Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Regenerative medicine and injection therapies in stress urinary incontinence

Nature Reviews Urology volume 17, pages 151–161 (2020)Cite this article

Subjects

An Author Correction to this article was published on 26 May 2020

This article has been updated

Abstract

Stress urinary incontinence (SUI) is a common and bothersome condition. Anti-incontinence surgery has high cure rates, but concerns about mesh tapes have resulted in the resurgence of surgical procedures that involve increased abdominopelvic dissection and morbidity. Injection therapy with urethral bulking agents or stem cell formulations have been developed as minimally invasive alternatives. Many synthetic and biological bulking agents have been trialled, but several have been discontinued owing to safety concerns. The use of Macroplastique and Contigen has the largest evidence base, but, overall, success rates seem to be similar between the various agents and positive outcomes are poorly sustained for more than 6 months. Furthermore, subjective cure rates, although initially high, also deteriorate over time. The available data consistently demonstrate manifestly poorer outcomes for injection therapies than for surgery. Stem cell treatments are thought to functionally regenerate the urethral sphincter in patients with suspected intrinsic sphincter deficiency. Autologous adipose and muscle-derived stem cells seem to be the intuitive cell source, as they are comparatively abundant, can be harvested and cause minimal donor site morbidity. To date, only a few small clinical studies have been reported and most data are derived from animal models. The success rates of stem cell injection therapies seem to be comparable with those of bulking agents.

Key points

  • An increasing number of bulking procedures are being performed with objective cure rates that are inferior to those of open surgery, but their minimally invasive application is an attractive prospect.

  • The rates of subjective improvements for bulking agent therapies are high, but these treatments should not be offered to patients who seek a permanent cure of their stress urinary incontinence.

  • Stem cells derived from muscle or fat are the most commonly studied cells for use as a regenerative injection therapy.

  • Harvest and injection of stem cells seem not to have high rates of morbidity, and the outcomes of stem cell injections seem to be better maintained at 12 months than those of bulking agents.

  • Studies of labelled-cell injections to enable tracking demonstrate low stem cell proportions in the sphincter by 12 months; hence, paracrine effects of the cellular concentrate might be as important as the cells themselves.

  • The development of stem cell therapies is limited to preclinical and human feasibility studies, owing to the difficulty of assessing injected cell fate; thus, outcome measurements are limited to subjective and objective cure rates.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Neural control of the female lower urinary tract and the structure of the female urethra.
Fig. 2: Application of urethral bulking agents.

Similar content being viewed by others

Change history

References

  1. Haylen, B. T. et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol. Urodyn. 29, 4–20 (2010).

    PubMed  Google Scholar 

  2. Abrams, P., Cardozo, L., Wagg, A. & Wein, A. Incontinence 6th edn (ICI-RS. International Continence Society, 2017).

  3. Abrams, P. et al. 6th International Consultation on Incontinence. Recommendations of the International Scientific Committee: evaluation and treatment of urinary incontinence, pelvic organ prolapse and faecal incontinence. Neurourol. Urodyn. 37, 2271–2272 (2018).

    PubMed  Google Scholar 

  4. Rortveit, G., Hannestad, Y. S., Daltveit, A. K. & Hunskaar, S. Age- and type-dependent effects of parity on urinary incontinence: the Norwegian EPINCONT study. Obstet. Gynecol. 98, 1004–1010 (2001).

    CAS  PubMed  Google Scholar 

  5. Blaivas, J. G. & Olsson, C. A. Stress incontinence: classification and surgical approach. J. Urol. 139, 727–731 (1988).

    CAS  PubMed  Google Scholar 

  6. McGuire, E. J., Lytton, B., Kohorn, E. I. & Pepe, V. The value of urodynamic testing in stress urinary incontinence. J. Urol. 124, 256–258 (1980).

    CAS  PubMed  Google Scholar 

  7. McGuire, E. J., Lytton, B., Pepe, V. & Kohorn, E. I. Stress urinary incontinence. Obstet. Gynecol. 47, 255–264 (1976).

    CAS  PubMed  Google Scholar 

  8. Kayigil, O., Iftekhar Ahmed, S. & Metin, A. The coexistence of intrinsic sphincter deficiency with type II stress incontinence. J. Urol. 162, 1365–1366 (1999).

