title: Periurethral injection of autologous adipose-derived stem cells for the treatment of stress urinary incontinence in patients undergoing radical prostatectomy: report of two initial cases.
abstract: OBJECTIVE
  To report a novel cell therapy using autologous adipose tissue-derived stem cells (ADSC) for stress urinary incontinence caused by urethral sphincteric deficiency and the outcomes in two initial cases undergoing periurethral injection of stem cells for the treatment of urinary incontinence after radical prostatectomy.
  
  
  METHODS
  Two patients with moderate stress incontinence after radical prostatectomy were enrolled. After liposuction of 250 mL of adipose tissue from the abdomen, we isolated ADSC from this tissue by using the Celution system. Subsequently, the isolated ADSC and a mixture of stem cells and adipose tissue were transurethrally injected into the rhabdosphincter and submucosal space of the urethra, respectively. Short-term outcomes during a 12-week follow-up were assessed by a 24-h pad test, a validated patient questionnaire, urethral pressure profile, transrectal ultrasonography, and magnetic resonance imaging.
  
  
  RESULTS
  Urinary incontinence progressively improved after 2 weeks of injection up to 12 weeks in terms of decreased leakage volume in a 24-h pad test, decreased frequency and amount of incontinence, and improved quality of life as per the questionnaire. In urethral pressure profile, both maximum urethral closing pressure and functional profile length increased. Ultrasonography and magnetic resonance imaging showed sustained presence of the injected adipose tissue. Enhanced ultrasonography showed a progressive increase in the blood flow to the injected area. No significant adverse events were observed peri- and postoperatively.
  
  
  CONCLUSIONS
  This preliminary study showed that periurethral injection of the autologous ADSC is a safe and feasible treatment modality for stress urinary incontinence.
authors.affiliation: Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Tokunori
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Momokazu
authors.initials: M
authors.lastname: Gotoh
authors.forename: Ryohei
authors.initials: R
authors.lastname: Hattori
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Toriyama
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Kamei
authors.forename: Hideki
authors.initials: H
authors.lastname: Iwaguro
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Matsukawa
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Funahashi
mesh_terms: D000273:Adipose Tissue / Q000166:cytology*; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D007267:Injections; D008297:Male; D011468:Prostatectomy / Q000009:adverse effects*; D033581:Stem Cell Transplantation / Q000379:methods; D014521:Urethra; D014550:Urinary Incontinence, Stress / Q000209:etiology* / Q000601:surgery*