) defines SUI as “complaint of involuntary loss of urine on effort or physical exertion including sporting activities, or on sneezing or coughing” [12]. The etiology of this symptom is manifold but often caused by previous injury to the pelvic floor. The search for new solutions and different treatments has been ongoing for decades, but without any great success. Tissue engineering (TE) utilizing stem cells has emerged as a promising regenerative and minimal-invasive solution for this multifaceted disease [17]
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