**9. New technologies**

Efficacy, safety & technical feasibility of intrasphincteric injections of autologous muscle derived stem cells have been shown by several groups in both animal models and humans. (Mitterberger et al. 2008; Sebe et al. 2011) In the human studies, myoblasts and fibroblasts were obtained from muscle biopsies of the patient. Cells are then grown in a culture facility to yield more myoblasts. After amplification, the cells are collected and frozen in a pellet, which is transferred to the urologist and thawed immediately prior to endourethral injection under endoscopic control. A recent review of stem cells for the treatment of urinary incontinence nicely describes the theory behind the use of stem cells for the treatment of urinary incontinence. (Staack & Rodriguez 2011) Ideally, these autologous cells provide additional mucosal coaptation in order to restore resting urethral closing pressures. These studies are in their infancy and no data has been reported on women with refractory stress urinary incontinence, however this might provide a more effective means of endoscopic bulking without the use of collagen and other synthetic materials.
