Recommandations concernant la thérapie cellulaire pour l’incontinence urinaire

Systematic review of guidelines for urinary incontinence in women

INTRODUCTION AND OBJECTIVE

Urinary incontinence in women is the subject of multiple recommendations all over the world. The aim of our study was to compare methodologies and search for inconsistencies in texts and grades in these guidelines.

METHODS

Seventeen recommendations from different medical societies in English, French and German were included. Their methodologies were analyzed, including writing methods, cyclicity, level of evidence (LE) and grades. The recommendations were synthesized and inconsistencies in texts and grades were studied. The quality of recommendations was evaluated with the Appraisal of Guidelines for Research and Evaluation (AGREE II) scale.

RESULTS

Methods, rigour and cyclicity varied depending on societies. LE and grades are broadly consensual for higher LE and grades and less so for lower LE and grades. The Collège National des Gynécologues et Obstétriciens Français, the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, the European Association of Urology, the International Consultation on Urological Diseases and the National Institute for Health and Care Excellence have an AGREE score ≥ 80 % (third quartile). Grading and textual inconsistencies are explained by the order of studies or the absence of high LE.

CONCLUSION

With the present study we closely explored comparatively the methods and semantics of recommendations for urinary incontinence in women.

[Cellular therapy and urinary incontinence]

AIM

The objective of the current study was to perform a review of literature concerning stem cells therapy (preclinical and clinical studies) applied to the treatment of stress urinary incontinence (SUI).

METHODS

Review of literature (Pubmed/Medline) using the following key words: stem cells, urinary incontinence, stress. Among 38 published articles (English or French language), 16 studies were selected (comparative preclinical and clinical studies).

RESULTS

Multipotentes mesenchymal stem cells (MSC), present in the adults in most of the tissues derived from the mesoderm have been tested in the treatment of SUI. Three sources of MSC have been mainly used in urology: bone marrow, striated muscle and adipose tissue. The general principle consists in extracting the MSC from the source tissue and grafting these MSC in the injured urinary sphincter. The preclinical studies proved the capacity of these transplanted cells to differenciate into contractile myocytes and to reconstitute nerve junctions. Clinical studies are very different in terms of methodology, with sample size ranging from four to 123 subjects and a median follow-up of 1 year; these studies showed success rates (complete continence) ranging from 12 to 79 % and improvement rates (quality of life and/or pad test) from 13 to 66%. Only one study reported two cases of worsening incontinence after cell therapy.

CONCLUSION

The few available clinical studies have reported that at short-term follow-up, cell therapy was associated with encouraging results with few side effects.