Oleg Loutochin

Bone marrow mesenchymal stromal cell therapy for external urethral sphincter restoration in a rat model of stress urinary incontinence

To assess the effect of intra‐sphincteric injections of bone marrow mesenchymal stromal cells (MSCs) on Valsalva leak point pressure (VLPP) changes in an animal model of stress urinary incontinence (SUI).

Bladder tissue engineering: A literature review

PURPOSE OF REVIEW In bladder cancer and neuro-bladder, reconstruction of the bladder requires bowel segment grafting for augmentation cystoplasty or neo-bladder creation. However, even if currently considered as the gold standard, it is associated with potentially severe short- and long-term adverse effects. Thus, bladder tissue engineering is a promising approach to bladder reconstruction. RECENT FINDINGS In the last few years, progress has been made with the development of new biomaterials for bladder tissue replacement and in deciphering the role of stem cells as well as their contribution to bladder scaffold integration and tissue regeneration. SUMMARY This review of recently published articles allows us to forecast the characteristics of efficient and safe bladder biomaterials. However, several factors, such as native bladder traits, the specific involvement of urine, and bladder tissue replacement indications, have to be assessed with caution before including bladder tissue engineering in clinical trials. Many authors agree that these challenging techniques could deliver significant benefits with clinical application, reducing morbidity and global long-term costs.

Novel, Remotely Controlled, Artificial Urinary Sphincter: A Retro-Compatible Device

Implantation of artificial urinary sphincters (AUSs) is considered to be the gold standard treatment in severe cases of stress urinary incontinence. The functioning of these implants is purely hydromechanical, as they apply constant pressure around the bulbous urethra. Common reasons for device revision are insufficient cuff pressure and, in contrast, urethral atrophy secondary to this constant pressure. Furthermore, functioning requires some dexterity, limiting their implantation in some patients. We present in this study a novel electronic AUS that offers the possibility of remotely controlling the sphincter rapidly and without mechanical effort. The implants embedded software can also be updated remotely. Its design eliminates the manual pump, making implantation easier in men and women. Furthermore, it is compatible with already-implanted AUS and can be employed for treating other sphincter deficiencies. The device has been tested on a custom test bed and on pig bladders in vitro. Different occlusive cuff pressure ranges were employed and acceptable performance was obtained. Design challenges and results are reported and discussed here.

Tissue engineering of rat bladder using marrow-derived mesenchymal stem cells and bladder acellular matrix.

Bladder replacement or augmentation is required in congenital malformations or following trauma or cancer. The current surgical solution involves enterocystoplasty but is associated with high complication rates. Strategies for bladder tissue engineering are thus actively sought to address this unmet clinical need. Because of the poor efficacy of synthetic polymers, the use of bladder acellular matrix (BAM) has been proposed. Indeed when cellular components are removed from xenogenic or allogeneic bladders, the extracellular matrix scaffold thus obtained can be used alone or in combination with stem cells. In this study, we propose the use of BAM seeded with marrow-derived mesenchymal stem cells (MSCs) for bladder tissue engineering. We optimized a protocol for decellularization of bladder tissue from different species including rat, rabbit and swine. We demonstrate the use of non-ionic detergents followed by nuclease digestion results in efficient decellularization while preserving the extracellular matrix. When MSCs were seeded on acellular matrix scaffold, they remained viable and proliferative while adopting a cellular phenotype consistent with their microenvironment. Upon transplantation in rats after partial cystectomy, MSC-seeded BAM proved superior to unseeded BAM with animals recovering nearly 100% normal bladder capacity for up to six months. Histological analyses also demonstrated increased muscle regeneration.

Novel, Wirelessly Controlled, and Adaptive Artificial Urinary Sphincter

Severe stress urinary incontinence is a nonnegligible complication that affects men as well as women. When initial therapies are not sufficient, implantation of artificial urinary sphincters (AUS) is considered the gold standard treatment. This hydromechanical device applies constant pressure on the urethra to keep urine inside the bladder. Although recovery from incontinence is full or partial, this approach has certain disadvantages. In addition to the difficulties and discomfort encountered when operating the device, insufficient pressure, urethral atrophy, and erosion from constant pressure on the urethra may necessitate revision surgery. In this study, we present a novel, remote-controlled AUS with variable urethral pressure that improves continence and avoids revision surgery. The proposed design eliminates the manual pump, facilitating implantation in men and women. It is compatible with current AUS. The device requires very little power and its parameters can be monitored and updated post-operatively. It has been tested on pig bladders ex vivo. Different pressure control algorithms have been developed, and expected performances have been achieved. Design challenges and experimentation results are reported.

A Bluetooth-based Low-Energy Qi-compliant battery charger for implantable medical devices

In this paper, we present a smart battery charging system implementing the recently established Qi wireless power transmission standard. Proposed device offers the possibility of charging batteries with any Qi certified power transmitter. It eliminates the dependency to a special charger making energy supplying possible in public places and foreign countries without special equipment or adapters. It is remotely controlled through Bluetooth Low Energy protocol allowing real-time control and supervision with smartphones. The proposed device can be used with single or multiple implants architecture. Experiments have been conducted with various implants prototypes. Proposed charging system ensured proper operation and supervision. System design and experimental results are reported and discussed.

