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Injections and Biomaterials

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Urologic Surgery in the Digital Era

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Abstract

Injection-based therapies and biomaterials can be used for the management of a variety of urological disorders. Experimental data has shown their potential to provide minimally invasive solutions for prevalent conditions such as benign prostatic obstruction, erectile dysfunction, stress urinary incontinence, and pelvic organ prolapse. Furthermore, acellular biomaterials and cell-seeded scaffolds were tested for the purpose of bladder augmentation or reconstruction in patients with neurogenic lower urinary tract dysfunction who would otherwise destined to undergo bowel interposition and be exposed to its inherent morbidities. Biomaterials were also used for the treatment of complicated urethral strictures, in the context of tubularized or augmentation urethroplasty.

Herein, we reviewed and discussed the relevant literature, focusing on the clinical trials with a relatively higher degree of evidence. Despite promising results achieved in animal studies, many of the discussed therapeutic novelties lack robust clinical data to justify their routine use in practice. Putting synthetic biomaterials that have been used in pelvic floor reconstruction aside, the major advantage of utilizing such treatment alternatives would be their favorable adverse effect profile rather than the magnitude and durability of their clinical benefit. Nevertheless, they may serve well to meet the expectations of selected patients who prioritize minimally invasiveness and aim to avoid major complications that would necessitate additional intervention and/or be a cause of long lasting morbidity. Additionally, most of these treatment alternatives (especially the injectables) are replicable and do not preclude the application of subsequent, more invasive and potentially more definitive procedures.

Given the recent innovations in drug development and delivery systems together with the rise of tissue engineering applications in regenerative urology, further research with potentially “practice-changing” results are awaited related to the clinical use of injections and biomaterials in urological disorders.

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References

  1. Serati M, Salvatore S, Uccella S, et al. Surgical treatment for female stress urinary incontinence: what is the gold-standard procedure? Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:619–21.

    Article  PubMed  Google Scholar 

  2. Sassani P, Aboseif SR. Stress urinary incontinence in women. Curr Urol Rep. 2009;10:333–7.

    Article  PubMed  Google Scholar 

  3. Keegan PE, Atiemo K, Cody J, McClinton S, Pickard R. Periurethral injection therapy for urinary incontinence in women. Cochrane Database Syst Rev. 2007;3:CD003881.

    Google Scholar 

  4. Chapple CR, Wein AJ, Brubaker L, et al. Stress incontinence injection therapy: what is best for our patients? Eur Urol. 2005;48:552–65.

    Article  PubMed  Google Scholar 

  5. Plotti F, Zullo MA, Sansone M, et al. Post radical hysterectomy urinary incontinence: a prospective study of transurethral bulking agents injection. Gynecol Oncol. 2009;112:90–4.

    Article  PubMed  Google Scholar 

  6. Siddiqui ZA, Abboudi H, Crawford R, Shah S. Intraurethral bulking agents for the management of female stress urinary incontinence: a systematic review. Int Urogynecol J. 2017;28:1275–84.

    Article  PubMed  Google Scholar 

  7. Kocjancic E, Mourad S, Acar Ö. Complications of urethral bulking therapy for female stress urinary incontinence. Neurourol Urodyn. 2019;38(Suppl 4):12–20.

    Google Scholar 

  8. Herschorn S. Female pelvic floor anatomy: the pelvic floor, supporting structures, and pelvic organs. Rev Urol. 2004;6(Suppl 5):2–10.

    Google Scholar 

  9. Kocjancic E, Motiani K, Joneja J. Stem cells for the treatment of stress urinary incontinence. In Gopal Badlani editor. Minimally invasive therapy for urinary incontinence and pelvic organ prolapse, Springer; 2014, p. 115–121.

    Google Scholar 

  10. Meirelles L, Fontes AM, Covas DT, et al. Mechanisms involved in the therapeutic properties of mesenchymal stem cells. Cytokine Growth Factor Rev. 2009;20:419–27.

    Article  CAS  Google Scholar 

  11. Eberli D, Aboushwareb T, Soker S, Yoo JJ, Atala A. Muscle precursor cells for the restoration of irreversibly damaged sphincter function. Cell Transplant. 2012;21:2089–98.

