Assessment of the effects of autologous muscle-derived cell injections on urethral sphincter morphometry using 3D/4D ultrasound

Implantation of Autologous Skeletal Muscle-Derived Cells Combined with Electrical Stimulation in Patients with Stress Urinary Incontinence

INTRODUCTION AND HYPOTHESIS

Intrasphincteric injection of autologous skeletal muscle-derived cells (aSMDCs) is a minimally invasive treatment for stress urinary incontinence (SUI). This study investigated two cell counts (high/low dose) for functional urethral sphincter regeneration in combination with electrical stimulation, treatment safety and efficacy, and its potential superiority to duloxetine-placebo or duloxetine.

METHODS

This phase II, placebo-controlled trial randomised women with SUI to cell implantation (low or high cell number) and to control groups (duloxetine-placebo or duloxetine), each treatment combined with electrical stimulation. The primary efficacy endpoint was the mean reduction of incontinence episode frequency (IEF) at 12 weeks post-treatment compared with baseline. Secondary efficacy parameters included 1-h pad test, visual analogue scale (VAS), Incontinence Quality of Life questionnaire, clinical global impression score and frequency of responders based on IEF. Adverse events were analysed for safety evaluation. Additional follow-up data on IEF and selected secondary efficacy variables were obtained in a sub-population of patients after 12 and 48 months.

RESULTS

The mean reduction ± SD in IEF after 12 weeks was: low cells: -16.4 ± 13.3 (61 patients), high cells: -18.5 ± 18.7 (56), placebo: -9.7 ± 13.7 (68), duloxetine -11.2 ± 19.6 (32). Cell treatments were significantly superior over placebo regarding IEF reduction and all secondary endpoints except for VAS. No safety issues were observed following cell implantation. Improvements were sustained over 12 and 48 months, with no difference between low and high cell implantation groups.

CONCLUSIONS

Therapy for SUI with aSMDCs in combination with electrical stimulation is safe, effective and sustained over at least 48 months.

An International Continence Society (ICS) report on the terminology for pelvic floor muscle assessment

INTRODUCTION

The terminology for female and male pelvic floor muscle (PFM) assessment has expanded considerably since the first PFM function and dysfunction standardization of terminology document in 2005. New terms have entered assessment reports, and new investigations to measure PFM function and dysfunction have been developed. An update of this terminology was required to comprehensively document the terms and their definitions, and to describe the assessment method and interpretation of the finding, to standardize assessment procedures and aid diagnostic decision making.

METHODS

This report combines the input of members of the Standardisation Committee of the International Continence Society (ICS) Working Group 16, with contributions from recognized experts in the field and external referees. A logical, sequential, clinically directed assessment framework was created against which the assessment process was mapped. Within categories and subclassifications, each term was assigned a numeric coding. A transparent process of 12 rounds of full working group and external review was undertaken to exhaustively examine each definition, plus additional extensive internal development, with decision making by collective opinion (consensus).

RESULTS

A Terminology Report for the symptoms, signs, investigations, and diagnoses associated with PFM function and dysfunction, encompassing 185 separate definitions/descriptors, has been developed. It is clinically based with the most common assessment processes defined. Clarity and user-friendliness have been key aims to make it interpretable by clinicians and researchers of different disciplines.

CONCLUSION

A consensus-based Terminology Report for assessment of PFM function and dysfunction has been produced to aid clinical practice and be a stimulus for research.