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  • Review Article
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Stem cell therapy for voiding and erectile dysfunction

Nature Reviews Urology volume 9, pages 435–447 (2012)Cite this article

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Abstract

Voiding dysfunction comprises a variety of disorders, including stress urinary incontinence and overactive bladder, and affects millions of men and women worldwide. Erectile dysfunction (ED) also decreases quality of life for millions of men, as well as for their partners. Advanced age and diabetes are common comorbidities that can exacerbate and negatively impact upon the development of these disorders. Therapies that target the pathophysiology of these conditions to halt progression are not currently available. However, stem cell therapy could fill this therapeutic void. Stem cells can reduce inflammation, prevent fibrosis, promote angiogenesis, recruit endogenous progenitor cells, and differentiate to replace damaged cells. Adult multipotent stem cell therapy, in particular, has shown promise in case reports and preclinical animal studies. Stem cells also have a role in urological tissue engineering for ex vivo construction of bladder wall and urethral tissue (using a patient's own cells) prior to transplantation. More recent studies have focused on bioactive factor secretion and homing of stem cells. In the future, clinicians are likely to utilize allogeneic stem cell sources, intravenous systemic delivery, and ex vivo cell enhancement to treat voiding dysfunction and ED.

Key Points

  • Voiding and erectile dysfunction are progressive disorders that can significantly diminish quality of life; optimizing the timing of therapy initiation is of great importance

  • Conventional stem cell therapy has focused on the ability of cells to differentiate and replace damaged or diseased tissue; however, mounting evidence suggests that stem cells also exert functional benefit by secreting bioactive factors that trigger local and systemic responses to injury

  • For tissue engineering applications, stems cells can be seeded onto scaffolds to facilitate the incorporation of the graft by native tissue

  • Although most clinical trials in the field have focused on autologous cell sources, the use of allogeneic stem cells offers the potential for 'off-the-shelf' treatment with disease-free cells; this approach is already being used in other fields of medicine

  • Further research is needed to better understand the mechanisms by which stem cells exert their therapeutic action; this information could be used to optimize treatment algorithms

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Change history

  • 26 June 2012

    In the version of this article initially published online, two authors (Patricia Toomey and Markus Renninger) were missing from the author list. The error has been corrected for the print, HTML and PDF versions of the article.

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Acknowledgements

The authors would like to thank Simone Di Giovanni (Assistant Professor at the Laboratory for NeuroRegeneration and Repair at the Hertie Institute for Clinical Neuroscience) and Wilhelm Aicher (Professor at the Department of Urology, University Hospital of Tuebingen) for their critical review of the manuscript.

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Authors and Affiliations

  1. Department of Urology, University of Tuebingen, Hoppe-Seyler-Strasse 3, Tuebingen, D72076, Germany

    Martin Vaegler, Lisa Daum, Bastian Amend, Arnulf Stenzl, Patricia Toomey, Markus Renninger & Karl-Dietrich Sievert

  2. The Cleveland Clinic, Case Western Reserve University School of Medicine, 9500 Euclid Avenue, Cleveland, 44195, OH, USA

    Andrew T. Lenis & Margot S. Damaser

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The equal first authors, M. Vaegler and A. T. Lenis, contributed to researching information, discussions of content, and writing the manuscript. The equal senior authors, M. S. Damaser and K.-D. Sievert, also participated in researching information, discussions of content, and writing this Review. L. Daum contributed to researching information, content discussions, and writing. P. Toomey contributed towards researching and reviewing the article. B. Amend, M. Renninger, and A. Stenzl reviewed and edited the manuscript prior to submission.

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Correspondence to Karl-Dietrich Sievert.

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Vaegler, M., Lenis, A., Daum, L. et al. Stem cell therapy for voiding and erectile dysfunction. Nat Rev Urol 9, 435–447 (2012). https://doi.org/10.1038/nrurol.2012.111

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