Effect of the anticonvulsant medications Pregabalin and Lamotrigine on urodynamic parameters in an animal model of neurogenic detrusor overactivity

To assess the effects of different doses and treatment durations of Pregabalin and Lamotrigine on the urodynamic parameters of an animal model of neurogenic detrusor overactivity (NDO).

Novel Electromechanic Artificial Urinary Sphincter

Implantation of an artificial urinary sphincter (AUS) is the treatment of choice for managing severe stress urinary incontinence. This hydromechanical implant mimics a healthy sphincter by exerting a constant circumferential pressure around the urethra to close it and keep urine in the bladder. Common complications experienced with this device are urethral atrophy, erosion, and mechanical breakdown. Furthermore, AUS operation requires some dexterity resulting in difficulty and discomfort of use, and limiting the implantation in some patients. We present in this study a novel remote-controlled electromechanic AUS allowing rapid and effortless sphincter operation. Its design eliminates the classic manual pump, enhancing reliability, easing implantation in men and women, and achieving compatibility with already-implanted AUS. The device has been tested in vitro and ex vivo on fresh pig bladders. Different occlusive cuff pressure (OCP) ranges were employed and expected performance was obtained. Experimentation results and design challenges are reported and discussed here in.

Montreal electronic artificial urinary sphincters: Our futuristic alternatives to the AMS800™

INTRODUCTION We aimed to present three novel remotely controlled hydromechanical artificial urinary sphincters (AUSs) and report their in-vitro and ex-vivo results. METHODS We successively developed three distinct hydromechanical AUSs on the basis of the existing AMS800™ device by incorporating an electronic pump. No changes were made to the cuff and balloon. The AUS#1 was designed as an electromagnetically controlled device. The AUS#2 and AUS#3 were conceived as Bluetooth 2.1 remotely controlled and Bluetooth 4.0 remotely-controlled, adaptive devices, respectively. In-vitro experiments profiled occlusive cuff pressure (OCP) during a complete device cycle, with different predetermined OCP. Ex-vivo experiments were performed on a fresh pig bladder with 4 cm cuff placed around the urethra. Leak point pressure with different predetermined OCP values was successively measured during cystometry via a catheter at the bladder dome. RESULTS Our in-vitro and ex-vivo experiments demonstrated that these three novel AUSs provided stable and predetermined OCP - within the physiological range - and completely deflated the cuff, when required, in a limited time compatible with physiological voiding cycles. CONCLUSIONS Our three novel, remotely controlled AUSs showed promising results that should be confirmed by in-vivo experiments focusing on efficacy and safety.

EFFECT OF ANTICONVULSANT MEDICATIONS, PREGABALIN AND LAMOTRIGINE, ON URODYNAMIC PARAMETERS OF AN ANIMAL MODEL OF NEUROGENIC DETRUSOR OVERACTIVITY

Aims: To assess the effects of different doses and treatment durations of Pregabalin and Lamotrigine on the urodynamic parameters of an animal model of neurogenic detrusor overactivity (NDO). Materials and Methods: Ninety rats were used; six as normal controls and the remaining 84 were divided as follows: Six ‘‘paraplegic controls,’’ 6 ‘‘paraplegic-vehicle controls,’’ and the remaining 72 divided into two equal groups. Group 1 was divided into six subgroups; Pregabalin was given in doses of 10 mg/kg, 20 mg/kg, or 30 mg/kg for 1 or 2 weeks. Group 2 was similarly subdivided; Lamotrigine was given in doses of 1.5 mg/kg, 3 mg/kg, or 6 mg/kg for 1 or 2 weeks. Results: All paraplegic controls developed NDO within 3 weeks from spinalization. Their baseline bladder pressure (BBP) 19 4.4 cmH2O, detrusor pressure at maximum capacity (DPMaxC) 47.6 4.3 cmH2O, bladder capacity (BC) 0.45 0.1 ml, and frequency of detrusor overactivity (FDO) 3.7 0.9/min. Both Pregabalin and Lamotrigine produced significant improvement. Urodynamic values in those treated with 20 mg Pregabalin for 1 or 2 weeks were: BBP 11.7 1.3 and 9 0.2 cmH2O, BC 0.6 0.1 and 0.7 0.01 ml, DPMaxC 17.3 4.0 and 23 2.6 cmH2O, FDO 2.1 0.2/min and 1.7 0.1/min. Urodynamic values in those treated with 3 mg/kg Lamotrigine for 1 or 2 weeks were: BBP 9.7 2.2 and 8.6 1.9 cmH2O, DPMaxC 17.2 1.8 and 29 1.2 cmH2O, BC 0.7 0.1 and 0.8 0.1 ml, FDO 1.9 0.2/min and 1.9 0.2/min (P < 0.001). Conclusions: Pregabalin and Lamotrigine may represent novel alternative treatments of NDO. Clinical trials remain to be performed. Neurourol. Urodynam. 31:1197–1202, 2012. 2012 Wiley Periodicals, Inc.