Michael Mitterberger

RETRACTED: Autologous myoblasts and fibroblasts versus collagen for treatment of stress urinary incontinence in women: a randomised controlled trial

BACKGROUNDnPreclinical studies have suggested that transurethral injections of autologous myoblasts can aid in regeneration of the rhabdosphincter, and fibroblasts in reconstruction of the urethral submucosa. We aimed to compare the effectiveness and tolerability of ultrasonography-guided injections of autologous cells with those of endoscopic injections of collagen for stress incontinence.nnnMETHODSnBetween 2002 and 2004, we recruited 63 eligible women with urinary stress incontinence. 42 of these women were randomly assigned to receive transurethral ultrasonography-guided injections of autologous myoblasts and fibroblasts, and 21 to receive conventional endoscopic injections of collagen. The first primary outcome measure was an incontinence score (range 0-6) based on a 24-hour voiding diary, a 24-hour pad test, and a patient questionnaire. The other primary outcome measures were contractility of the rhabdosphincter and thickness of both the urethra and rhabdosphincter. Analysis was by intention to treat. This trial is registered with Controlled-Trials.com, number CCT-NAPN-16630.nnnFINDINGSnAt 12-months follow-up, 38 of the 42 women injected with autologous cells were completely continent, compared with two of the 21 patients given conventional treatment with collagen. The median incontinence score decreased from a baseline of 6.0 (IQR 6.0-6.0; where 6 represents complete incontinence), to 0 (0-0) for patients treated with autologous cells, and 6.0 (3.5-6.0) for patients treated with collagen (p<0.0001). Ultrasonographic measurements showed that the mean thickness of the rhabdosphincter increased from a baseline of 2.13 mm (SD 0.39) for all patients to 3.38 mm (0.26) for patients treated with autologous cells and 2.32 mm (0.44) for patients treated with collagen (p<0.0001). Contractility of the rhabdosphincter increased from a baseline of 0.58 mm (SD 0.32) to 1.56 mm (0.28) for patients treated with autologous cells and 0.67 mm (0.51) for controls (p<0.0001). The change in the thickness of the urethra after treatment was not significantly different between treatment groups. No adverse effects were recorded in any of the 63 patients.nnnINTERPRETATIONnLong-term postoperative results and data from multicentre trials with larger numbers of patients are needed to assess whether injection of autologous cells into the rhabdosphincter and the urethra could become a standard treatment for urinary incontinence.

Acute pyelonephritis: comparison of diagnosis with computed tomography and contrast-enhanced ultrasonography.

To assess the value of contrast‐enhanced ultrasonography (US) with the contrast pulse‐sequence (CPS) technique for detecting renal parenchymal changes in acute pyelonephritis (APN), compared with contrast‐enhanced computed tomography (CT) as the reference standard.

Three-dimensional transrectal ultrasound of the male urethral rhabdosphincter

The rhabdosphincter of the male urethra is an omega-shaped loop of striated muscle fibers that surrounds the membranous urethra at its lateral and anterior aspects. We investigated whether this muscle can be visualized by means of three-dimensional ultrasound to define morphological and dynamic ultrasound criteria. We examined the rhabdosphincter of the male urethra in 77 patients by means of this new imaging technique; 37 patients presented with urinary stress incontinence after transurethral resection of the prostate or radical prostatectomy while 40 were fully continent after radical prostatectomy and served as a control group. Contractility of the muscle was quantified by a specially defined parameter (rhabdosphincter–urethra distance). The anatomical arrangement and the contractions of the rhabdosphincter-loop could be clearly visualized in three-dimensional transrectal and transurethral ultrasound; during contraction the rhabdosphincter retracts the urethra, pulling it towards the rectum. We detected defects and postoperative scarrings in the majority of the patients with postoperative urinary stress incontinence. Furthermore, the patients presented with thinnings in parts of the muscle and atrophies of the rhabdosphincter. The rhabdosphincter–urethra distance was significantly lower in the incontinent group than in the continent group (59 vs. 1.42xa0mm). Our study shows that the rhabdosphincter of the male urethra can be visualized by means of three-dimensional transrectal ultrasound. The sonographic pathomorphological findings of postoperative urinary stress incontinence are well correlated well with the clinical symptoms

