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This Month in Adult Urology

Autologous Muscle Derived Cells as


Treatment for Stress Urinary Incontinence
Some reports going back a decade ago proposed that
injection of skeletal muscle cells along the urethra
may be used to treat stress urinary incontinence.
However, reproducibility, function and viability of
this regenerative tissue engineering approach were
issues. In this multi-institutional industry trial of
autologous muscle derived cells Peters et al (page
469) pooled 2 phase I/II studies of women with
refractory stress incontinence.1 They performed a
dose ranging study from 10 to 200  106 autologous
cells derived from biopsies of the quadriceps femoris
in 80 patients, and safety was the primary outcome.
Potential efficacy was measured by changes in 3-day
voiding diaries, 24-hour pad tests, and UDI-6 and
IIQ-7 scores. Of the patients 72 completed diaries.
The authors note that the higher dose groups tended to include more patients with at least 50%
reduction in stress leaks and pad weight at
12-month followup. All groups showed improvement
in UDI-6 and IIQ-7 scores compared to baseline at
12 months. The authors conclude that autologous
muscle derived cell treatment appears to be safe,
and efficacy data suggest a potential dose response
with patients more responsive to higher doses.

Tissue Engineered Cystoplasty Augmentation


for Neurogenic Bladder
Zhang and Liao (page 544) from China used small intestinal submucosa as scaffolding for bladder reconstruction in 8 patients with poor capacity of diverse
etiologies.2 Patients ranged in age from 14 to 54 years,
and 6 had myelomeningocele and 2 had spinal cord
injury. At followup (range 11 to 36 months, mean
12 months) maximum bladder capacity increased from
a mean of 170 cc preoperatively to 365 cc at 3 months
and 385 cc at 12 months postoperatively. The authors
also note a significant increase in bladder compliance
and decrease in maximum detrusor pressure.
They state that wrapping the scaffolding with omentum was important for the success of the procedure as
well as periodic bladder cycling by clamping the
catheter every 2 hours. The results are promising,
although additional studies are needed to determine
reproducibility.
0022-5347/14/1922-0291/0
THE JOURNAL OF UROLOGY
2014 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION

AND

RESEARCH, INC.

Cross-Sectional Study of Upper and Lower


Tract Outcomes in Adults with Spinal
Dysraphism
European guidelines for neurogenic bladder recommend annual urodynamics for all adults with spinal
dysraphism. Veenboer et al (page 477) from the
Netherlands prospectively followed 120 patients for
26 months by comparing their videourodynamic
studies.3 In a multivariable model, unsafe bladder
was found to be significantly associated with being
wheelchair bound (OR 5.36, p0.008). In patients
who were not wheelchair bound the negative predictive value of urodynamic studies for finding an
unsafe bladder was high. The authors suggest that
mobility status was the most important determinant, although compliance with intermittent catheterization has been shown by other investigators to
be important. Details whether urodynamically unsafe bladders resulted in deterioration of renal
function or hydronephrosis are not provided but
the authors state that there was no significant
association between the combination of urodynamic
findings and renal impairment. Current renal abnormalities may have been caused by unfavorable
bladder function in the past. Because this was a
cross-sectional study there is a potential for selection bias. The optimum method of following patients
with neurogenic bladder remains to be determined
by larger data repositories, ideally with a prospective study.

Port Site Metastasis after Surgery


for Renal Cell Carcinoma
The development of port site metastases following
laparoscopic nephrectomy has been reported
sporadically. In a multicenter study Song et al (page
364) identified 16 such cases from a literature
search using MEDLINE, including 11 with longterm outcomes data for further analysis.4 The survival curves showed poor prognosis with a 32%
overall 1-year survival rate. No identifiable reason
for the port site metastasis, such as specimen morcellation, absence of entrapment or tumor rupture,
was found in 9 cases. The tumors were uniformly
aggressive with Fuhrman grade 3 or higher. The
authors conclude that while port site metastasis in
http://dx.doi.org/10.1016/j.juro.2014.05.028
Vol. 192, 291-292, August 2014
Printed in U.S.A.

www.jurology.com

291

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THIS MONTH IN ADULT UROLOGY

tumors treated with minimally invasive treatment


is rare, it is associated with an extremely poor
prognosis. Biological factors like high tumor grade
appear to be a risk factor.

Percutaneous Image Guided Ablation of


Metastatic Renal Cell Carcinoma
Of every 3 patients diagnosed with renal cell carcinoma one will present with metastasis and another
will likely have metachronous metastatic disease.
Although surgical extirpation of metastatic deposits
can result in improved survival, such procedures
can be technically challenging and lead to substantial morbidity. Welch et al (page 357) from Rochester,
Minnesota performed a retrospective review of the
records of 61 patients who underwent 74 ablation
procedures to treat 82 metastatic renal cell carcinoma lesions.5 Approximately 8% of these lesions
recurred at a mean of 1.6 years following ablation.
Technical failures occurred in 4 cases (5%). Local
recurrence-free survival rates at 1, 2 and 3 years
were 94%, 94% and 83%, respectively. Overall survival rates at 1, 2 and 3 years following ablation
were 87%, 83% and 76%, respectively. The authors

conclude that metastatic ablation in cases of renal


cell carcinoma is a relatively safe procedure with
acceptable local control rates but it remains to be
determined whether it offers a true survival benefit.
Obviously the choice of percutaneous ablation
depends on the lesion site and previously reported outcomes.
William D. Steers
Editor

1. Peters KM, Dmochowski RR, Carr LK et al: Autologous muscle derived cells for
treatment of stress urinary incontinence in women. J Urol 2014; 192: 469.
2. Zhang F and Liao L: Tissue engineered cystoplasty augmentation for treatment
of neurogenic bladder using small intestinal submucosa: an exploratory study.
J Urol 2014; 192: 544.
3. Veenboer PW, Ruud Bosch JL, Rosier PF et al: Cross-sectional study of
determinants of upper and lower urinary tract outcomes in adults with spinal
dysraphism d new recommendations for urodynamic followup guidelines?
J Urol 2014; 192: 477.
4. Song J, Kim E, Mobley J et al: Port site metastasis after surgery for renal cell
carcinoma: harbinger of future metastasis. J Urol 2014; 192: 364.
5. Welch BT, Callstrom MR, Morris JM et al: Feasibility and oncologic control
after percutaneous image guided ablation of metastatic renal cell carcinoma.
J Urol 2014; 192: 357.