    CAS  PubMed  Google Scholar 

  9. McGuire, E. J. Urodynamic findings in patients after failure of stress incontinence operations. Prog. Clin. Biol. Res. 78, 351–360 (1981).

    CAS  PubMed  Google Scholar 

  10. Shah, H. N. & Badlani, G. H. Mesh complications in female pelvic floor reconstructive surgery and their management: a systematic review. Indian. J. Urol. 28, 129–153 (2012).

    PubMed  PubMed Central  Google Scholar 

  11. Blaivas, J. G. et al. Safety considerations for synthetic sling surgery. Nat. Rev. Urol. 12, 481–509 (2015).

    PubMed  Google Scholar 

  12. Kuismanen, K. et al. Autologous adipose stem cells in treatment of female stress urinary incontinence: results of a pilot study. Stem Cell Transl Med. 3, 936–941 (2014).

    Google Scholar 

  13. Davis, N. F., Kheradmand, F. & Creagh, T. Injectable biomaterials for the treatment of stress urinary incontinence: their potential and pitfalls as urethral bulking agents. Int. Urogynecol. J. 24, 913–919 (2013).

    PubMed  Google Scholar 

  14. Rud, T., Andersson, K. E., Asmussen, M., Hunting, A. & Ulmsten, U. Factors maintaining the intraurethral pressure in women. Invest. Urol. 17, 343–347 (1980).

    CAS  PubMed  Google Scholar 

  15. Onuf, B. Notes on the arrangement and function of the cell groups in the sacral region of the spinal cord. J. Nerv. Ment. Dis. 26, 498–504 (1899).

    Google Scholar 

  16. Sand, P. K., Bowen, L. W., Panganiban, R. & Ostergard, D. R. The low pressure urethra as a factor in failed retropubic urethropexy. Obstet. Gynecol. 69, 399–402 (1987).

    CAS  PubMed  Google Scholar 

  17. Betson, L. H., Siddiqui, G. & Bhatia, N. N. Intrinsic urethral sphincteric deficiency: critical analysis of various diagnostic modalities. Curr. Opin. Obstet. Gynecol. 15, 411–417 (2003).

    PubMed  Google Scholar 

  18. McGuire, E. J. et al. Clinical assessment of urethral sphincter function. J. Urol. 150, 1452–1454 (1993).

    CAS  PubMed  Google Scholar 

  19. Parker, R. The paraffin injection treatment of Gersuny, with a report of cases. JAMA XXXVIII, 1000–1003 (1902).

    Google Scholar 

  20. Murless, B. The injection treatment of stress incontinence. J. Obstet. Gynaecol. Br. Emp. 45, 521–524 (1938).

    Google Scholar 

  21. Sachse, H. Treatment of urinary incontinence with sclerosing solutions. Indications, results, complications. Urol. Int. 15, 225–244 (1963).

    CAS  PubMed  Google Scholar 

  22. Dmochowski, R. R. & Appell, R. A. Injectable agents in the treatment of stress urinary incontinence in women: where are we now? Urology 56, 32–40 (2000).

    CAS  PubMed  Google Scholar 

  23. Chaliha, C. & Williams, G. Periurethral injection therapy for the treatment of urinary incontinence. Br. J. Urol. 76, 151–155 (1995).

    CAS  PubMed  Google Scholar 

  24. Lee, P. E., Kung, R. C. & Drutz, H. P. Periurethral autologous fat injection as treatment for female stress urinary incontinence: a randomized double-blind controlled trial. J. Urol. 165, 153–158 (2001).

    CAS  PubMed  Google Scholar 

  25. Mayer, R. D. et al. Multicenter prospective randomized 52-week trial of calcium hydroxylapatite versus bovine dermal collagen for treatment of stress urinary incontinence. Urology 69, 876–880 (2007).

    CAS  PubMed  Google Scholar 

  26. Lightner, D. et al. A new injectable bulking agent for treatment of stress urinary incontinence: results of a multicenter, randomized, controlled, double-blind study of Durasphere. Urology 58, 12–15 (2001).

