title: Slings for urinary incontinence and the application of cell-based therapy.
abstract: The most commonly used technique for the treatment of stress urinary incontinence (SUI) in women is the suburethral polypropylene sling, using either a retropubic or transobturator tape approach This treatment results in a cure rate of over 80%, based on both subjective and objective evaluations. Biological slings have been largely abandoned due to lack of efficacy. Despite the high success rates, 10-20% of women remain incontinent. Cell-based therapy might offer solutions for the future both for the primary setting as for the treatment of failures. Preclinical studies suggest that stem cells (SC) can enhance the recovery of damaged tissue either by direct integration and replacement of damaged tissue (differentiation) or by secreting factors that influence host response mechanisms (paracrine effect). The clinical data to date do not allow strong efficacy conclusions, except that SC therapy seems to be safe in the short term. Most published studies use autologous cells. Allogeneic cell sources need to be investigated as well to allow ready-to-use solutions in the future. Most importantly, we need better insight into the mechanisms of action. We need more basic stem cell research, better acute and chronic animal models, better investigational tools and more efforts using tissue engineering approach.
authors.affiliation: Department of Development and Regeneration, Urology, KU Leuven-University of Leuven, Herestraat 49, Leuven 3000, Belgium; Faculty of Medicine, Department of Urology, Airlangga University/Dr Soetomo General Hospital, Mayjend Moestopo 6-8, Surabaya 60235, Indonesia. Electronic address: lukman.hakim@uzleuven.be.
authors.forename: Lukman
authors.initials: L
authors.lastname: Hakim
authors.affiliation: Department of Development and Regeneration, Urology, KU Leuven-University of Leuven, Herestraat 49, Leuven 3000, Belgium. Electronic address: dirk.deridder@uzleuven.be.
authors.forename: Dirk
authors.initials: D
authors.lastname: De Ridder
authors.affiliation: Department of Development and Regeneration, Urology, KU Leuven-University of Leuven, Herestraat 49, Leuven 3000, Belgium. Electronic address: frank.vanderaa@uzleuven.be.
authors.forename: Frank
authors.initials: F
authors.lastname: Van der Aa
mesh_terms: D064987:Cell- and Tissue-Based Therapy / Q000639:trends*; D005260:Female; D006801:Humans; D044968:Regenerative Medicine / Q000639:trends*; D053825:Suburethral Slings / Q000639:trends*; D023822:Tissue Engineering / Q000639:trends*; D014550:Urinary Incontinence, Stress / Q000601:surgery / Q000628:therapy*
keywords: Bulking agent; Regenerative medicine; Sling; Stem cell; Stress urinary incontinence; Urethral sphincter