    Article  PubMed  Google Scholar 

  12. Shi LB, Cai HX, Chen LK, et al. Tissue engineered bulking agent with adipose-derived stem cells and silk fibroin microspheres for the treatment of intrinsic urethral sphincter deficiency. Biomaterials. 2014;35:1519–30.

    Article  CAS  PubMed  Google Scholar 

  13. Mitterberger M, Marksteiner R, Margreiter E, et al. Autologous myoblasts and fibroblasts for female stress incontinence: a 1-year follow-up in 123 patients. BJU Int. 2007;100:1081–5.

    PubMed  Google Scholar 

  14. Mitterberger M, Marksteiner R, Margreiter E, et al. Myoblast and fibroblast therapy for post-prostatectomy urinary incontinence: 1-year followup of 63 patients. J Urol. 2008;179:226–31.

    Article  PubMed  Google Scholar 

  15. Mitterberger M, Pinggera GM, Marksteiner R, et al. Adult stem cell therapy of female stress urinary incontinence. Eur Urol. 2008;53:169–75.

    Article  PubMed  Google Scholar 

  16. Gerullis H, Eimer C, Georgas E, et al. Muscle-derived cells for treatment of iatrogenic sphincter damage and urinary incontinence in men. ScientificWorldJournal. 2012;2012:898535.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Stangel-Wojcikiewicz K, Jarocha D, Piwowar M, et al. Autologous muscle-derived cells for the treatment of female stress urinary incontinence: a 2-year follow-up of a Polish investigation. Neurourol Urodyn. 2014;33:324–30.

    Article  PubMed  Google Scholar 

  18. Kuismanen K, Sartoneva R, Haimi S, et al. Autologous adipose stem cells in treatment of female stress urinary incontinence: results of a pilot study. Stem Cells Transl Med. 2014;3:936–41.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Schulster ML, Liang SE, Najari BB. Metabolic syndrome and sexual dysfunction. Curr Opin Urol. 2017;27:435–40.

    Article  PubMed  Google Scholar 

  20. Lokeshwar SD, Patel P, Shah SM, Ramasamy R. A systematic review of human trials using stem cell therapy for erectile dysfunction. Sex Med Rev. 2020;8:122–30.

    Article  PubMed  Google Scholar 

  21. Haahr MK, Harken Jensen C,Toyserkani NM, et al. A 12-month follow-up after a single intracavernous injection of autologous adipose-derived regenerative cells in patients with erectile dysfunction following radical prostatectomy: An open-label phase I clinical trial. Urology 2018;121. 203.e6203.e13. https://doi.org/10.1016/j.urology.2018.06.018.

  22. Bahk JY, Jung JH, Han H, et al. Treatment of diabetic impotence with umbilical cord blood stem cell intracavernosal transplant: preliminary report of 7 cases. Exp Clin Transplant. 2010;8:150–60.

    PubMed  Google Scholar 

  23. Dykstra DD, Sidi AA, Scott AB, Pagel JM, Goldish GD. Effects of botulinum A toxin on detrusor-sphincter dyssynergia in spinal cord injury patients. J Urol. 1988;139:919–22.

    Article  CAS  PubMed  Google Scholar 

  24. Karsenty G, et al. Botulinum toxin A (Botox) intradetrusor injections in adults with neurogenic detrusor overactivity/neurogenic overactive bladder: a systematic literature review. Eur Urol. 2008;53:275–87.

    Article  CAS  PubMed  Google Scholar 

  25. Smith CP, et al. Botulinum toxin a has antinociceptive effects in treating interstitial cystitis. Urology. 2004;64:871–5.

    Article  PubMed  Google Scholar 

  26. Magistro G, Stief CG, Gratzke C. New intraprostatic injectables and prostatic urethral lift for male LUTS. Nat Rev Urol. 2015;12:461–71.

    Article  PubMed  Google Scholar 

  27. Maria G, et al. Relief by botulinum toxin of voiding dysfunction due to benign prostatic hyperplasia: results of a randomized, placebo-controlled study. Urology. 2003;62:259–64.

