Discussion:
A single modality may be inadequate for treatment of MUI and multiple
treatment modalities are required. There is a controversy about the
results of pharmaceutical treatment for MUI and surgical treatment is
associated with significant failure rates. It is mentioned that applying
of anti-incontinence procedures may be effective in treating both the
stress and urge components of MUI. (4)
American urology association (AUA) mentioned “the success rate of TVT
surgery is between 51% and 87 %” (5). Labire et al (6) expressed that
the pharmacological therapy is less effective in comparison to surgery
after 12 months. Surgery is done for those patients who deny
conservative managements or symptoms have not been improved
inadequately. (1) Kulseng-hanssen et,al (7) mentioned “the TVT
objective care was 87.3% after 7 months and 82.7 after 38 months. The
subjective care was 60 % and 53.8% after 7 and 38 months”.
Botulinum toxin is a neurotoxin which has been used for various clinical
applications for many years, and inhibits the release of the
neurotransmitter acetylcholine at the presynaptic nerve terminals.
Urologists use it for patients with lower urinary tract symptoms
secondary to idiopathic overactive bladder (OAB) and also after initial
therapeutic modalities have failed to improve symptoms. Intradetrusor
botulinum toxin injection has shown to improve urinary urgency,
frequency, nocturia, and urgency urinary incontinence. In the other
hand, not all patients can achieve excellent therapeutic outcomes which
is leakage associated with a rise in abdominal pressure e.g., due to
cough, sneeze and exercise (8). Phelan et al reported that after
injection, 67% of patients were able to void smoothly with the PVR
decreased by 71% and voiding pressure decreased by 38% (9).
For tissue regeneration of muscles; stem cells, PRP and fibrin glue
strongly collaborate together to create new blood vessels and
capillaries, extracellular matrix through cell proliferation,
chemotaxis, cell differentiation, and angiogenesis. PRP provides the
best concentration of growth factors (transforming growth factor–β,
platelet-derived growth factor, insulin-like growth factor, fibroblast
growth factor, epidermal growth factor, vascular endothelial growth
factor, and endothelial cell growth) and bioactive factors (serotonin,
histamine, dopamine, calcium, and adenosine). These factors lead to
wound healing events by modulating the recruitment, duplication,
activation, and differentiation. FG creates a temporary matrix and
stimulating the local proliferation of fibroblasts, collagen synthesis,
new blood vessels formation and connective tissue (3). The malfunction
old cells will be replenished by stem cells which these young workers
actively collaborate in vascularization and muscle tissue repairmen. In
our previous report, peripheral stem cells and PRP are used for
treatment of SUI. (10)
In this case report, PRP-Fibrin Glue- Stem Cell injection, Botox
injection, and TVT has been used for treatment of MUI. Further research
is need to validate the efficacy of these mixed treatments for
recalcitrant MUI.
Conclusion: Mix treatment of PRP-Fibrin Glue- Stem Cell
injection, Botox injection, and TVT may be a very good approach for
treatment of patients with MUI who have a very open sphincter. Further
research is need to validate the efficacy of these mixed treatments for
recalcitrant MUI.
Acknowledgments : None