    CAS  PubMed  Google Scholar 

  27. Sokol, E. R., Karram, M. M. & Dmochowski, R. Efficacy and safety of polyacrylamide hydrogel for the treatment of female stress incontinence: a randomized, prospective, multicenter North American study. J. Urol. 192, 843–849 (2014).

    CAS  PubMed  Google Scholar 

  28. Lose, G., Mouritsen, L. & Nielsen, J. B. A new bulking agent (polyacrylamide hydrogel) for treating stress urinary incontinence in women. BJU Int. 98, 100–104 (2006).

    CAS  PubMed  Google Scholar 

  29. Reynolds, W. S. & Dmochowski, R. R. Urethral bulking: a urology perspective. Urol. Clin. North. Am. 39, 279–287 (2012).

    PubMed  Google Scholar 

  30. Henly, D. R. et al. Particulate silicone for use in periurethral injections: local tissue effects and search for migration. J. Urol. 153, 2039–2043 (1995).

    CAS  PubMed  Google Scholar 

  31. Hurtado, E. A. & Appell, R. A. Complications of tegress injections. Int. Urogynecol J. Pelvic Floor. Dysfunct. 20, 127; author reply 129 (2009).

    PubMed  Google Scholar 

  32. Lightner, D. et al. Randomized controlled multisite trial of injected bulking agents for women with intrinsic sphincter deficiency: mid-urethral injection of Zuidex via the implacer versus proximal urethral injection of Contigen cystoscopically. Urology 74, 771–775 (2009).

    PubMed  Google Scholar 

  33. Kulkarni, S., Davies, A. J., Treurnicht, K., Dudderidge, T. J. & Al-Akraa, M. Misplaced macroplastique injection presenting as a vaginal nodule and a bladder mass. Int. J. Clin. Pract. Suppl. https://doi.org/10.1111/j.1368-504x.2005.00287.x (2005).

    Article  PubMed  Google Scholar 

  34. Kirchin, V. et al. Urethral injection therapy for urinary incontinence in women. Cochrane Database Syst. Rev. 7, CD003881 (2017).

    PubMed  Google Scholar 

  35. Klarskov, N. & Lose, G. Urethral injection therapy: what is the mechanism of action? Neurourol. Urodyn. 27, 789–792 (2008).

    PubMed  Google Scholar 

  36. Pickard, R. et al. Periurethral injection therapy for urinary incontinence in women. Cochrane Database Syst. Rev. 3, CD003881 (2003).

    Google Scholar 

  37. Schulz, J. A., Nager, C. W., Stanton, S. L. & Baessler, K. Bulking agents for stress urinary incontinence: short-term results and complications in a randomized comparison of periurethral and transurethral injections. Int. Urogynecol. J. Pelvic Floor Dysfunct. 15, 261–265 (2004).

    PubMed  Google Scholar 

  38. Mitterberger, M. et al. Comparison of the precision of transurethral endoscopic versus ultrasound-guided application of injectables. BJU Int. 101, 245–249 (2008).

    PubMed  Google Scholar 

  39. Kuhn, A., Stadlmayr, W., Lengsfeld, D. & Mueller, M. D. Where should bulking agents for female urodynamic stress incontinence be injected? Int. Urogynecol. J. Pelvic Floor Dysfunct. 19, 817–821 (2008).

    PubMed  Google Scholar 

  40. Ghoniem, G. et al. Cross-linked polydimethylsiloxane injection for female stress urinary incontinence: results of a multicenter, randomized, controlled, single-blind study. J. Urol. 181, 204–210 (2009).

    PubMed  Google Scholar 

  41. Bano, F., Barrington, J. W. & Dyer, R. Comparison between porcine dermal implant (Permacol) and silicone injection (Macroplastique) for urodynamic stress incontinence. Int. Urogynecol. J. Pelvic Floor Dysfunct. 16, 147–150; discussion 150 (2005).

    CAS  PubMed  Google Scholar 

  42. ter Meulen, P. H., Berghmans, L. C., Nieman, F. H. & van Kerrebroeck, P. E. Effects of macroplastique implantation system for stress urinary incontinence and urethral hypermobility in women. Int. Urogynecol. J. Pelvic Floor Dysfunct. 20, 177–183 (2009).