    Article  PubMed  Google Scholar 

  28. Marberger M, et al. A randomized double-blind placebo-controlled phase 2 dose-ranging study of onabotulinumtoxinA in men with benign prostatic hyperplasia. Eur Urol. 2013;63:496–503.

    Article  CAS  PubMed  Google Scholar 

  29. Shore N, Cowan B. The potential for NX-1207 in benign prostatic hyperplasia: an update for clinicians. Ther Adv Chronic Dis. 2011;2:377–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Elhilali MM, et al. Prospective, randomized, double-blind, vehicle controlled, multicenter phase IIb clinical trial of the pore forming protein PRX302 for targeted treatment of symptomatic benign prostatic hyperplasia. J Urol. 2013;189:1421–6.

    Article  CAS  PubMed  Google Scholar 

  31. Rehman J, Benet A, Melman A. Use of intralesional verapamil to dissolve Peyronie’s disease plaque: a long-term single-blind study. Urology. 1998;51:620–6.

    Article  CAS  PubMed  Google Scholar 

  32. Soh J, Kawauchi A, Kanemitsu N, et al. Nicardipine vs. saline injection as treatment for Peyronie’s disease: a prospective, randomized, single-blind trial. J Sex Med. 2010;7:3743–9.

    Article  CAS  PubMed  Google Scholar 

  33. Russo GI, Milenkovic U, Hellstrom W, Levine LA, Ralph D, Albersen M. Clinical efficacy of injection and mechanical therapy for Peyronie’s disease: a systematic review of the literature. Eur Urol. 2018;74:767–81.

    Article  PubMed  Google Scholar 

  34. Kendirci M, Usta MF, Matern RV, Nowfar S, Sikka SC, Hellstrom WJ. The impact of intralesional interferon alpha-2b injection therapy on penile hemodynamics in men with Peyronie’s disease. J Sex Med. 2005;2:709–15.

    Article  CAS  PubMed  Google Scholar 

  35. Hellstrom WJG, Kendirci M, Matern R, et al. Single-blind, multicenter, placebo controlled, parallel study to assess the safety and efficacy of intralesional interferon a-2b for minimally invasive treatment for Peyronie’s disease. J Urol. 2006;176:394–8.

    Article  CAS  PubMed  Google Scholar 

  36. Gennaro R, Barletta D, Paulis G. Intralesional hyaluronic acid: an innovative treatment for Peyronie’s disease. Int Urol Nephrol. 2015;47:1595–602.

    Article  CAS  PubMed  Google Scholar 

  37. Lipshultz LI, Goldstein I, Seftel AD, et al. Clinical efficacy of collagenase Clostridium histolyticum in the treatment of Peyronie’s disease by subgroup: results from two large, double-blind, randomized, placebo-controlled, phase III studies. BJU Int. 2015;116:650–6.

    Article  CAS  PubMed  Google Scholar 

  38. Gallien P, Reymann JM, Amarenco G, Nicolas B, de Seze M, Bellissant E. Placebo controlled, randomised, double blind study of the effects of botulinum A toxin on detrusor sphincter dyssynergia in multiple sclerosis patients. J Neurol Neurosurg Psychiatry. 2005;76:1670–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Kuo HC. Effectiveness of urethral injection of botulinum A toxin in the treatment of voiding dysfunction after radical hysterectomy. Urol Int. 2005;75:247–51.

    Article  CAS  PubMed  Google Scholar 

  40. Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med. 2008;1:165–74.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Epifanova MV, Gvasalia BR, Durashov MA, et al. Platelet-rich plasma therapy for male sexual dysfunction: myth or reality? Sex Med Rev. 2020;8:106–13.

    Article  PubMed  Google Scholar 

  42. Matz EL, Pearlman AM, Terlecki RP. Safety and feasibility of platelet rich fibrin matrix injections for treatment of common urologic conditions. Invest Clin Urol. 2018;59:61–5.

    Article  Google Scholar 

  43. Rizk DE, El-Safty MM. Female pelvic floor dysfunction in the Middle East: a tale of three factors—Culture, religion and socialization of health role stereotypes. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17:436–8.

