President of Continence Society Prof. Dr. Tufan Tarcan made important statements on stem cell therapy and urinary incontinence. Stating that it is very difficult to say anything about the future cure for urinary incontinence with stem cell therapy, Prof. Dr. Tufan Tarcan said, “Right now, research continues. However, we have not been able to apply it routinely on patients in the medical field yet.” said.
“The aim of stem cell therapy is to re-develop an organ that has lost its function in the human body or a part of it that has a specific function in the human body or in the laboratory environment by enabling the stem cells to differentiate in the desired direction and thus to restore the lost organ function.” Explaining that Continence Association President Prof. Dr. Tufan Tarcan, “The most successful and valid example of stem cell therapy today is bone marrow transplantation. Apart from this, studies on stem cell treatments are continuing in many fields.” he said.
Research topic of the last 30 years in functional urological diseases
Stating that in functional urological diseases, stem cell therapies and organ engineering have been the subject of research for the last 30 years and concentrated in 3 groups, Prof. Dr. Tufan Tarcan continued as follows: “We can list the treatment of erectile dysfunction in men, repair of the external urethral sphincter, which consists of striated muscle that has lost its ability to hold urine, and construction of a new bladder with tissue engineering instead of the bladder that has permanently lost its ability to store or empty.”
In the first two articles, the President of Continence Association Prof. stated that the researches have reached the clinical application stage but long-term successes have not been achieved yet. Dr. Tufan Tarcan said, “We accept such applications at the research stage. On the other hand, the third item, namely, the creation of a new bladder with tissue engineering, remained at the stage of laboratory and animal experiments and could not pass to the stage of clinical research.” he said.
In some cases, the urinary retention mechanism may completely lose its function.
prof. Dr. Tufan Tarcan shared the aim of stem cell application to the urethral sphincter as follows: “In some cases, the external urethral sphincter, which is the most important component of the urinary retention mechanism, can weaken; It may even completely lose its function. When the sphincter structure weakens, our patients start to leak urine when they cough, laugh, sneeze or move. This situation, which we see increasing with age and childbearing in women, can also be seen in men after radical prostatectomy operations that we perform for the treatment of prostate cancer. Urinary incontinence due to sphincter weakness can sometimes be seen in underlying neurological diseases such as multiple sclerosis (MS) or spina bifida. In fact, sometimes sphincter function may be completely lost and these patients cannot accumulate any urine in their bladders; They are constantly leaking urine. Bladder pads designed and manufactured to collect urine stand out as the first remedy in this patient group. However, since our aim is to make the patient completely dry, we need to perform complicated surgeries in specialized centers. Therefore, restoring sphincter function with stem cell therapy creates great hope in all patient groups with stress or total urinary incontinence. In this regard, a certain level has been reached in laboratory studies and animal models. Muscle cells developed in vitro in humans were injected into the sphincter muscle. However, although this application seemed to be effective in the short term, it failed in the long term and no significant benefit could be obtained in the patients. Therefore, it has not yet been a treatment alternative that we can safely offer to our patients. It looks like we need more research on this.”
New bladder idea excites all urologists
prof. Dr. Tufan Tarcan continued his words as follows: “The idea of producing a new bladder in the laboratory and transplanting it to the patient excites all urologists. Our patients who hear about these studies are also waiting. Unfortunately, basic and clinical studies on neobladder engineering have failed. I think we need a longer time to achieve success. Let me briefly summarize in which diseases the new bladder application developed with tissue engineering can break new ground. Especially in cases such as spinal cord injury, spina bifida and diabetes, and sometimes in unexplained idiopathic conditions, the bladder loses its storage and evacuation function. Or we have to remove the bladder because of bladder cancer. In these cases, it is possible to make a new bladder from the intestine and thus save its storage function, but there is no bladder sensation in the new bladder made from the intestine and the bladder cannot contract and empty the urine. Therefore, with the clean intermittent catheterization method, the patient empties the bladder by self-probing 6 times a day. This process has to be done for life. If a new bladder that provides sensation and contraction of the bladder can be created with tissue engineering, our patients will not have to empty their bladders with the clean intermittent catheterization method and normal urination will be possible. Unfortunately, a bladder that can feel and contract has not yet been made with tissue engineering. However, research continues.”