Stammzelltherapie der Harninkontinenz

ZusammenfassungIn präklinischen und klinischen Studien wurde untersucht, ob mittels der transurethralen ultraschallgezielten Applikation von autologen Myoblasten und Fibroblasten Harninkontinenz erfolgreich therapiert werden kann.In 8 weiblichen Schweinen wurde diese Therapie experimentell durchgeführt. Es zeigte sich, dass die injizierten Zellen am Injektionsort verbleiben und neue Muskelfasern bilden. In weiterer Folge wurden bisher 42xa0Patienten (29 Frauen, 13 Männer) mit dieser neuen Methode behandelt. Die Fibroblasten wurden mit einer kleinen Menge Kollagen als Trägermaterial vermischt und in die Submukosa der Urethra appliziert, um Atrophien der Schleimhaut zu behandeln. Die Myoblasten wurden in den Rhabdosphinkter injiziert, um morphologische und funktionelle Defekte des Muskels zu therapieren und den Muskel zu rekonstruieren. Bei 35xa0Patienten konnte die Inkontinenz geheilt werden, bei 7xa0Patienten (davon 5 mehrfach voroperiert bzw. bestrahlt) kam es zu einer Verbesserung der Inkontinenz. Postoperativ traten keine Nebenwirkungen oder Komplikationen auf.Die präklinischen und klinischen Resultate zeigen, dass mit dieser neuen Therapie Harninkontinenz tatsächlich erfolgreich behandelt werden kann. Die bisher vorliegenden Ergebnisse lassen den Schluss zu, dass es sich bei dem erstmals klinisch evaluierten therapeutischen Konzept um ein sehr vielversprechendes neues Verfahren handelt.AbstractExperimental and clinical studies investigated whether urinary incontinence can be effectively treated with transurethral ultrasound-guided injections of autologous myoblasts and fibroblasts.This new therapy was performed in eight female pigs. It could be shown that the injected cells survived well and that new muscle tissue was formed. Next, 42 patients (29 women, 13 men) suffering from urinary stress incontinence were treated. The fibroblasts were mixed with a small amount of collagen as carrier material and injected into the urethral submucosa to treat atrophies of the mucosa. The myoblasts were directly injected into the rhabdosphincter to reconstruct the muscle and to heal morphological and functional defects. In 35 patients urinary incontinence could be completely cured. In seven patients who had undergone multiple surgical procedures and radiotherapy urinary incontinence improved. No side effects or complications were encountered postoperatively.The experimental as well as the clinical data clearly demonstrate that urinary incontinence can be treated effectively with autologous stem cells. The present data support the conclusion that this new therapeutic concept may represent a very promising treatment modality in the future.

Dynamic transurethral sonography and 3-dimensional reconstruction of the rhabdosphincter and urethra: initial experience in continent and incontinent women.

Objective. The purpose of this study was to evaluate the female urethra and the striated urinary sphincter, the rhabdosphincter (RS), by means of dynamic transurethral sonography and sonographic 3‐dimensional (3D) reconstructions. Methods. In 15 female patients with urinary stress incontinence (mean age, 67.5 years) and 5 continent women (mean age, 48.3 years), morphologic characteristics and function of the RS and urethra were examined with a 10‐MHz transurethral ultrasound transducer. With the help of a mechanical pullback system, the transducer was slowly retracted to scan the whole urethra and the RS from the bladder neck to the urethral orifice. Subsequently, 3D reconstructions of the urethra using an integrated computer system were performed. The RS as well as the length of the urethra were investigated under contracted and noncontracted conditions to measure contractility of the RS and dynamic changes of the lower urinary tract. Results. Partial or complete loss of RS function was detected in patients with stress incontinence. The findings on sonography were found to correlate well with the grade of incontinence. Furthermore, under contraction of the RS, a median increase in urethral length was observed. In incontinent patients, the increase in the urethral length was statistically significantly less (P = .04), which was related to the reduced contractility of the RS. Conclusions. Dynamic transurethral sonography with subsequent 3D reconstructions allows for assessment of function and morphologic characteristics of the RS and urethra. Normal contraction of the RS results in an elongation of the urethra.

Pathological features of Gleason score 6 prostate cancers in the low and intermediate range of prostate-specific antigen level : is there a difference?

To assess the pathological features of Gleason score 6 prostate cancers after radical prostatectomy in the low (<4u2003ng/mL) and intermediate range of prostate‐specific antigen level (4–10u2003ng/mL), as such prostate cancers are considered to be well differentiated tumours with a low risk for recurrence after therapy.

Transrektale dreidimensionale Sonographie

ZusammenfassungIn der transrektalen dreidimensionalen Sonographie ist es erstmals möglich, das zu untersuchende Areal gleichzeitig in 3xa0Schnittebenen zu analysieren. Dadurch kann eine sehr genaue Beurteilung der anatomischen Strukturen des kleinen Beckens und der Beckenbodenregion durchgeführt werden. Mit Hilfe dieser neuen Untersuchungstechnik können die Glandulae bulbourethrales routinemäßig untersucht sowie Zysten dieser Drüsen diagnostiziert werden. Die Zonen der Prostata und ihre Relationen zueinander, insbesondere das Wachstum der Transitionalzone im Rahmen der benignen Prostathyperplasie, können exakt bestimmt werden. Die transrektale 3D-Sonographie ermöglicht auch, die Morphologie und die Funktion des Rhabdosphinkters zu untersuchen und zu quantifizieren. Die 3D-sonographisch gezielte Punktion und Drainage von Prostataabszessen stellt ein attraktives und minimal-invasives Behandlungsverfahren dar. Diese Methode kann generell zur Punktion und zur Applikation von Nadeln oder Implantaten im unteren Harntrakt eingesetzt werden. Die transrektale dreidimensionale Sonographie bietet somit neue diagnostische und therapeutische Möglichkeiten bei der Beurteilung von Veränderungen des unteren Harntraktes.AbstractIn 3-D transrectal ultrasound it is possible, for the first time, to investigate the region of interest in three planes simultaneously. Exact examination of the organs of the small pelvis as well as of pathologic changes in the region of the pelvic floor can be performed with this new imaging technique. The bulbourethral glands can be investigated routinely, which enables the diagnosis of cysts of these glands. The prostatic zones, their relations as well as the growth of the transitional zone during the development of benign prostatic hyperplasia can be visualized. Furthermore, 3-D transrectal ultrasound allows investigation of morphology and function of the rhabdosphincter. The contractility of the muscle can be quantified. 3-D ultrasound guided puncture and drainage of prostatic abscesses represents a minimally invasive therapeutic modality. This technique can be used to place needles as well as implants in the lower urinary tract. Generally, 3-D transrectal ultrasound offers new diagnostic and therapeutic possibilities.