Feasibility, technique and accuracy of ultrasound-guided transurethral injections into the urinary sphincter of female c
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TECHNICAL ADVANCE
Feasibility, technique and accuracy of ultrasound‑guided transurethral injections into the urinary sphincter of female cadavers: proof of concept Florian A. Schmid1, Dominic Gascho2, Niklaus Zoelch2, Jenny A. Prange1, Giovanni Colacicco3 and Daniel Eberli1*
Abstract Background: The injection of muscle precursor cells (MPC) into the external urinary sphincter muscle (EUS) is a promising therapeutic option for regenerative treatment of stress urinary incontinence (SUI). The objective of the present project was to conduct a pre-clinical trial to investigate the feasibility and accuracy of ultrasound (US) guided, transurethral injections into the EUS of female cadavers. Methods: This is a prospective, anatomical, interventional and radiological cadaveric laboratory investigation. Two urologists performed transurethral US-guided injections to deliver nano-iron particles into the EUS. The intervention was performed in three unfixed, fresh female cadavers. Each cadaver received MRI before and CT as well as MRI of the pelvis after the injections. Results: The precision and accumulation of nano-iron particles in the EUS was compared using a rating scale to evaluate left versus right and anterior versus posterior distribution in axial and sagittal orientation with US, MRI and CT. The accuracy of our US-guided injections into the anterior target region yielded 4 points on the rating scale. Adequate precision and accumulation of particles in the left versus right EUS were also demonstrated (3 vs. 3.33 points, respectively). Signal intensity in MRI revealed a mean ratio of 0.33 before and after injection. CT scans showed no relevant artefacts impairing the assessment. Conclusion: US-guided, transurethral injection into the EUS is feasible and imaging reveals a precise accumulation in the target region. Our method provides an appropriate approach to deliver MPC in the EUS muscle for a regenerative treatment of SUI in the near future. Keywords: Transurethral injection, Urinary sphincter, Ultrasound-guided, MRI, Female Background Stress Urinary Incontinence (SUI) is a disease affecting almost 200 million people worldwide and is twice as common in women as in men [1]. The quality of life *Correspondence: [email protected] 1 Department of Urology, University Hospital of Zurich, University of Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland Full list of author information is available at the end of the article
in these patients is markedly decreased due to reduced activity, unpleasant sensation and odor as well as recurrent urinary tract infections caused by wet pads [2, 3]. Several therapeutic options exist in the treatment of SUI: Besides physiotherapy of the lower pelvis, various medical, mechanical and surgical approaches can be discussed with the patients [4–8]. However, all of these therapies have limitations and new solutions with long-term effects are needed. The regenerative approach, administering
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