    PubMed  Google Scholar 

  43. Corcos, J. et al. Multicenter randomized clinical trial comparing surgery and collagen injections for treatment of female stress urinary incontinence. Urology 65, 898–904 (2005).

    CAS  PubMed  Google Scholar 

  44. Maher, C. F. et al. Pubovaginal sling versus transurethral macroplastique for stress urinary incontinence and intrinsic sphincter deficiency: a prospective randomised controlled trial. BJOG 112, 797–801 (2005).

    PubMed  Google Scholar 

  45. Gaddi, A., Guaderrama, N., Bassiouni, N., Bebchuk, J. & Whitcomb, E. L. Repeat midurethral sling compared with urethral bulking for recurrent stress urinary incontinence. Obstet. Gynecol. 123, 1207–1212 (2014).

    PubMed  Google Scholar 

  46. Scottish Government. The Scottish independent review of the use, safety and efficacy of transvaginal mesh implants in the treatment of stress urinary incontinence and pelvic organ prolapse in women: final report. Scottish Government https://www.gov.scot/publications/scottish-independent-review-use-safety-efficacy-transvaginal-mesh-implants-treatment-9781786528711/pages/6/ (2017).

  47. Siddiqui, Z. A., Abboudi, H., Crawford, R. & Shah, S. Intraurethral bulking agents for the management of female stress urinary incontinence: a systematic review. Int. Urogynecol. J. 28, 1275–1284 (2017).

    PubMed  Google Scholar 

  48. Andersen, R. C. Long-term follow-up comparison of durasphere and contigen in the treatment of stress urinary incontinence. J. Low. Genit. Tract. Dis. 6, 239–243 (2002).

    PubMed  Google Scholar 

  49. Lose, G. et al. An open multicenter study of polyacrylamide hydrogel (Bulkamid(R)) for female stress and mixed urinary incontinence. Int. Urogynecol. J. 21, 1471–1477 (2010).

    PubMed  PubMed Central  Google Scholar 

  50. Burkhard, F. C., Bosch, J. L. H. R., Cruz, F., Lemack, G. E. & Nambiar, A. K. EAU guidelines on urinary incontinence in adults. EAU https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Urinary-Incontinence_2018-V3.pdf (2018).

  51. Kobashi, K. C. et al. Surgical treatment of female stress urinary incontinence: AUA/SUFU guideline. J. Urol. 198, 875–883 (2017).

    PubMed  Google Scholar 

  52. Martinez-Climent, J. A., Andreu, E. J. & Prosper, F. Somatic stem cells and the origin of cancer. Clin. Transl. Oncol. 8, 647–663 (2006).

    CAS  PubMed  Google Scholar 

  53. Lee, J. Y. et al. Clonal isolation of muscle-derived cells capable of enhancing muscle regeneration and bone healing. J. Cell Biol. 150, 1085–1100 (2000).

    CAS  PubMed  PubMed Central  Google Scholar 

  54. Qu-Petersen, Z. et al. Identification of a novel population of muscle stem cells in mice: potential for muscle regeneration. J. Cell Biol. 157, 851–864 (2002).

    CAS  PubMed  PubMed Central  Google Scholar 

  55. Cannon, T. W. et al. Improved sphincter contractility after allogenic muscle-derived progenitor cell injection into the denervated rat urethra. Urology 62, 958–963 (2003).

    PubMed  Google Scholar 

  56. Chancellor, M. B. et al. Preliminary results of myoblast injection into the urethra and bladder wall: a possible method for the treatment of stress urinary incontinence and impaired detrusor contractility. Neurourol. Urodyn. 19, 279–287 (2000).

    CAS  PubMed  Google Scholar 

  57. Chermansky, C. J. et al. Intraurethral muscle-derived cell injections increase leak point pressure in a rat model of intrinsic sphincter deficiency. Urology 63, 780–785 (2004).

    PubMed  Google Scholar 

  58. Lee, J. Y. et al. The effects of periurethral muscle-derived stem cell injection on leak point pressure in a rat model of stress urinary incontinence. Int. Urogynecol. J. Pelvic Floor Dysfunct. 14, 31–37; discussion 37 (2003).

