Yonsei Med J.  2016 Sep;57(5):1152-1158. 10.3349/ymj.2016.57.5.1152.

Adipose-Derived Regenerative Cell Injection Therapy for Postprostatectomy Incontinence: A Phase I Clinical Study

• Choi JY
• Kim TH
• Yang JD
• Suh JS
• Kwon TG

• KMID: 2374160
• DOI: http://doi.org/10.3349/ymj.2016.57.5.1152

Abstract

PURPOSE
We report our initial experience with transurethral injection of autologous adipose-derived regenerative cells (ADRCs) for the treatment of urinary incontinence after radical prostatectomy.
MATERIALS AND METHODS
After providing written informed consent, six men with persistent urinary incontinence after radical prostatectomy were enrolled in the study. Under general anesthesia, about 50 mL of adipose tissue was obtained from the patients by liposuction. ADRCs were obtained by separation with centrifugation using the Celution cell-processing device. A mixture of ADRCs and adipose tissue were transurethrally injected into the submucosal space of the membranous urethra. Functional and anatomical improvement was assessed using a 24-h pad test, validated patient questionnaire, urethral pressure profile, and magnetic resonance imaging (MRI) during 12-week follow-up.
RESULTS
Urine leakage volume was improved with time in all patients in the 24-h pad test, with the exemption of temporal deterioration at the first 2 weeks post-injection in 2 patients. Subjective symptoms and quality of life assessed on the basis of questionnaire results showed similar improvement. The mean maximum urethral closing pressure increased from 44.0 to 63.5 cm H2O at 12 weeks after injection. MRI showed an increase in functional urethral length (from 6.1 to 8.3 mm) between the lower rim of the pubic bone and the bladder neck. Adverse events, such as pelvic pain, inflammation, or de novo urgency, were not observed in any case during follow-up.
CONCLUSION
This study demonstrated that transurethral injection of autologous ADRCs can be a safe and effective treatment modality for postprostatectomy incontinence.

Keyword

Urinary incontinence; injections; adipose tissue; regenerative medicine

MeSH Terms

Adipose Tissue/*cytology/transplantation
Aged
Female
Humans
Injections/methods
Magnetic Resonance Imaging
Male
Middle Aged
Prostatectomy/*adverse effects
Quality of Life
Stem Cell Transplantation/*methods
Surveys and Questionnaires
Transplantation, Autologous
Treatment Outcome
Urethra/diagnostic imaging
Urinary Incontinence/etiology/*therapy

Figure

• 

  Fig. 1 Before injection, the external urethral sphincter was open. Solution and adipose tissue was injected into the rhabdosphincter and submucosal space at the 5 and 7 o'clock positions and at the 4, 6, and 8 o'clock positions to facilitate complete coaptation of the urethral mucosa by the bulking effect.

• 

  Fig. 2 In case of patient E, MRI showed an increase in the functional urethral length (from 5.07 to 8.59 mm) between the lower rim of the pubic bone and bladder neck 4 weeks after injection (A: baseline, B: 4 wks after injection).

• 

  Fig. 3 Changes in 24-h pad test, MUCP, MRI, ICIQ-SF. MUCP, maximum urethral closing pressure; MRI, magnetic resonance imaging; ICIQ-SF, International Consultation on Incontinence Questionnaire-Short Form.

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