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Clinical application of stem cell therapy in neurogenic bladder: a systematic review and meta-analysis

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Abstract

Introduction and hypothesis

This review aims to investigate the effect of stem cell (SC) therapy on the management of neurogenic bladder (NGB) in four neurological diseases, including spinal cord injury (SCI), Parkinson’s disease (PD), multiple sclerosis (MS), and stroke, in the clinical setting.

Methods

An electronic database search was conducted in the Cochrane Library, EMBASE, Proquest, Clinicaltrial.gov, WHO, Google Scholar, MEDLINE via PubMed, Ovid, Web of Science, Scopus, ongoing trial registers, and conference proceedings in June 2019 and updated by hand searching on 1 February 2021. All randomized controlled trials (RCTs), quasi RCTs, phase I/II clinical trials, case-control, retrospective cohorts, and comprehensive case series that evaluated the regenerative potential of SCs on the management of NGB were included. Cochrane appraisal risk of bias checklist and the standardized critical appraisal instrument from the JBI Meta-Analysis of Statistics, Assessment, and Review Instrument (JBI-MAStARI) were used to appraise the studies.

Results

Twenty-six studies among 1282 relevant publications met our inclusion criteria. Only SC therapy was applied for SCI or MS patients. Phase I/II clinical trials (without control arm) were the most conducted studies, and only four were RCTs. Four studies with 153 participants were included in the meta-analysis. The main route of transplantation was via lumbar puncture. There were no serious adverse events. Only nine studies in SCI and one in MS have used urodynamics, and the others have reported improvement based on patient satisfaction. SC therapy did not significantly improve residual urine volume, detrusor pressure, and maximum bladder capacity. Also, the quality of these publications was low or unclear.

Conclusion

Although most clinical trials provide evidence of the safety and effectiveness of MSCs on the management of NGB, the meta-analysis results did not show a significant improvement; however, the interpretation of study results is difficult because of the lack of placebo controls.

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Acknowledgments

This study is part of a PhD thesis funded by the Research Center for Evidence-based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran (grant no. 59224). The local ethics committee approved this meta-analysis of Tabriz University of Medical Sciences (IR.TBZMED.REC.1397.451). This study was funded by the Research Vice-Chancellor, Tabriz University of Medical Sciences, Tabriz, Iran, and Iran National Science Foundation (INSF) (grant no. 96010038).

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Authors and Affiliations

  1. Research Center for Evidence-based Medicine, Iranian EBM Center: A Joanna Briggs Institute Center of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Azadi, Golgasht Ave, Tabriz, East Azarbaijan, 5166/15731, Iran

    Hanieh Salehi-pourmehr, Ozra Nouri, Amirreza Naseri, Hadi Mostafaei, Nasrin Abolhasanpour, Ali Mostafaei & Sakineh Hajebrahimi

  2. Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran

    Ozra Nouri & Amirreza Naseri

  3. Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran

    Saeed Sadigh-Eteghad, Javad Mahmoudi & Leila Hoseini

  4. Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

    Leila Roshangar & Reza Rahbarghazi

  5. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria

    Hadi Mostafaei

  6. Icahn School of Medicine at Mount Sinai, NYC, New York, NY, USA

    M. Reza Roshandel

  7. Urology Department of Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran

    Sakineh Hajebrahimi

  8. Bristol Urological Institute, Bristol, UK

    Hashim Hashim

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  1. Hanieh Salehi-pourmehr
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  2. Ozra Nouri
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Correspondence to Sakineh Hajebrahimi.

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Salehi-pourmehr, H., Nouri, O., Naseri, A. et al. Clinical application of stem cell therapy in neurogenic bladder: a systematic review and meta-analysis. Int Urogynecol J 33, 2081–2097 (2022). https://doi.org/10.1007/s00192-021-04986-6

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