Clinical Research Group 273 Urinary Incontinence

Urinary incontinence, defined as frequent involuntary leakage of urine, leads to social problems even in small amounts, but also to health problems when larger amounts are involved. The costs incurred in Germany for incontinence aids alone exceed half a billion euros annually. For the most common cause of urinary incontinence, stress incontinence (SUI), usually caused by a weakness or malfunction of the urethral sphincter, no sustainable curative treatment exists to date. The Clinical Research Group (KFO) is investigating various aspects of a potential curative, cell-based therapy to strengthen the weakened urethral sphincter

Urinary incontinence corresponds to the objectifiable involuntary loss of urine, which is a major and complex problem that primarily affects the affected patients themselves in their quality of life, hygiene, health (acute and chronic urinary tract infections up to permanent organ damage) and their social connection, but can also place a great burden on their environment. In Germany alone, around six to eight million women and men suffer from incontinence.[nbsp] The most common form of urinary incontinence is stress urinary incontinence (SUI), the main cause of which is usually a weakening or malfunction of the sphincter muscles. A sustainable curative treatment of sphincter-related stress incontinence does not exist for the majority of patients to date. 
The increase in SUI in older age correlates directly with the spontaneous apoptosis rate of muscle cells in the bladder sphincter. Muscle injury may also contribute to an increased risk of incontinence with age. Other risk factors include body weight, pelvic floor surgery, and pregnancy or vaginal birth and the perimenopausal stage of life. Anatomical and functional studies confirmed that both the striated external urethral sphincter and the trilobar smooth muscle of the urethra are the continence mechanism. Functional limitations of the rhabdosphincter or loss of tone of the urethral smooth muscle are mainly responsible for the development of SUI. Under favorable circumstances, the loss of functional muscle cells in the sphincter uretrae externus muscle can initially be temporarily compensated by improving the function of the remaining cells. Cell-based therapy to strengthen the sphincter muscle, which has been weakened for various reasons, as well as possible improvement of innervation, therefore represent promising therapeutic concepts that attack the real cause of the problem.The focus is on three key clinical questions: 1.) Can cells or implants be applied to the urethral sphincter in a targeted and intraoperatively comprehensible manner? 2) Do the applied cells integrate physiologically into the muscle and are they connected to the nervous control mechanism? 3) Do the applied cells remain vital in the injection area and what regenerative role do they play over time?