RESUMEN
We evaluated the safety and feasibility of adipose-derived mesenchymal stem cells to treat endoscopically urinary incontinence after radical prostatectomy in men or female stress urinary. We designed two prospective, nonrandomized phase I-IIa clinical trials of urinary incontinence involving 9 men (8 treated) and 10 women to test the feasibility and safety of autologous mesenchymal stem cells for this use. Cells were obtained from liposuction containing 150 to 200 g of fat performed on every patient. After 4 to 6 weeks and under sedation, endoscopic intraurethral injection of the cells was performed. On each visit (baseline, 1, 3, 6, and 12 months), clinical parameters were measured, and blood samples, urine culture, and uroflowmetry were performed. Every patient underwent an urethrocystoscopy and urodynamic studies on the first and last visit. Data from pad test, quality-of-life and incontinence questionnaires, and pads used per day were collected at every visit. Statistical analysis was done by Wilcoxon signed-rank test. No adverse effects were observed. Three men (37.5%) and five women (50%) showed an objective improvement of >50% (P < .05) and a subjective improvement of 70% to 80% from baseline. In conclusion, intraurethral application of stem cells derived from adipose tissue is a safe and feasible procedure to treat urinary incontinence after radical prostatectomy or in female stress urinary incontinence. A statistically significant difference was obtained for pad-test improvement in 3/8 men and 5/10 women. Our results encourage studies to confirm safety and to analyze efficacy.
Asunto(s)
Trasplante de Células Madre Mesenquimatosas/métodos , Células Madre Mesenquimatosas/metabolismo , Incontinencia Urinaria/terapia , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Objectives: To evaluate the results of erectile function rehabilitation with sildenafil after laparoscopic radical prostatectomy (LRP). Materials and methods: We have evaluated on a retrospective way a subgroup of LRP with neurovascular bundles sparing that have followed a treatment schedule for erectile function rehabilitation based on sildenafil citrate. We defined the initial erectile function state as penetrate without drugs, with drugs and do not penetrate. A comparison with the erectile function after the treatment was performed. Data were analyzed at our biostatistics section. Results: We selected a total of 33 patients, 7 with unilateral neurovascular bundles sparing and 26 with bilateral neurovascular bundles sparing treated with sildenafil citrate after surgery. The recuperation rate of erectile function with bilateral sparing was 80.7%. This success rate reaches 87.5% in patients <70 years old. In the unilateral sparing group the success rate was 85.7%. Two patients abandoned the treatment schedule. Conclusions: Laparoscopic radical prostatectomy with neurovascular bundles sparing offers a high preservation rate of erectile function on expert surgeons. The maintenance treatment with phosphodiesterase-5 inhibitors may offer benefits for the erectile function rehabilitation and it has to be initiated as soon as possible. (AU)
Objetivos: Evaluar los resultados de la rehabilitación de la función eréctil con sildenafilo tras prostatectomía radical laparoscópica (PRL). Material y Metodos: Hemos evaluado de forma retrospectiva un subgrupo de PRL con preservación de haces neurovasculares que han seguido una pauta de tratamiento para la rehabilitación de la función sexual con citrato de sildenafilo. Se ha definido el estado basal de la función eréctil como penetra sin fármacos, penetra con fármacos y no penetra. Se compararon los resultados antes y después del tratamiento. Los datos fueron analizados en nuestra sección de bioestadística. Resultados: Se han seleccionado un total de 33 pacientes, 7 con preservación unilateral de haces neurovasculares y 26 con preservación bilateral. La tasa de recuperación de la función eréctil con preservación bilateral es del 80.7%. Esta tasa alcanza el 87.5% en pacientes < de 70 años. Para el grupo de preservación unilateral la tasa es de 85.7%. Dos pacientes han abandonado la terapia. Conclusiones: La PRL con preservación de erectores ofrece una elevada tasa de conservación de la función eréctil cuando es llevada a cabo por cirujanos expertos. La terapia mantenida con iPDE5 puede ofrecer beneficios para la rehabilitación de la función eréctil y debe administrarse lo antes posible (AU)
