Analysis: Botox, stem cells help bladder

By ED SUSMAN  |  May 22, 2006 at 9:41 AM
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ATLANTA, May 21 (UPI) -- Researchers suggested Thi week that incontinence caused by so-called "overactive bladder" or age-related failure of muscles that control urination may be successfully treated with new innovative treatments.

Doctors demonstrated how the injection of botulinum toxin Type A - Botox -can permanently relieve the constant urge to urinate, often referred to as overactive bladder. Botulinum toxin is deadly when it occurs naturally but used in minute amounts as a medicine, it appears to have a variety of uses in treating muscle-related disorders.

Another research team found that by transplanting adult stem cells from the muscles of one part of the body to the muscles that control flow of urine from the bladder can strengthen those urethral muscles enough to make it possible for older individuals to live without special undergarments.

Daniel Schmid Jr., assistant professor of urology at the University of Zurich, Switzerland, said he and his colleagues were surprised to find that when they injected patients with Botox in an attempt to relieve the overactive bladder symptoms "we changed something with these patients."

Usually with Botox, re-injections are required after 3 to 6 months. But after 11 months, only 23 percent of patients have needed re-injections, Schmid told United Press International. He treated 150 people in the study, he said.

"Most of these patients have become continent with just one injection of Botox," Schmid said Sunday at the annual meeting of the American Urological Association in Atlanta, Ga.

"I'm not sure what happened with these patients," Schmid said. He said it might be possible that the injections actually caused anatomic changes that allows patients better control of their bladders or that the injections gave patients a chance to re-train their response to bladder stimuli that was making them have the need to urgently void.

"There seems to be a signal here that we can change this disease," said Roger Dmochowski, professor of urology at University of Vanderbilt, Nashville, Tenn. "There is the potential of hope that we can cure this disease." Dmochowski acted as moderator of the press briefing at which the research was presented.

In older individuals, especially women, and in men who have undergone prostate surgery, incontinence has emerged as a major quality of life problem. Hannes Strasser, associate professor of urology at the University of Innsbruck, Austria, found that his stem cell transplantation technique may prove to be a cure for many of these patients.

"There have been more than a hundred proposed treatments for incontinence in these individuals," Strasser said, "but all of them have limitations. The use of a person's own adult stem cells appears to overcome ethical issues regarding embryonic cells and, more importantly, they seem to work."

Doctors insert a needle into a muscle and extract a number of cells. The stem cells collected from this muscle biopsy are isolated and then are grown in culture. Once enough cells are produced, they are reinserted into deteriorating muscle structures around the bladder. These cells resume their role as muscles and exert superior contractability on the bladder sphincter, preventing urine from spilling.

"In our first 186 patients, we have had 156 successes -- that is, 82 percent of the people no longer have to use pads," Strasser told UPI. "Overall we have now treated 265 patients but we do not have outcome data on these other patients."

In addition, Strasser said doctors in Germany, Switzerland, Italy, the Netherlands and elsewhere in Europe have been trained to do the procedure. The procedure costs about $16,000, he said.

"That is within the range of what such last resort procedures would cost in the United states," Dmochowkski told UPI. "This is promising work. The Europeans have moved ahead of the United States in stem cell research due to the politics surrounding the term in this country. Even though this procedure has nothing to do with embryonic stem cells, the political fallout has extended to that work here."

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