Université Libre de Bruxelles, Medicine Faculty, route de Lennik 808, 1070 Brussels, Belgium.
Departments of Gynecology and Obstetrics, IRIS South Hospital, rue Jean-Paquot 63, 1050 Brussels, Belgium.
Eur J Obstet Gynecol Reprod Biol. 2022 Nov;278:38-44. doi: 10.1016/j.ejogrb.2022.08.028. Epub 2022 Sep 9.
To assess the feasibility and the safety of treating female stress urinary incontinence (SUI) with suburethral implantation of a mixture of the stromal vascular fraction from adipose tissue and leukocyte-and platelet-rich-fibrin.
Patients with SUI were treated with a mixture of stromal vascular fraction and leukocyte-and platelet-rich fibrin. The stromal vascular fraction was obtained from enzymatic digestion of autologous adipose-tissue and added to an leukocyte-and platelet-rich-fibrin membrane. The mixture was transvaginally implanted into the suburethral area. A fraction of the Stromal vascular fraction sample was used for cellular characterization. Patients were followed for 9 months. Every 3 months, the patients were clinically evaluated with a cough- stress test and a validated-questionnaire. An MRI was performed preoperatively and 3 months after the procedure to assess tissue changes.
Ten patients received the surgical procedure. The validated-questionnaire revealed a subjective SUI improvement in nine patients 3 months after the operation and in seven patients 9 months after the operation. Eight, six, and four patients achieved a negative cough-stress test 3, 6 and 9 months post-injection, respectively. Flow cytometric analysis of stromal vascular fraction cell phenotypes revealed predominantly mesenchymal and endothelial cell heterogeneity. In total, we injected 0,18 × 10 to 13,6 × 10 cells. No adverse events were observed peri- or postoperatively.
These preliminary results suggest that the suburethral implantation of a combination of SVF and l-PRF is a feasible and safe modality for treating female SUI. However, evidence is lacking and further research are needed to clarify the respective roles of SVF and l-PRF in female SUI treatment.
评估经阴道尿道下植入脂肪组织基质血管成分和富含白细胞及血小板纤维蛋白混合物治疗女性压力性尿失禁（SUI）的可行性和安全性。
对 SUI 患者采用基质血管成分和富含白细胞及血小板纤维蛋白混合物进行治疗。基质血管成分从自体脂肪组织的酶消化中获得，并添加到富含白细胞及血小板纤维蛋白膜中。将混合物经阴道植入尿道下区域。对基质血管成分样本的一部分进行细胞特征分析。患者接受 9 个月的随访。每 3 个月，对患者进行咳嗽压力测试和经过验证的问卷进行临床评估。术前和术后 3 个月进行 MRI 检查以评估组织变化。
10 名患者接受了手术。经过验证的问卷显示，9 名患者在术后 3 个月和 7 名患者在术后 9 个月主观上改善了 SUI。术后 3、6 和 9 个月，8、6 和 4 名患者分别实现了阴性咳嗽压力测试。基质血管成分细胞表型的流式细胞分析显示主要为间充质和内皮细胞异质性。总共注射了 0.18×10 到 13.6×10 个细胞。术后围手术期未观察到不良事件。
这些初步结果表明，经阴道尿道下植入 SVF 和 l-PRF 联合物是治疗女性 SUI 的一种可行且安全的方法。然而，目前缺乏证据，需要进一步研究以阐明 SVF 和 l-PRF 在女性 SUI 治疗中的各自作用。
