Chen Yao, Li Bao, Zhao Xiang, He Xinyu, Gao Wei, Li Qian
School of Medical Laboratory, Shandong Second Medical University, Weifang, P.R. China.
Department of Urology, Weifang People's Hospital, Weifang, P.R. China.
Cell Transplant. 2025 Jan-Dec;34:9636897251383979. doi: 10.1177/09636897251383979. Epub 2025 Oct 17.
Stress urinary incontinence (SUI) is characterized by the involuntary leakage of urine from the urethra due to increased abdominal pressure. The complex pathophysiological mechanisms underlying SUI have driven the development of diverse therapeutic strategies. Current treatment options encompass both conservative and surgical interventions, with surgical approaches generally often regarded as the most effective option approach for severe cases. However, many surgical techniques carry significant risks of complications. In this context, urethral injection therapy, primarily based on stem cell-mediated regenerative approaches, has emerged as a minimally invasive alternative. Stem cell therapies leverage their multipotent differentiation capacity and paracrine signaling pathways to directly target the pathophysiological contributors to SUI, including urethral sphincter dysfunction, neuromuscular junction degeneration, and imbalances in elastin and collagen homeostasis. This narrative review provides a critical evaluation of current stem cell-mediated regenerative strategies for SUI, focusing on cellular mechanisms and the therapeutic effects driven by paracrine signaling. Recent clinical advances, unresolved scientific controversies, and innovative combinatorial delivery systems incorporating targeted therapeutic approaches are analyzed. Despite challenges remain, such as determining the optimal stem cell dosage and improving in vivo survival rates, ongoing research offers valuable insights into the development of cell-free bioactive derivatives, advanced combination delivery systems, and precise molecularly targeted therapies.
压力性尿失禁（SUI）的特征是由于腹压增加导致尿液从尿道不自主漏出。SUI背后复杂的病理生理机制推动了多种治疗策略的发展。目前的治疗选择包括保守治疗和手术干预，手术方法通常被认为是严重病例最有效的治疗方法。然而，许多手术技术都有显著的并发症风险。在此背景下，主要基于干细胞介导的再生方法的尿道注射疗法已成为一种微创替代方法。干细胞疗法利用其多能分化能力和旁分泌信号通路直接针对SUI的病理生理因素，包括尿道括约肌功能障碍、神经肌肉接头退化以及弹性蛋白和胶原蛋白稳态失衡。这篇叙述性综述对当前用于SUI的干细胞介导的再生策略进行了批判性评估，重点关注细胞机制和旁分泌信号驱动的治疗效果。分析了近期的临床进展、未解决的科学争议以及结合靶向治疗方法的创新组合递送系统。尽管仍存在挑战，如确定最佳干细胞剂量和提高体内存活率，但正在进行的研究为无细胞生物活性衍生物、先进的联合递送系统和精确的分子靶向治疗的发展提供了有价值的见解。
