title: Safety, efficacy and health related quality of life of autologous myoblast transplantation for treatment of urinary incontinence in children with bladder exstrophy-epispadias complex.
abstract: OBJECTIVE
  Children with bladder exstrophy-epispadias complex undergoing endourethral autologous myoblast transplantation to treat urinary incontinence were evaluated at 4 years of followup regarding the safety, efficacy and durability of the procedure, and health related quality of life.
  
  
  METHODS
  Seven boys underwent autologous myoblast transplantation between May and December 2006. All patients had persistent urinary incontinence after bladder neck reconstruction and bulking agent injection. Patients were followed for 4 years after autologous myoblast transplantation regarding clinical outcomes and cystometric, urodynamic, uroflowmetric and urethrocystoscopic evaluations. Health related quality of life was also measured before treatment and at final followup.
  
  
  RESULTS
  No evidence of urinary obstruction was observed. Five children (71%) were completely continent and 2 (29%) were socially dry with complete daytime dryness at final followup. Health related quality of life was improved significantly. Urodynamic studies revealed a progressive increase in bladder capacity (p <0.001). Mean detrusor leak point pressure showed a 27 cm H(2)O (158%) increase during 4-year followup. Uroflowmetry parameters of voided volume and average maximum flow rate were improved significantly (p <0.001).
  
  
  CONCLUSIONS
  The 4-year outcomes demonstrate that autologous myoblast transplantation for urinary incontinence in children with bladder exstrophy-epispadias complex is relatively reliable, reproducible, safe and effective with minimal morbidity. This novel treatment represents a promising therapeutic approach in patients with urinary incontinence. Further randomized trials with larger numbers of patients and longer followup are needed.
authors.affiliation: Pediatric Urology Research Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran. kajbafzd@sina.tums.ac.ir
authors.forename: Azadeh
authors.initials: A
authors.lastname: Elmi
authors.forename: Abdol-Mohammad
authors.initials: AM
authors.lastname: Kajbafzadeh
authors.forename: Ali
authors.initials: A
authors.lastname: Tourchi
authors.forename: Saman Shafaat
authors.initials: SS
authors.lastname: Talab
authors.forename: Shadi Abdar
authors.initials: SA
authors.lastname: Esfahani
mesh_terms: D001746:Bladder Exstrophy / Q000150:complications / Q000601:surgery*; D002648:Child; D004842:Epispadias / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D032446:Myoblasts / Q000637:transplantation*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery*; D014549:Urinary Incontinence / Q000150:complications / Q000601:surgery*; D014563:Urodynamics