    CAS  PubMed  Google Scholar 

  59. Lee, J. Y. et al. Long term effects of muscle-derived stem cells on leak point pressure and closing pressure in rats with transected pudendal nerves. Mol. Cell 18, 309–313 (2004).

    CAS  Google Scholar 

  60. Tamaki, T. et al. Functional recovery of damaged skeletal muscle through synchronized vasculogenesis, myogenesis, and neurogenesis by muscle-derived stem cells. Circulation 112, 2857–2866 (2005).

    PubMed  Google Scholar 

  61. Badra, S., Andersson, K. E., Dean, A., Mourad, S. & Williams, J. K. Long-term structural and functional effects of autologous muscle precursor cell therapy in a nonhuman primate model of urinary sphincter deficiency. J. Urol. 190, 1938–1945 (2013).

    PubMed  Google Scholar 

  62. Williams, J. K. et al. The dose-effect safety profile of skeletal muscle precursor cell therapy in a dog model of intrinsic urinary sphincter deficiency. Stem Cell Transl Med. 4, 286–294 (2015).

    CAS  Google Scholar 

  63. Mitterberger, M. et al. Autologous myoblasts and fibroblasts for female stress incontinence: a 1-year follow-up in 123 patients. BJU Int. 100, 1081–1085 (2007).

    PubMed  Google Scholar 

  64. Carr, L. K. et al. Autologous muscle derived cell therapy for stress urinary incontinence: a prospective, dose ranging study. J. Urol. 189, 595–601 (2013).

    PubMed  Google Scholar 

  65. Gras, S., Klarskov, N. & Lose, G. Intraurethral injection of autologous minced skeletal muscle: a simple surgical treatment for stress urinary incontinence. J. Urol. 192, 850–855 (2014).

    PubMed  Google Scholar 

  66. Blaganje, M. & Lukanovic, A. Intrasphincteric autologous myoblast injections with electrical stimulation for stress urinary incontinence. Int. J. Gynaecol. Obstet. 117, 164–167 (2012).

    PubMed  Google Scholar 

  67. Peters, K. M. et al. Autologous muscle derived cells for treatment of stress urinary incontinence in women. J. Urol. 192, 469–476 (2014).

    PubMed  Google Scholar 

  68. Ning, H., Lin, G., Lue, T. F. & Lin, C. S. Neuron-like differentiation of adipose tissue-derived stromal cells and vascular smooth muscle cells. Differentiation 74, 510–518 (2006).

    CAS  PubMed  Google Scholar 

  69. Zuk, P. A. et al. Multilineage cells from human adipose tissue: implications for cell-based therapies. Tissue Eng. 7, 211–228 (2001).

    CAS  PubMed  Google Scholar 

  70. Miranville, A. et al. Improvement of postnatal neovascularization by human adipose tissue-derived stem cells. Circulation 110, 349–355 (2004).

    CAS  PubMed  Google Scholar 

  71. Miyahara, Y. et al. Monolayered mesenchymal stem cells repair scarred myocardium after myocardial infarction. Nat. Med. 12, 459–465 (2006).

    CAS  PubMed  Google Scholar 

  72. Gotoh, M. et al. Regenerative treatment of male stress urinary incontinence by periurethral injection of autologous adipose-derived regenerative cells: 1-year outcomes in 11 patients. Int. J. Urol. 21, 294–300 (2014).

    PubMed  Google Scholar 

  73. Kong, K. Y., Ren, J., Kraus, M., Finklestein, S. P. & Brown, R. H. Jr. Human umbilical cord blood cells differentiate into muscle in sjl muscular dystrophy mice. Stem Cell 22, 981–993 (2004).

    CAS  Google Scholar 

  74. Lee, C. N. et al. Human cord blood stem cell therapy for treatment of stress urinary incontinence. J. Korean Med. Sci. 25, 813–816 (2010).

