Assessment of the effects of autologous muscle-derived cell injections on urethral sphincter morphometry using 3D/4D ultrasound
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The primary objective was to evaluate the effect of autologous muscle-derived cell (AMDC) injections on the urethral sphincter morphometry compared to placebo injections. Secondary aims were to explore the reduction of stress incontinence episode frequency (IEF) and factors associated with the efficacy of AMDC.
This prospective randomized-controlled study compared the urethral sphincter volumes of participants who had received either an intra-sphincteric injection of 4 cc AMDC in injection media or 4 cc placebo solution, using a transperineal 3D/4D ultrasound at baseline and at 12 months. The reduction of stress IEF on 3-day bladder diary and potential predictors at baseline for response to AMDC were assessed.
Fifty-eight participants were included in the study. Compared to baseline, the mean total and external sphincter volumes increased significantly in both groups (respectively, p = 0.001 and p < 0.001 in the AMDC group, p < 0.001 and p = 0.005 in the placebo group) at 12 months. Both groups showed a significant reduction of stress IEF compared to baseline (p = 0.03 and p ≤ 0.001 for AMDC and placebo groups, respectively). There were no between-group differences regarding total and external sphincter volumes and reduction of stress IEF. A longer urethral length (p ≤ 0.001) and a larger external sphincter volume (p ≤ 0.05) were significantly associated with lower stress IEF.
Significant increases of sphincter volumes as well as reduction of stress IEF occurred among the AMDC and placebo injection groups with no between-group differences at 12 months. A longer urethral length and a larger external sphincter volume at baseline were identified as potential predictors of AMDC injection response.
KeywordsStress urinary incontinence Urethra Muscle cells Cell therapy Ultrasonography
This research and infrastructure were funded by Cook Myosite and the Canadian Foundation for Innovation, respectively. Dr. Mélanie Morin is supported by a research salary award from the Fonds de la recherche du Québec—Santé. The authors wish to acknowledge the involvement of physiotherapy students (C. Mitterer, G. Jeanotte Maranda, M. Gervais-Mercier, K. Langelier, and L. Lapierre) in the development of ultrasound data analysis. The authors also thank Marie-Pierre Garant (Unité clinique et épidémiologique from the research center of the CHUS) for her advice on statistical analysis.
SI: data analysis, manuscript writing/editing. MM: protocol/project development, data collection, manuscript writing/editing. LMT: protocol/project development, data collection, manuscript writing/editing.
This research and infrastructure were funded by Cook Myosite and the Canadian Foundation for Innovation, respectively. Dr. Mélanie Morin is supported by a research salary award from the Fonds de la recherche du Québec—Santé.
Compliance with ethical standards
Conflicts of interest
The authors declare that they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institution (Comité d’éthique de la recherche en santé chez l’humain du CHUS et de l’Université de Sherbrooke, reference number not applicable) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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