**3.2.4 Outcome of the SIS Sling**

The suitability of the SIS sling is better reflected by the clinical outcome. In terms of clinical efficacy in correction of SUI, the results of different studies showed that SIS was able to provide a strong suburethral support and durable clinical results (table 7).

Rutner et al, reported in their work utilizing SIS as a pubovaginal slings in the treatment of female SUI that all patients had minimal local reactions and pelvic pain; no cases of erosion

Futuristic Concept in Management

**(Ho et al, 2004).** 

preliminary results.

**4.1 Introduction** 

**4.2 Cell source** 

**4. Stem cell therapy** 

damaged tissue or organs.

of Female SUI: Permanent Repair Without Permanent Material 307

role in inflammatory reactions, because these high complication rates were not observed with the older 1-ply and 4-ply formulations **(John et al, 2008; Santucci and Barber, 2005)**.

Fig. 10. CT shows inflammation of subcutaneous tissue (*A*) and along arms of the SIS sling

The SIS graft material is well accepted by the host tissue, and considered safe and effective with lower incidence of erosion and infection than the synthetic midurethral slings. However, Long period of follow up are still required to support the durability of these

Stem cells therapy for the regenerative repair of the deficient rhabdosphincter has been the most recent advance in incontinence research. The ultimate goal has been to achieve a permanent cure for SUI by restoration of the intrinsic and extrinsic urethral sphincter and the surrounding connective tissue, including peripheral nerves and blood vessels. Overall, the aim of stem cell therapy is to replace, repair, or enhance the biological function of

There are two general types of stem cells potentially useful for therapeutic treatment, embryonic stem cells (ESCs) and adult stem cells **(Novara and Artibani, 2007).** The practical use of ESCs has ethical limitations inherent to cell harvesting from fetal tissue and histocompatibility problems. **(Edwards, 2007)**. In contrast, adult stem cells have no significant ethical issues related to their use and have more limited differentiation potential which makes them safer. Tissues engineering therapies are based on autologous multipotent stem cells, of which bone marrow stromal cells are most often used. The bone marrow stromal cells contain mesenchymal stem cells (MSCs) that are capable of differentiating into into adipogenic, osteogenic, chondrogenic and myogenic cells **(Pittenger et al, 1999; Ferrari et al, 1998; Prockop, 1997; Dezawa et al, 2005),** However, bone marrow compartment usage has significant limitations due to its painful nature which usually require general or spinal

No study till now compared the 1-ply, 4-ply, and 8-ply SIS grafts in humans.

or extrusion were noted. The authors also performed a biopsy for cases which required reoperation for correction of incontinence. They observed absence of the implanted graft on gross examination. Microscopically, only a few remnants of the SIS (< 0.4 mm) could be found **(Rutner et al, 2003)**. Farahat et al, reported also using SIS as TVT (figure 9) in the treatment of female SUI that the SIS sling was accepted nicely by the tissue after 12 months. No erosion, extrusion, or severe inflammatory reactions were noted. Most reactions were mild and usually observed as early as 10 days or as late as 45 days after the procedure. Most reactions were well tolerated and resolved spontaneously **(Farahat et al, 2009).**


Table 7. Treatment outcome of SIS graft.

Fig. 9. SIS as TVT sling **(Farahat et al, 2009).**