    PubMed  PubMed Central  Google Scholar 

  75. Pittenger, M. F. et al. Multilineage potential of adult human mesenchymal stem cells. Science 284, 143–147 (1999).

    CAS  PubMed  Google Scholar 

  76. Kinebuchi, Y. et al. Autologous bone-marrow-derived mesenchymal stem cell transplantation into injured rat urethral sphincter. Int. J. Urol. 17, 359–368 (2010).

    PubMed  Google Scholar 

  77. Gunetti, M. et al. Myogenic potential of whole bone marrow mesenchymal stem cells in vitro and in vivo for usage in urinary incontinence. PLoS One 7, e45538 (2012).

    CAS  PubMed  PubMed Central  Google Scholar 

  78. Roman, S. et al. Developing a tissue engineered repair material for treatment of stress urinary incontinence and pelvic organ prolapse-which cell source? Neurourol. Urodyn. 33, 531–537 (2014).

    CAS  PubMed  Google Scholar 

  79. Amend, B. et al. Precise injection of human mesenchymal stromal cells in the urethral sphincter complex of Gottingen minipigs without unspecific bulking effects. Neurourol. Urodyn. 36, 1723–1733 (2017).

    CAS  PubMed  Google Scholar 

  80. Deng, K. et al. Mesenchymal stem cells and their secretome partially restore nerve and urethral function in a dual muscle and nerve injury stress urinary incontinence model. Am. J. Physiol. Ren. Physiol. 308, F92–F100 (2015).

    CAS  Google Scholar 

  81. Dissaranan, C. et al. Rat mesenchymal stem cell secretome promotes elastogenesis and facilitates recovery from simulated childbirth injury. Cell Transpl. 23, 1395–1406 (2014).

    Google Scholar 

  82. Williams, J. K. et al. Cell versus chemokine therapy in a nonhuman primate model of chronic intrinsic urinary sphincter deficiency. J. Urol. 196, 1809–1815 (2016).

    CAS  PubMed  Google Scholar 

  83. Sebe, P. et al. Intrasphincteric injections of autologous muscular cells in women with refractory stress urinary incontinence: a prospective study. Int. Urogynecol. J. 22, 183–189 (2011).

    PubMed  Google Scholar 

Download references

Acknowledgements

C.J.H., S.M., W.K.A., A.S. and C.R.C are members of the Regenerative Sphincter Therapy (ReST) Consortium funded by the European Cooperation in Science and Technology (COST).

Review criteria

A search of the PubMed and Scopus databases was performed to identify articles published between 1995 and May 2018 using the following search terms: “bulking agent”, “urethral injection”, “regenerative medicine” and “stem cell injection”. Results were limited to “stress urinary incontinence”. All available randomized controlled trials, cohort studies and case series were included in this narrative review.

Author information

Authors and Affiliations

  1. Royal Hallamshire Hospital, Glossop Road, Sheffield, UK

    Christopher J. Hillary & Christopher R. Chapple

  2. Department of Materials Science and Engineering, Kroto Research Institute, University of Sheffield, Sheffield, UK

    Christopher J. Hillary, Sabiniano Roman & Sheila MacNeil

  3. Members of the Regenerative Sphincter Therapy (ReST) Consortium funded by the European Cooperation in Science and Technology (COST), Brussels, Belgium

    Christopher J. Hillary, Sheila MacNeil, Wilhelm K. Aicher, Arnulf Stenzl & Christopher R. Chapple

  4. University of Tuebingen Medical Center, Department of Urology, Tuebingen, Germany

    Wilhelm K. Aicher & Arnulf Stenzl

Authors
  1. Christopher J. Hillary
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sabiniano Roman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sheila MacNeil
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wilhelm K. Aicher
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Arnulf Stenzl
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christopher R. Chapple
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

C.J.H. and S.R. researched data for the article. All authors made substantial contributions to the discussion of content and wrote the manuscript. C.J.H., S.M., W.K.A., A.S. and C.R.C. reviewed and/or edited the manuscript before submission.

Corresponding author

Correspondence to Christopher J. Hillary.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hillary, C.J., Roman, S., MacNeil, S. et al. Regenerative medicine and injection therapies in stress urinary incontinence. Nat Rev Urol 17, 151–161 (2020). https://doi.org/10.1038/s41585-019-0273-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41585-019-0273-4

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing