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Hannes Strasser - One of the best experts on this subject based on the ideXlab platform.

  • Anatomical approach for surgery of the male posterior urethra
    BJU international, 2008
    Co-Authors: Orietta Dalpiaz, Michael Mitterberger, Germarmichael Pinggera, Georg Bartsch, Andrea Kerschbaumer, Hannes Strasser
    Abstract:

    OBJECTIVE To investigate, in a morphological study, the anatomy of the male Rhabdosphincter and the relation between the membranous urethra, the Rhabdosphincter and the neurovascular bundles (NVBs) to provide the anatomical basis for surgical approach of the posterior urethra as successful outcomes in urethral reconstructive surgery still remain a challenging issue. MATERIALS AND METHODS In all, 11 complete pelves and four tissue blocks of prostate, rectum, membranous urethra and the Rhabdosphincter were studied. Besides anatomical preparations, the posterior urethra and their relationship were studied by means of serial histological sections. RESULTS In the histological cross-sections, the Rhabdosphincter forms an omega-shaped loop around the anterior and lateral aspects of the membranous urethra. Ventrally and laterally, it is separated from the membranous urethra by a delicate sheath of connective tissue. Through a midline approach displacing the nerves and vessels laterally, injuries to the NVBs can be avoided. With meticulous dissection of the delicate ventral connective tissue sheath between the ventral wall of the membranous urethra and the Rhabdosphincter, the two structures can be separated without damage to either of them. This anatomical approach can be used for dissection of the anterior urethral wall in urethral surgery. CONCLUSIONS Based on precise anatomical knowledge, the ventral wall of the posterior urethra can be dissected and exposed without injuring the Rhabdosphincter and the NVBs. This approach provides the basis for sparing of the Rhabdosphincter and for successful outcomes in urethral surgery for the treatment of bulbo-membranous urethral strictures.

  • adult stem cell therapy of female stress urinary incontinence
    European Urology, 2008
    Co-Authors: Michael Mitterberger, Germarmichael Pinggera, Rainer Marksteiner, Eva Margreiter, Martin Fussenegger, Ferdinand Frauscher, Hanno Ulmer, Steffen Hering, Georg Bartsch, Hannes Strasser
    Abstract:

    Abstract Objectives To investigate the efficacy of transurethral ultrasound (TUUS)-guided injections of autologous myoblasts and fibroblasts in women with incontinence. Methods Between January and June 2005, 20 female patients suffering from stress urinary incontinence (SUI) were included. Skeletal muscle biopsies were taken from the left arm to obtain cultures from autologous fibroblasts and myoblasts. By TUUS guidance the fibroblasts were injected into the urethral submucosa and the myoblasts were injected into the Rhabdosphincter. A defined incontinence score, quality-of-life score and urodynamic, electromyographic, and laboratory parameters, as well as morphology and function of urethra and Rhabdosphincter were evaluated before and up to 2 yr after therapy. Results Eigtheen of 20 patients were cured 1 yr after injection of autologous stem cells and in 2 patients SUI was improved. Two years after therapy 16 of the 18 patients presented as cured, 2 others were improved, and 2 were lost to follow-up. Incontinence and quality-of-life scores were significantly improved postoperatively. The thickness of urethra and Rhabdosphincter as well as activity and contractility of the Rhabdosphincter were also statistically significantly increased after therapy. Conclusions Clinical results demonstrate that SUI can be treated effectively with autologous stem cells. The present data support the conclusion that this therapeutic concept represents an elegant and minimally invasive treatment modality to treat SUI.

  • Autologous myoblasts and fibroblasts for female stress incontinence: a 1‐year follow‐up in 123 patients
    BJU international, 2007
    Co-Authors: Michael Mitterberger, Germarmichael Pinggera, Rainer Marksteiner, Eva Margreiter, Martin Fussenegger, Ferdinand Frauscher, Hanno Ulmer, Georg Bartsch, Daniela Colleselli, Hannes Strasser
    Abstract:

    OBJECTIVE To assess the efficacy and safety of the application of autologous myoblasts and fibroblasts for treating female stress urinary incontinence (SUI) after a follow-up of ≥1 year. PATIENTS AND METHODS In all, 123 women with SUI (aged 36–84 years) were treated with transurethral ultrasonography-guided injections with autologous myoblasts and fibroblasts obtained from skeletal muscle biopsies. The fibroblasts were suspended in a small amount of collagen as carrier material and injected into the urethral submucosa, while the myoblasts were implanted into the Rhabdosphincter. All patients were evaluated before and 12 months after the injection using the Incontinence and Quality of Life Instrument (I-QOL) scores, urodynamic variables, and morphology and function of the urethra and Rhabdosphincter. RESULTS At 1 year after implanting the cells, 94 of the 119 women (79%) were completely continent, 16 (13%) had a substantial improvement and nine (8%) a slight improvement. Four patients were lost to follow-up.The incontinence and I-QOL scores, and the thickness, contractility and electromyographic activity of the Rhabdosphincter were significantly improved after treatment. CONCLUSIONS These results show the efficacy and safety of transferring autologous myoblasts and fibroblasts in the treatment of female SUI, after a follow-up of 1 year.

  • erratum to transurethral ultrasonography guided injection of adult autologous stem cells versus transurethral endoscopic injection of collagen in treatment of urinary incontinence
    World Journal of Urology, 2007
    Co-Authors: Hannes Strasser, Michael Mitterberger, Germarmichael Pinggera, Rainer Marksteiner, Eva Margreiter, Martin Fussenegger, Ferdinand Frauscher, Kurt Kofler, G. Bartsch
    Abstract:

    In the last years preclinical studies have paved the way for the use of adult muscle derived stem cells for reconstruction of the lower urinary tract. Between September 2002 and October 2004, 42 women and 21 men suffering from urinary stress incontinence (age 36-84 years) were recruited and subsequently treated with transurethral ultrasonography-guided injections of autologous myoblasts and fibroblasts obtained from skeletal muscle biopsies. The fibroblasts were injected into the urethral submucosa, while the myoblasts were implanted into the Rhabdosphincter. In parallel, 7 men and 21 women (age 39-83 years) also diagnosed with urinary stress incontinence were treated with standard transurethral endoscopic injections of collagen. Patients were randomly assigned to both groups. After a follow-up of 12 months incontinence was cured in 39 women and 11 men after injection of autologous myoblasts and fibroblasts. Mean quality of life score (51.38 preoperatively, 104.06 postoperatively), thickness of urethra and Rhabdosphincter (2.103 mm preoperatively, 3.303 mm postoperatively) as well as contractility of the Rhabdosphincter (0.56 mm preoperatively, 1.462 mm postoperatively) were improved postoperatively. Only in two patients treated with injections of collagen incontinence was cured. The present clinical results demonstrate that, in contrast to injections of collagen, urinary incontinence can be treated effectively with ultrasonography-guided injections of autologous myo- and fibroblasts.

  • retracted autologous myoblasts and fibroblasts versus collagen for treatment of stress urinary incontinence in women a randomised controlled trial
    The Lancet, 2007
    Co-Authors: Hannes Strasser, Michael Mitterberger, Germarmichael Pinggera, Rainer Marksteiner, Eva Margreiter, Martin Fussenegger, Ferdinand Frauscher, Hanno Ulmer, Kurt Kofler, Georg Bartsch
    Abstract:

    Summary Background Preclinical 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. Methods Between 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. Findings At 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 Interpretation Long-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.

Michael Mitterberger - One of the best experts on this subject based on the ideXlab platform.

  • Anatomical approach for surgery of the male posterior urethra
    BJU international, 2008
    Co-Authors: Orietta Dalpiaz, Michael Mitterberger, Germarmichael Pinggera, Georg Bartsch, Andrea Kerschbaumer, Hannes Strasser
    Abstract:

    OBJECTIVE To investigate, in a morphological study, the anatomy of the male Rhabdosphincter and the relation between the membranous urethra, the Rhabdosphincter and the neurovascular bundles (NVBs) to provide the anatomical basis for surgical approach of the posterior urethra as successful outcomes in urethral reconstructive surgery still remain a challenging issue. MATERIALS AND METHODS In all, 11 complete pelves and four tissue blocks of prostate, rectum, membranous urethra and the Rhabdosphincter were studied. Besides anatomical preparations, the posterior urethra and their relationship were studied by means of serial histological sections. RESULTS In the histological cross-sections, the Rhabdosphincter forms an omega-shaped loop around the anterior and lateral aspects of the membranous urethra. Ventrally and laterally, it is separated from the membranous urethra by a delicate sheath of connective tissue. Through a midline approach displacing the nerves and vessels laterally, injuries to the NVBs can be avoided. With meticulous dissection of the delicate ventral connective tissue sheath between the ventral wall of the membranous urethra and the Rhabdosphincter, the two structures can be separated without damage to either of them. This anatomical approach can be used for dissection of the anterior urethral wall in urethral surgery. CONCLUSIONS Based on precise anatomical knowledge, the ventral wall of the posterior urethra can be dissected and exposed without injuring the Rhabdosphincter and the NVBs. This approach provides the basis for sparing of the Rhabdosphincter and for successful outcomes in urethral surgery for the treatment of bulbo-membranous urethral strictures.

  • adult stem cell therapy of female stress urinary incontinence
    European Urology, 2008
    Co-Authors: Michael Mitterberger, Germarmichael Pinggera, Rainer Marksteiner, Eva Margreiter, Martin Fussenegger, Ferdinand Frauscher, Hanno Ulmer, Steffen Hering, Georg Bartsch, Hannes Strasser
    Abstract:

    Abstract Objectives To investigate the efficacy of transurethral ultrasound (TUUS)-guided injections of autologous myoblasts and fibroblasts in women with incontinence. Methods Between January and June 2005, 20 female patients suffering from stress urinary incontinence (SUI) were included. Skeletal muscle biopsies were taken from the left arm to obtain cultures from autologous fibroblasts and myoblasts. By TUUS guidance the fibroblasts were injected into the urethral submucosa and the myoblasts were injected into the Rhabdosphincter. A defined incontinence score, quality-of-life score and urodynamic, electromyographic, and laboratory parameters, as well as morphology and function of urethra and Rhabdosphincter were evaluated before and up to 2 yr after therapy. Results Eigtheen of 20 patients were cured 1 yr after injection of autologous stem cells and in 2 patients SUI was improved. Two years after therapy 16 of the 18 patients presented as cured, 2 others were improved, and 2 were lost to follow-up. Incontinence and quality-of-life scores were significantly improved postoperatively. The thickness of urethra and Rhabdosphincter as well as activity and contractility of the Rhabdosphincter were also statistically significantly increased after therapy. Conclusions Clinical results demonstrate that SUI can be treated effectively with autologous stem cells. The present data support the conclusion that this therapeutic concept represents an elegant and minimally invasive treatment modality to treat SUI.

  • Autologous myoblasts and fibroblasts for female stress incontinence: a 1‐year follow‐up in 123 patients
    BJU international, 2007
    Co-Authors: Michael Mitterberger, Germarmichael Pinggera, Rainer Marksteiner, Eva Margreiter, Martin Fussenegger, Ferdinand Frauscher, Hanno Ulmer, Georg Bartsch, Daniela Colleselli, Hannes Strasser
    Abstract:

    OBJECTIVE To assess the efficacy and safety of the application of autologous myoblasts and fibroblasts for treating female stress urinary incontinence (SUI) after a follow-up of ≥1 year. PATIENTS AND METHODS In all, 123 women with SUI (aged 36–84 years) were treated with transurethral ultrasonography-guided injections with autologous myoblasts and fibroblasts obtained from skeletal muscle biopsies. The fibroblasts were suspended in a small amount of collagen as carrier material and injected into the urethral submucosa, while the myoblasts were implanted into the Rhabdosphincter. All patients were evaluated before and 12 months after the injection using the Incontinence and Quality of Life Instrument (I-QOL) scores, urodynamic variables, and morphology and function of the urethra and Rhabdosphincter. RESULTS At 1 year after implanting the cells, 94 of the 119 women (79%) were completely continent, 16 (13%) had a substantial improvement and nine (8%) a slight improvement. Four patients were lost to follow-up.The incontinence and I-QOL scores, and the thickness, contractility and electromyographic activity of the Rhabdosphincter were significantly improved after treatment. CONCLUSIONS These results show the efficacy and safety of transferring autologous myoblasts and fibroblasts in the treatment of female SUI, after a follow-up of 1 year.

  • erratum to transurethral ultrasonography guided injection of adult autologous stem cells versus transurethral endoscopic injection of collagen in treatment of urinary incontinence
    World Journal of Urology, 2007
    Co-Authors: Hannes Strasser, Michael Mitterberger, Germarmichael Pinggera, Rainer Marksteiner, Eva Margreiter, Martin Fussenegger, Ferdinand Frauscher, Kurt Kofler, G. Bartsch
    Abstract:

    In the last years preclinical studies have paved the way for the use of adult muscle derived stem cells for reconstruction of the lower urinary tract. Between September 2002 and October 2004, 42 women and 21 men suffering from urinary stress incontinence (age 36-84 years) were recruited and subsequently treated with transurethral ultrasonography-guided injections of autologous myoblasts and fibroblasts obtained from skeletal muscle biopsies. The fibroblasts were injected into the urethral submucosa, while the myoblasts were implanted into the Rhabdosphincter. In parallel, 7 men and 21 women (age 39-83 years) also diagnosed with urinary stress incontinence were treated with standard transurethral endoscopic injections of collagen. Patients were randomly assigned to both groups. After a follow-up of 12 months incontinence was cured in 39 women and 11 men after injection of autologous myoblasts and fibroblasts. Mean quality of life score (51.38 preoperatively, 104.06 postoperatively), thickness of urethra and Rhabdosphincter (2.103 mm preoperatively, 3.303 mm postoperatively) as well as contractility of the Rhabdosphincter (0.56 mm preoperatively, 1.462 mm postoperatively) were improved postoperatively. Only in two patients treated with injections of collagen incontinence was cured. The present clinical results demonstrate that, in contrast to injections of collagen, urinary incontinence can be treated effectively with ultrasonography-guided injections of autologous myo- and fibroblasts.

  • RETRACTED ARTICLE: Transurethral ultrasonography-guided injection of adult autologous stem cells versus transurethral endoscopic injection of collagen in treatment of urinary incontinence
    World Journal of Urology, 2007
    Co-Authors: H. Strasser, Michael Mitterberger, Germarmichael Pinggera, Rainer Marksteiner, Eva Margreiter, Martin Fussenegger, Ferdinand Frauscher, Kurt Kofler, G. Bartsch
    Abstract:

    In the last years preclinical studies have paved the way for the use of adult muscle derived stem cells for reconstruction of the lower urinary tract. Between September 2002 and October 2004, 42 women and 21 men suffering from urinary stress incontinence (age 36–84 years) were recruited and subsequently treated with transurethral ultrasonography-guided injections of autologous myoblasts and fibroblasts obtained from skeletal muscle biopsies. The fibroblasts were injected into the urethral submucosa, while the myoblasts were implanted into the Rhabdosphincter. In parallel, 7 men and 21 women (age 39–83 years) also diagnosed with urinary stress incontinence were treated with standard transurethral endoscopic injections of collagen. Patients were randomly assigned to both groups. After a follow-up of 12 months incontinence was cured in 39 women and 11 men after injection of autologous myoblasts and fibroblasts. Mean quality of life score (51.38 preoperatively, 104.06 postoperatively), thickness of urethra and Rhabdosphincter (2.103 mm preoperatively, 3.303 mm postoperatively) as well as contractility of the Rhabdosphincter (0.56 mm preoperatively, 1.462 mm postoperatively) were improved postoperatively. Only in two patients treated with injections of collagen incontinence was cured. The present clinical results demonstrate that, in contrast to injections of collagen, urinary incontinence can be treated effectively with ultrasonography-guided injections of autologous myo- and fibroblasts.

Georg Bartsch - One of the best experts on this subject based on the ideXlab platform.

  • Anatomical approach for surgery of the male posterior urethra
    BJU international, 2008
    Co-Authors: Orietta Dalpiaz, Michael Mitterberger, Germarmichael Pinggera, Georg Bartsch, Andrea Kerschbaumer, Hannes Strasser
    Abstract:

    OBJECTIVE To investigate, in a morphological study, the anatomy of the male Rhabdosphincter and the relation between the membranous urethra, the Rhabdosphincter and the neurovascular bundles (NVBs) to provide the anatomical basis for surgical approach of the posterior urethra as successful outcomes in urethral reconstructive surgery still remain a challenging issue. MATERIALS AND METHODS In all, 11 complete pelves and four tissue blocks of prostate, rectum, membranous urethra and the Rhabdosphincter were studied. Besides anatomical preparations, the posterior urethra and their relationship were studied by means of serial histological sections. RESULTS In the histological cross-sections, the Rhabdosphincter forms an omega-shaped loop around the anterior and lateral aspects of the membranous urethra. Ventrally and laterally, it is separated from the membranous urethra by a delicate sheath of connective tissue. Through a midline approach displacing the nerves and vessels laterally, injuries to the NVBs can be avoided. With meticulous dissection of the delicate ventral connective tissue sheath between the ventral wall of the membranous urethra and the Rhabdosphincter, the two structures can be separated without damage to either of them. This anatomical approach can be used for dissection of the anterior urethral wall in urethral surgery. CONCLUSIONS Based on precise anatomical knowledge, the ventral wall of the posterior urethra can be dissected and exposed without injuring the Rhabdosphincter and the NVBs. This approach provides the basis for sparing of the Rhabdosphincter and for successful outcomes in urethral surgery for the treatment of bulbo-membranous urethral strictures.

  • adult stem cell therapy of female stress urinary incontinence
    European Urology, 2008
    Co-Authors: Michael Mitterberger, Germarmichael Pinggera, Rainer Marksteiner, Eva Margreiter, Martin Fussenegger, Ferdinand Frauscher, Hanno Ulmer, Steffen Hering, Georg Bartsch, Hannes Strasser
    Abstract:

    Abstract Objectives To investigate the efficacy of transurethral ultrasound (TUUS)-guided injections of autologous myoblasts and fibroblasts in women with incontinence. Methods Between January and June 2005, 20 female patients suffering from stress urinary incontinence (SUI) were included. Skeletal muscle biopsies were taken from the left arm to obtain cultures from autologous fibroblasts and myoblasts. By TUUS guidance the fibroblasts were injected into the urethral submucosa and the myoblasts were injected into the Rhabdosphincter. A defined incontinence score, quality-of-life score and urodynamic, electromyographic, and laboratory parameters, as well as morphology and function of urethra and Rhabdosphincter were evaluated before and up to 2 yr after therapy. Results Eigtheen of 20 patients were cured 1 yr after injection of autologous stem cells and in 2 patients SUI was improved. Two years after therapy 16 of the 18 patients presented as cured, 2 others were improved, and 2 were lost to follow-up. Incontinence and quality-of-life scores were significantly improved postoperatively. The thickness of urethra and Rhabdosphincter as well as activity and contractility of the Rhabdosphincter were also statistically significantly increased after therapy. Conclusions Clinical results demonstrate that SUI can be treated effectively with autologous stem cells. The present data support the conclusion that this therapeutic concept represents an elegant and minimally invasive treatment modality to treat SUI.

  • Autologous myoblasts and fibroblasts for female stress incontinence: a 1‐year follow‐up in 123 patients
    BJU international, 2007
    Co-Authors: Michael Mitterberger, Germarmichael Pinggera, Rainer Marksteiner, Eva Margreiter, Martin Fussenegger, Ferdinand Frauscher, Hanno Ulmer, Georg Bartsch, Daniela Colleselli, Hannes Strasser
    Abstract:

    OBJECTIVE To assess the efficacy and safety of the application of autologous myoblasts and fibroblasts for treating female stress urinary incontinence (SUI) after a follow-up of ≥1 year. PATIENTS AND METHODS In all, 123 women with SUI (aged 36–84 years) were treated with transurethral ultrasonography-guided injections with autologous myoblasts and fibroblasts obtained from skeletal muscle biopsies. The fibroblasts were suspended in a small amount of collagen as carrier material and injected into the urethral submucosa, while the myoblasts were implanted into the Rhabdosphincter. All patients were evaluated before and 12 months after the injection using the Incontinence and Quality of Life Instrument (I-QOL) scores, urodynamic variables, and morphology and function of the urethra and Rhabdosphincter. RESULTS At 1 year after implanting the cells, 94 of the 119 women (79%) were completely continent, 16 (13%) had a substantial improvement and nine (8%) a slight improvement. Four patients were lost to follow-up.The incontinence and I-QOL scores, and the thickness, contractility and electromyographic activity of the Rhabdosphincter were significantly improved after treatment. CONCLUSIONS These results show the efficacy and safety of transferring autologous myoblasts and fibroblasts in the treatment of female SUI, after a follow-up of 1 year.

  • retracted autologous myoblasts and fibroblasts versus collagen for treatment of stress urinary incontinence in women a randomised controlled trial
    The Lancet, 2007
    Co-Authors: Hannes Strasser, Michael Mitterberger, Germarmichael Pinggera, Rainer Marksteiner, Eva Margreiter, Martin Fussenegger, Ferdinand Frauscher, Hanno Ulmer, Kurt Kofler, Georg Bartsch
    Abstract:

    Summary Background Preclinical 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. Methods Between 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. Findings At 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 Interpretation Long-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.

  • Functional and Histological Changes after Myoblast Injections in the Porcine Rhabdosphincter
    European urology, 2007
    Co-Authors: Michael Mitterberger, Germarmichael Pinggera, Rainer Marksteiner, Eva Margreiter, Georg Bartsch, Raffael Plattner, Günter Klima, Hannes Strasser
    Abstract:

    Abstract Objective Transurethral ultrasound-guided injection of autologous myoblasts has recently been shown to cure urinary stress incontinence. In the present study, the dose-dependent changes in maximal urethral closure pressures after application of myoblasts were investigated in a porcine animal model. Methods Myoblast cultures were grown from a porcine muscle biopsy. The biopsy was enzymatically dissociated by using a modified cell dispersion technique. Single myoblasts in suspension were manually collected with a micropipette under microscopic control. Next a clonal myoblast culture was prepared. Before the cells were applied, fluorescence labelling (PKH) was used to assess integration of the injected myoblasts into the Rhabdosphincter. With the help of a transurethral ultrasound probe (23 F, 11MHz) and a special injection system, the myoblasts were injected into the Rhabdosphincter of five pigs under direct sonographic control. Into two different areas of the Rhabdosphincter, increasing different cell counts were injected (total volume 1.5ml). At each area, 10 depots of 150μl volume were injected all along the Rhabdosphincter. The following cell counts were used: 1.5 × 10 6 , 2.1 × 10 6 , 4.2 × 10 6 (low range) 5.69 × 10 6 , 8.1 × 10 6 , 1.13 × 10 7 , 1.6 × 10 7 (mid range) 2.26 × 10 7 , 4.4 × 10 7 , and 7.8 × 10 7 (high range). To avoid possible cell rejection, we immunosuppressed the pigs with daily cortisone (1g Solu Dacortin) because allogenic myoblasts were used. Urethral pressure profiles (UPPs) were measured before and 3 wk postoperatively before the pigs were put to sleep. The lower urinary tract was removed in all pigs for histological analysis. Results Histological examination of the specimens revealed that the injected cells had survived at the injection site and had formed new myofibres. Overall the UPP curves revealed dose-dependent changes. Statistically significant increased pressure values of up to more than 300% could be observed in all cases in which higher concentrations of cells had been applied. Increases were also noted in mid range concentrations although not to such a high extent (approximately 150%). Pressure values had even diminished (approximately 50%) after injecting the three lowest concentrations (1.5 × 10 6 , 2.1 × 10 6 , 4.2 × 10 6 ). Conclusions The present results show that the effects after application of myoblasts into the Rhabdosphincter are dose-dependent.

Germarmichael Pinggera - One of the best experts on this subject based on the ideXlab platform.

  • Anatomical approach for surgery of the male posterior urethra
    BJU international, 2008
    Co-Authors: Orietta Dalpiaz, Michael Mitterberger, Germarmichael Pinggera, Georg Bartsch, Andrea Kerschbaumer, Hannes Strasser
    Abstract:

    OBJECTIVE To investigate, in a morphological study, the anatomy of the male Rhabdosphincter and the relation between the membranous urethra, the Rhabdosphincter and the neurovascular bundles (NVBs) to provide the anatomical basis for surgical approach of the posterior urethra as successful outcomes in urethral reconstructive surgery still remain a challenging issue. MATERIALS AND METHODS In all, 11 complete pelves and four tissue blocks of prostate, rectum, membranous urethra and the Rhabdosphincter were studied. Besides anatomical preparations, the posterior urethra and their relationship were studied by means of serial histological sections. RESULTS In the histological cross-sections, the Rhabdosphincter forms an omega-shaped loop around the anterior and lateral aspects of the membranous urethra. Ventrally and laterally, it is separated from the membranous urethra by a delicate sheath of connective tissue. Through a midline approach displacing the nerves and vessels laterally, injuries to the NVBs can be avoided. With meticulous dissection of the delicate ventral connective tissue sheath between the ventral wall of the membranous urethra and the Rhabdosphincter, the two structures can be separated without damage to either of them. This anatomical approach can be used for dissection of the anterior urethral wall in urethral surgery. CONCLUSIONS Based on precise anatomical knowledge, the ventral wall of the posterior urethra can be dissected and exposed without injuring the Rhabdosphincter and the NVBs. This approach provides the basis for sparing of the Rhabdosphincter and for successful outcomes in urethral surgery for the treatment of bulbo-membranous urethral strictures.

  • adult stem cell therapy of female stress urinary incontinence
    European Urology, 2008
    Co-Authors: Michael Mitterberger, Germarmichael Pinggera, Rainer Marksteiner, Eva Margreiter, Martin Fussenegger, Ferdinand Frauscher, Hanno Ulmer, Steffen Hering, Georg Bartsch, Hannes Strasser
    Abstract:

    Abstract Objectives To investigate the efficacy of transurethral ultrasound (TUUS)-guided injections of autologous myoblasts and fibroblasts in women with incontinence. Methods Between January and June 2005, 20 female patients suffering from stress urinary incontinence (SUI) were included. Skeletal muscle biopsies were taken from the left arm to obtain cultures from autologous fibroblasts and myoblasts. By TUUS guidance the fibroblasts were injected into the urethral submucosa and the myoblasts were injected into the Rhabdosphincter. A defined incontinence score, quality-of-life score and urodynamic, electromyographic, and laboratory parameters, as well as morphology and function of urethra and Rhabdosphincter were evaluated before and up to 2 yr after therapy. Results Eigtheen of 20 patients were cured 1 yr after injection of autologous stem cells and in 2 patients SUI was improved. Two years after therapy 16 of the 18 patients presented as cured, 2 others were improved, and 2 were lost to follow-up. Incontinence and quality-of-life scores were significantly improved postoperatively. The thickness of urethra and Rhabdosphincter as well as activity and contractility of the Rhabdosphincter were also statistically significantly increased after therapy. Conclusions Clinical results demonstrate that SUI can be treated effectively with autologous stem cells. The present data support the conclusion that this therapeutic concept represents an elegant and minimally invasive treatment modality to treat SUI.

  • Autologous myoblasts and fibroblasts for female stress incontinence: a 1‐year follow‐up in 123 patients
    BJU international, 2007
    Co-Authors: Michael Mitterberger, Germarmichael Pinggera, Rainer Marksteiner, Eva Margreiter, Martin Fussenegger, Ferdinand Frauscher, Hanno Ulmer, Georg Bartsch, Daniela Colleselli, Hannes Strasser
    Abstract:

    OBJECTIVE To assess the efficacy and safety of the application of autologous myoblasts and fibroblasts for treating female stress urinary incontinence (SUI) after a follow-up of ≥1 year. PATIENTS AND METHODS In all, 123 women with SUI (aged 36–84 years) were treated with transurethral ultrasonography-guided injections with autologous myoblasts and fibroblasts obtained from skeletal muscle biopsies. The fibroblasts were suspended in a small amount of collagen as carrier material and injected into the urethral submucosa, while the myoblasts were implanted into the Rhabdosphincter. All patients were evaluated before and 12 months after the injection using the Incontinence and Quality of Life Instrument (I-QOL) scores, urodynamic variables, and morphology and function of the urethra and Rhabdosphincter. RESULTS At 1 year after implanting the cells, 94 of the 119 women (79%) were completely continent, 16 (13%) had a substantial improvement and nine (8%) a slight improvement. Four patients were lost to follow-up.The incontinence and I-QOL scores, and the thickness, contractility and electromyographic activity of the Rhabdosphincter were significantly improved after treatment. CONCLUSIONS These results show the efficacy and safety of transferring autologous myoblasts and fibroblasts in the treatment of female SUI, after a follow-up of 1 year.

  • erratum to transurethral ultrasonography guided injection of adult autologous stem cells versus transurethral endoscopic injection of collagen in treatment of urinary incontinence
    World Journal of Urology, 2007
    Co-Authors: Hannes Strasser, Michael Mitterberger, Germarmichael Pinggera, Rainer Marksteiner, Eva Margreiter, Martin Fussenegger, Ferdinand Frauscher, Kurt Kofler, G. Bartsch
    Abstract:

    In the last years preclinical studies have paved the way for the use of adult muscle derived stem cells for reconstruction of the lower urinary tract. Between September 2002 and October 2004, 42 women and 21 men suffering from urinary stress incontinence (age 36-84 years) were recruited and subsequently treated with transurethral ultrasonography-guided injections of autologous myoblasts and fibroblasts obtained from skeletal muscle biopsies. The fibroblasts were injected into the urethral submucosa, while the myoblasts were implanted into the Rhabdosphincter. In parallel, 7 men and 21 women (age 39-83 years) also diagnosed with urinary stress incontinence were treated with standard transurethral endoscopic injections of collagen. Patients were randomly assigned to both groups. After a follow-up of 12 months incontinence was cured in 39 women and 11 men after injection of autologous myoblasts and fibroblasts. Mean quality of life score (51.38 preoperatively, 104.06 postoperatively), thickness of urethra and Rhabdosphincter (2.103 mm preoperatively, 3.303 mm postoperatively) as well as contractility of the Rhabdosphincter (0.56 mm preoperatively, 1.462 mm postoperatively) were improved postoperatively. Only in two patients treated with injections of collagen incontinence was cured. The present clinical results demonstrate that, in contrast to injections of collagen, urinary incontinence can be treated effectively with ultrasonography-guided injections of autologous myo- and fibroblasts.

  • RETRACTED ARTICLE: Transurethral ultrasonography-guided injection of adult autologous stem cells versus transurethral endoscopic injection of collagen in treatment of urinary incontinence
    World Journal of Urology, 2007
    Co-Authors: H. Strasser, Michael Mitterberger, Germarmichael Pinggera, Rainer Marksteiner, Eva Margreiter, Martin Fussenegger, Ferdinand Frauscher, Kurt Kofler, G. Bartsch
    Abstract:

    In the last years preclinical studies have paved the way for the use of adult muscle derived stem cells for reconstruction of the lower urinary tract. Between September 2002 and October 2004, 42 women and 21 men suffering from urinary stress incontinence (age 36–84 years) were recruited and subsequently treated with transurethral ultrasonography-guided injections of autologous myoblasts and fibroblasts obtained from skeletal muscle biopsies. The fibroblasts were injected into the urethral submucosa, while the myoblasts were implanted into the Rhabdosphincter. In parallel, 7 men and 21 women (age 39–83 years) also diagnosed with urinary stress incontinence were treated with standard transurethral endoscopic injections of collagen. Patients were randomly assigned to both groups. After a follow-up of 12 months incontinence was cured in 39 women and 11 men after injection of autologous myoblasts and fibroblasts. Mean quality of life score (51.38 preoperatively, 104.06 postoperatively), thickness of urethra and Rhabdosphincter (2.103 mm preoperatively, 3.303 mm postoperatively) as well as contractility of the Rhabdosphincter (0.56 mm preoperatively, 1.462 mm postoperatively) were improved postoperatively. Only in two patients treated with injections of collagen incontinence was cured. The present clinical results demonstrate that, in contrast to injections of collagen, urinary incontinence can be treated effectively with ultrasonography-guided injections of autologous myo- and fibroblasts.

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  • adult stem cell therapy of female stress urinary incontinence
    European Urology, 2008
    Co-Authors: Michael Mitterberger, Germarmichael Pinggera, Rainer Marksteiner, Eva Margreiter, Martin Fussenegger, Ferdinand Frauscher, Hanno Ulmer, Steffen Hering, Georg Bartsch, Hannes Strasser
    Abstract:

    Abstract Objectives To investigate the efficacy of transurethral ultrasound (TUUS)-guided injections of autologous myoblasts and fibroblasts in women with incontinence. Methods Between January and June 2005, 20 female patients suffering from stress urinary incontinence (SUI) were included. Skeletal muscle biopsies were taken from the left arm to obtain cultures from autologous fibroblasts and myoblasts. By TUUS guidance the fibroblasts were injected into the urethral submucosa and the myoblasts were injected into the Rhabdosphincter. A defined incontinence score, quality-of-life score and urodynamic, electromyographic, and laboratory parameters, as well as morphology and function of urethra and Rhabdosphincter were evaluated before and up to 2 yr after therapy. Results Eigtheen of 20 patients were cured 1 yr after injection of autologous stem cells and in 2 patients SUI was improved. Two years after therapy 16 of the 18 patients presented as cured, 2 others were improved, and 2 were lost to follow-up. Incontinence and quality-of-life scores were significantly improved postoperatively. The thickness of urethra and Rhabdosphincter as well as activity and contractility of the Rhabdosphincter were also statistically significantly increased after therapy. Conclusions Clinical results demonstrate that SUI can be treated effectively with autologous stem cells. The present data support the conclusion that this therapeutic concept represents an elegant and minimally invasive treatment modality to treat SUI.

  • Autologous myoblasts and fibroblasts for female stress incontinence: a 1‐year follow‐up in 123 patients
    BJU international, 2007
    Co-Authors: Michael Mitterberger, Germarmichael Pinggera, Rainer Marksteiner, Eva Margreiter, Martin Fussenegger, Ferdinand Frauscher, Hanno Ulmer, Georg Bartsch, Daniela Colleselli, Hannes Strasser
    Abstract:

    OBJECTIVE To assess the efficacy and safety of the application of autologous myoblasts and fibroblasts for treating female stress urinary incontinence (SUI) after a follow-up of ≥1 year. PATIENTS AND METHODS In all, 123 women with SUI (aged 36–84 years) were treated with transurethral ultrasonography-guided injections with autologous myoblasts and fibroblasts obtained from skeletal muscle biopsies. The fibroblasts were suspended in a small amount of collagen as carrier material and injected into the urethral submucosa, while the myoblasts were implanted into the Rhabdosphincter. All patients were evaluated before and 12 months after the injection using the Incontinence and Quality of Life Instrument (I-QOL) scores, urodynamic variables, and morphology and function of the urethra and Rhabdosphincter. RESULTS At 1 year after implanting the cells, 94 of the 119 women (79%) were completely continent, 16 (13%) had a substantial improvement and nine (8%) a slight improvement. Four patients were lost to follow-up.The incontinence and I-QOL scores, and the thickness, contractility and electromyographic activity of the Rhabdosphincter were significantly improved after treatment. CONCLUSIONS These results show the efficacy and safety of transferring autologous myoblasts and fibroblasts in the treatment of female SUI, after a follow-up of 1 year.

  • erratum to transurethral ultrasonography guided injection of adult autologous stem cells versus transurethral endoscopic injection of collagen in treatment of urinary incontinence
    World Journal of Urology, 2007
    Co-Authors: Hannes Strasser, Michael Mitterberger, Germarmichael Pinggera, Rainer Marksteiner, Eva Margreiter, Martin Fussenegger, Ferdinand Frauscher, Kurt Kofler, G. Bartsch
    Abstract:

    In the last years preclinical studies have paved the way for the use of adult muscle derived stem cells for reconstruction of the lower urinary tract. Between September 2002 and October 2004, 42 women and 21 men suffering from urinary stress incontinence (age 36-84 years) were recruited and subsequently treated with transurethral ultrasonography-guided injections of autologous myoblasts and fibroblasts obtained from skeletal muscle biopsies. The fibroblasts were injected into the urethral submucosa, while the myoblasts were implanted into the Rhabdosphincter. In parallel, 7 men and 21 women (age 39-83 years) also diagnosed with urinary stress incontinence were treated with standard transurethral endoscopic injections of collagen. Patients were randomly assigned to both groups. After a follow-up of 12 months incontinence was cured in 39 women and 11 men after injection of autologous myoblasts and fibroblasts. Mean quality of life score (51.38 preoperatively, 104.06 postoperatively), thickness of urethra and Rhabdosphincter (2.103 mm preoperatively, 3.303 mm postoperatively) as well as contractility of the Rhabdosphincter (0.56 mm preoperatively, 1.462 mm postoperatively) were improved postoperatively. Only in two patients treated with injections of collagen incontinence was cured. The present clinical results demonstrate that, in contrast to injections of collagen, urinary incontinence can be treated effectively with ultrasonography-guided injections of autologous myo- and fibroblasts.

  • RETRACTED ARTICLE: Transurethral ultrasonography-guided injection of adult autologous stem cells versus transurethral endoscopic injection of collagen in treatment of urinary incontinence
    World Journal of Urology, 2007
    Co-Authors: H. Strasser, Michael Mitterberger, Germarmichael Pinggera, Rainer Marksteiner, Eva Margreiter, Martin Fussenegger, Ferdinand Frauscher, Kurt Kofler, G. Bartsch
    Abstract:

    In the last years preclinical studies have paved the way for the use of adult muscle derived stem cells for reconstruction of the lower urinary tract. Between September 2002 and October 2004, 42 women and 21 men suffering from urinary stress incontinence (age 36–84 years) were recruited and subsequently treated with transurethral ultrasonography-guided injections of autologous myoblasts and fibroblasts obtained from skeletal muscle biopsies. The fibroblasts were injected into the urethral submucosa, while the myoblasts were implanted into the Rhabdosphincter. In parallel, 7 men and 21 women (age 39–83 years) also diagnosed with urinary stress incontinence were treated with standard transurethral endoscopic injections of collagen. Patients were randomly assigned to both groups. After a follow-up of 12 months incontinence was cured in 39 women and 11 men after injection of autologous myoblasts and fibroblasts. Mean quality of life score (51.38 preoperatively, 104.06 postoperatively), thickness of urethra and Rhabdosphincter (2.103 mm preoperatively, 3.303 mm postoperatively) as well as contractility of the Rhabdosphincter (0.56 mm preoperatively, 1.462 mm postoperatively) were improved postoperatively. Only in two patients treated with injections of collagen incontinence was cured. The present clinical results demonstrate that, in contrast to injections of collagen, urinary incontinence can be treated effectively with ultrasonography-guided injections of autologous myo- and fibroblasts.

  • retracted autologous myoblasts and fibroblasts versus collagen for treatment of stress urinary incontinence in women a randomised controlled trial
    The Lancet, 2007
    Co-Authors: Hannes Strasser, Michael Mitterberger, Germarmichael Pinggera, Rainer Marksteiner, Eva Margreiter, Martin Fussenegger, Ferdinand Frauscher, Hanno Ulmer, Kurt Kofler, Georg Bartsch
    Abstract:

    Summary Background Preclinical 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. Methods Between 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. Findings At 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 Interpretation Long-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.