Mitterberger M et al. (2008) Myoblast and fibroblast therapy for post-prostatectomy urinary incontinence: 1-year followup of 63 patients. J Urol 179: 226–231

Patency of the rhabdosphincter is a crucial determinant of continence after radical prostatectomy. In contrast to other interventions that treat postprostatectomy incontinence, injection of autologous myoblasts and fibroblasts directly addresses the loss of striated muscle cells from the rhabdosphincter, and can potentially restore normal function and anatomy. In their paper published in The Journal of Urology, Mitterberger and colleagues report 1-year outcomes of 63 patients who received myoblast and fibroblast injections to treat postprostatectomy urinary incontinence. In all patients, the interval between prostatectomy and myoblast–fibroblast therapy was ≥1 year.

Each patient underwent transurethral ultrasound-guided injection of autologous myoblasts (mean 2.8 × 107 cells) and fibroblasts (mean 3.8 × 107 cells, suspended with collagen to prevent migration), cultured from biceps muscle biopsy samples. No severe adverse effects of injection were reported.

At 1 year, 41 participants were completely continent; a further 17 patients had improved incontinence scores following treatment. No deterioration of continence was observed in the remaining five patients. In addition to improved incontinence scores, participants also showed improvements in quality of life scores, rhabdosphincter thickness and contractility, and urodynamic parameters.

The authors conclude that the improvements observed after myoblast–fibroblast therapy are attributable to regeneration of the urethral submucosa and rhabdosphincter, not just to a bulking effect of the injections. They emphasize the importance of careful patient selection and intraoperative ultrasonography to ensure precise application of the cultured cells.