Review
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Stem Cells. Oct 26, 2013; 5(4): 112-123
Published online Oct 26, 2013. doi: 10.4252/wjsc.v5.i4.112
Regenerative medicine based applications to combat stress urinary incontinence
Hatim Thaker, Arun K Sharma
Hatim Thaker, Arun K Sharma, Division of Pediatric Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, United States
Arun K Sharma, Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
Arun K Sharma, Institute for BioNanotechnology in Medicine (IBNAM), Northwestern University, Chicago, IL 60611, United States
Author contributions: Thaker H and Sharma AK contributed equally to this manuscript.
Correspondence to: Arun K Sharma, PhD, Institute for BioNanotechnology in Medicine, Northwestern University, 303 East Superior Street, IBNAM 11-113, Chicago, IL 60611, United States. arun-sharma@northwestern.edu
Telephone: +1-312-503-1101 Fax: +1-312-503-1222
Received: June 13, 2013
Revised: August 7, 2013
Accepted: August 20, 2013
Published online: October 26, 2013
Processing time: 139 Days and 15.5 Hours
Abstract

Stress urinary incontinence (SUI), as an isolated symptom, is not a life threatening condition. However, the fear of unexpected urine leakage contributes to a significant decline in quality of life parameters for afflicted patients. Compared to other forms of incontinence, SUI cannot be easily treated with pharmacotherapy since it is inherently an anatomic problem. Treatment options include the use of bio-injectable materials to enhance closing pressures, and the placement of slings to bolster fascial support to the urethra. However, histologic findings of degeneration in the incontinent urethral sphincter invite the use of tissues engineering strategies to regenerate structures that aid in promoting continence. In this review, we will assess the role of stem cells in restoring multiple anatomic and physiological aspects of the sphincter. In particular, mesenchymal stem cells and CD34+ cells have shown great promise to differentiate into muscular and vascular components, respectively. Evidence supporting the use of cytokines and growth factors such as hypoxia-inducible factor 1-alpha, vascular endothelial growth factor, basic fibroblast growth factor, hepatocyte growth factor and insulin-like growth factor further enhance the viability and direction of differentiation. Bridging the benefits of stem cells and growth factors involves the use of synthetic scaffolds like poly (1,8-octanediol-co-citrate) (POC) thin films. POC scaffolds are synthetic, elastomeric polymers that serve as substrates for cell growth, and upon degradation, release growth factors to the microenvironment in a controlled, predictable fashion. The combination of cellular, cytokine and scaffold elements aims to address the pathologic deficits to urinary incontinence, with a goal to improve patient symptoms and overall quality of life.

Keywords: Stress urinary incontinence; Smooth muscle; Tissue engineering; Regeneration; Stem cells; Biomaterials; Angiogenesis; Sphincter

Core tip: Stress urinary incontinence is a condition which affects millions of women on a world-wide basis. Current surgical strategies to alleviate the symptoms involved with this condition are temporary stop-gap measures. With the advent of tissue engineering strategies in combination with stem cells, the reality of creating a functional replacement for anatomic structures involved in stress urinary incontinence can be a reality.