经尿道自体脂肪干细胞注射治疗前列腺癌根治术后尿失禁

Transurethral injection of autologous adipose-derived stem cells for urinary incontinence after radical prostatectomy

背景:目前尚无可靠的治疗方法用于前列腺癌根治术后尿失禁并发症。药物治疗、尿道中段悬吊术、填充剂治疗等方法均具有一定局限性。因此,利用自体脂肪干细胞治疗前列腺癌术后尿失禁就成了学界热点,并有望成为一线治疗方案。目的:总结了经尿道注射自体脂肪干细胞治疗前列腺癌根治术后尿失禁的初步临床经验,并对其安全性及疗效进行评估。方法:试验前已充分告知患者及家属可能存在的风险及获益可能,在签署相关知情同意书后,共有6例前列腺癌根治术后出现持续性尿失禁症状患者被选入研究。在全身麻醉下,利用抽脂术获得50 m L自体脂肪组织,通过Celution系统进行细胞处理后,获得自体脂肪干细胞。将自体脂肪干细胞悬液及相应混合物,在膀胱镜引导下注入尿道膜部的黏膜下区域。在细胞治疗后的12周内,利用24 h尿垫试验、尿失禁质量问卷、尿流动力学及MRI来评估尿道外括约肌在结构及功能上的改变。结果与结论:①除2例患者在细胞治疗后第2周出现短暂恶化外,所有患者通过24 h尿垫试验测得的尿漏量在注射治疗12周后有明显改善;②基于问卷评分的患者主观感受及生活质量亦有好转;③细胞注射治疗12周后,患者的平均最大尿道闭合压由4.312 kPa升至6.223 kPa;④MRI则提示功能性尿道长度(耻骨联合下缘至膀胱颈距离)由6.1 mm增至8.3 mm; ⑤在随访观察中并未出现骨盆疼痛、尿道炎症等不良反应;⑥结果表明,经尿道自体脂肪干细胞注射治疗前列腺癌根治术后尿失禁是安全有效的。

BACKGROUND:Until now,there are no reliable methods for the treatment of urinary incontinence after radical prostatectomy.Some limitations exist in drug therapy,mid-urethral suspension,and filling agent treatment.Therefore,the use of autologous adipose-derived stem cells(ADSCs)is expected to become a first-line treatment strategy for urinary incontinence after radical prostatectomy.OBJECTIVE:To report our initial experience with transurethral injection of autologous ADSCs for the treatment of urinary incontinence after radical prostatectomy.METHODS:Patients and their families were informed of possible risks and benefits prior to the participation in the trial.After providing written informed consent,six patients with persistent urinary incontinence after radical prostatectomy were enrolled in the study.Under general anesthesia,about 50 mL of adipose tissue was obtained from each patient by liposuction.ADSCs were obtained by separation with centrifugation using the Celution cell-processing device.A mixture of ADSCs and adipose tissue was transurethrally injected into the submucosal space of the membranous urethra.Functional and anatomical improvement was assessed through a 24-hour pad test,validated patient questionnaire,urethral pressure profile,and magnetic resonance imaging(MRI)through 12-week follow-up.RESULTS AND CONCLUSION:Urine leakage volume was improved with time in all patients in the 24-hour pad test,with the exemption of temporal deterioration in two patients at the first 2 weeks post-injection.Subjective symptoms and quality of life assessed on the basis of questionnaire results showed similar improvement.The mean maximum urethral closing pressure increased from 4.312 kPa to 6.223 kPa at 12 weeks after cell injection.MRI results showed an increase in functional profile length(from 6.1 to 8.3 mm)between the lower rim of the pubic bone and the bladder neck.Adverse events,such as pelvic pain,inflammation,or de novo urgency,were undetected in any case during the follow-up.To conclude,the transurethral injection of autologous ADSCs can be a safe and effective treatment for urinary incontinence after radical prostatectomy.