Clinical application of stem cell therapy in neurogenic bladder

Background and Aim : Recently, stem cell (SC) therapy has been proposed as a potentially effective treatment option in neurourological disorders especially neurogenic bladder (NGB) as the most debilitating disorders. The aim of this review is evaluation the effect of SC therapy on management of NGB in four neurologic diseases including spinal cord injury (SCI), Parkinson’s disease (PD), multiple sclerosis (MS) and stroke in clinical setting.Methods : A comprehensive electronic databases searching was conducted in June 2019. All randomized or quasi clinical trials as well as observational studies that were investigated the effect of SC therapy on management of NGB were included. Cochrane appraisal risk of bias checklist and the standardized critical appraisal instrument from the JBI Meta-Analysis of Statistics, Assessment and Review Instrument (JBI-MAStARI) were used to appraise the studies.Results : Only 27 studies among 1189 relevant publications met our inclusion criteria. Only SCs therapy was examined on SCI or MS patients, and the other neurological diseases weren’t candidate for SC therapy for management of NGB in clinical setting. Phase I/II clinical trial (without control arm) were the most conducted studies, and only 4 studies were randomized controlled trial. In MS, included subjects were 49 MS patients in phase I and II open-label clinical trial and one case report. The prevalent used SCs were bone marrow mesenchymal SC. The mainly route of transplantation was lumbar puncture. There were not serious adverse events. SC therapy, improved bladder function. However, only nine studies in SCI and one in MS have used urodynamic and the others have reported improvement based on patient’s satisfaction. Also the quality of these publications was low or unclear.Conclusion : All these trials provide evidence of safety and effectiveness of MSCs on the management of NGB. However, the interpretation of studies results due to the lack of placebo controls are difficult. Double-blind placebo-controlled study with a larger number of patients are necessary.

Keywords:

Stem Cell Therapy , Spinal Cord Injury , Neurogenic Bladder , systematic review