    Article  PubMed  Google Scholar 

  44. Maher C, Baessler K, Glazener CM, et al. Surgical management of pelvic organ prolapse in women: a short version Cochrane review. Neurourol Urodyn. 2008;27:3–12.

    Article  CAS  PubMed  Google Scholar 

  45. Mettu JR, Colaco M, Badlani GH. Evidence-based outcomes for mesh-based surgery for pelvic organ prolapse. Curr Opin Urol. 2014;24:370–4.

    Article  PubMed  Google Scholar 

  46. Zhang C, Murphy SV, Atala A. Regenerative medicine in urology. Semin Pediatr Surg. 2014;23:106–11.

    Article  PubMed  Google Scholar 

  47. Aboushwareb T, McKenzie P, Wezel F, Southgate J, Badlani G. Is tissue engineering and biomaterials the future for lower urinary tract dysfunction (LUTD)/pelvic organ prolapse (POP)? Neurourol Urodyn. 2011;30:775–82.

    Article  CAS  PubMed  Google Scholar 

  48. Davis NF, et al. Biomaterials and regenerative medicine in urology. Adv Exp Med Biol Cell Biol Transl Med. 2018;3:189–98.

    Article  Google Scholar 

  49. Sutherland RS, Baskin LS, Hayward SW, Cunha GR. Regeneration of bladder urothelium, smooth muscle, blood vessels and nerves into an acellular tissue matrix. J Urol. 1996;156:571–7.

    Article  CAS  PubMed  Google Scholar 

  50. Probst M, Piechota HJ, Dahiya R, et al. Homologous bladder augmentation in dog with the bladder acellularmatrix graft. BJU Int. 2000;85:362–71.

    Article  CAS  PubMed  Google Scholar 

  51. Jayo MJ, Jain D, Ludlow JW, et al. Long-term durability, tissue regeneration and neo-organ growth during skeletal maturation with a neo-bladder augmentation construct. Regen Med. 2008;3:671–82.

    Article  PubMed  Google Scholar 

  52. Atala A, Bauer SB, Soker S, Yoo JJ, Retik AB. Tissue-engineered autologous bladders for patients needing cystoplasty. Lancet. 2006;367:1241–6.

    Article  PubMed  Google Scholar 

  53. Joseph DB, Borer JG, De Filippo RE, Hodges SJ, McLorie GA. Autologous cell seeded biodegradable scaffold for augmentation cystoplasty: phase II study in children and adolescents with spina bifida. J Urol. 2014;191:1389–95.

    Article  CAS  PubMed  Google Scholar 

  54. El-Kassaby AW, Retik AB, Yoo JJ, Atala A. Urethral stricture repair with an off-the-shelf collagen matrix. J Urol. 2003;169:170–3.

    Article  CAS  PubMed  Google Scholar 

  55. Palminteri E, Berdondini E, Colombo F, Austoni E. Small intestinal submucosa (SIS) graft urethroplasty: short-term results. Eur Urol. 2007;51:1695–701.

    Article  PubMed  Google Scholar 

  56. Raya-Rivera A, Esquiliano DR, Yoo JJ, Lopez-Bayghen E, Soker S, Atala A. Tissue- engineered autologous urethras for patients who need reconstruction: an observational study. Lancet. 2011;377:1175–82.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, University of Illinois College of Medicine, Chicago, IL, USA

    Ömer Acar & Ervin Kocjancic

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  1. Ömer Acar
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  2. Ervin Kocjancic
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Correspondence to Ömer Acar .

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  1. Grande Ospedale Metropolitano, Reggio Calabria, Italy

    Domenico Veneziano

  2. Department of Urology, Hacettepe University, Ankara, Turkey

    Emre Huri

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Acar, Ö., Kocjancic, E. (2021). Injections and Biomaterials. In: Veneziano, D., Huri, E. (eds) Urologic Surgery in the Digital Era. Springer, Cham. https://doi.org/10.1007/978-3-030-63948-8_7

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  • DOI: https://doi.org/10.1007/978-3-030-63948-8_7

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