Guiting Lin et al., 2024: Microenergy shockwave therapies for female stress urinary incontinence

Tuesday, 12 November 2024

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Guiting Lin, Tom F Lue
Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, CA, USA.

Abstract

Stress urinary incontinence (SUI) is one of the pelvic floor disorders affecting tens of million of women worldwide. In general, non-surgical options have relatively limited efficacy. The most effective treatment is mid-urethral sling surgery which carries substantial risks of perioperative and postoperative complications. Regenerative therapy with the injection of several types of stem cells and stem cell products is promising but further investigation is needed before clinical implementation can be considered. In recent years, the application of microenergy therapy as a non-invasive treatment for SUI has received increasing attention. Preclinical animal studies of these models have demonstrated that low-intensity extracorporeal shockwave therapy (Li-ESWT) and microenergy acoustic pulse (MAP) therapy are capable of regenerating urethral sphincter tissue and pelvic floor muscles leading to improved urinary continence. One pilot clinical trial with Li-ESWT also reported improved quality of life in women with SUI as well as the symptoms. The objective of this review is to summarize the potential mechanisms associated with Li-ESWT and MAP therapies of SUI: (I) activation of tissue-resident stem cells; (II) regeneration of musculature in the urethra and pelvic floor; (III) improvement in biomechanical property of pelvic floor muscles; (IV) modulation of cellular signaling pathways. Further studies of the molecular mechanisms, optimal treatment dosage and schedule, and potential long-term side effects are needed to provide this non-invasive regenerative therapy for millions of women with SUI.

Transl Androl Urol. 2024 Aug 31;13(8):1687-1694. doi: 10.21037/tau-23-9. Epub 2023 Aug 21.
PMID: 39280672 PMCID: PMC11399057

Comments 1

Jens Rassweiler on Tuesday, 12 November 2024 10:00

This article reviews microenergy shockwave therapies, specifically low-intensity extracorporeal shock wave therapy (Li-ESWT) and microenergy acoustic pulse (MAP) therapy, as emerging regenerative treatments for female stress urinary incontinence (SUI). SUI is marked by involuntary urine leakage during activities that increase abdominal pressure, such as coughing or physical exertion, due to dysfunction in the urethral sphincter and pelvic floor muscles. Traditional treatments have included surgical approaches, but concerns about complications have spurred interest in regenerative solutions, such as stem cell therapy, though it still faces practical challenges.
Shockwave Therapies for SUI
The article discusses Li-ESWT and MAP as non-invasive options to stimulate urethral and pelvic floor regeneration by activating local stem cells. Initially tested in animal models, Li-ESWT has shown promising results in increasing leak-point pressure (LPP) and improving muscle regeneration in rats subjected to SUI models. MAP therapy, particularly effective in cases of obesity-associated SUI, has demonstrated positive effects on muscle function and neuromuscular junction integrity in the urethral sphincter. Studies indicate these therapies enhance the recruitment and differentiation of muscle progenitor cells, support angiogenesis, and reduce nerve damage, ultimately improving sphincter function.
Mechanisms of Action
Both Li-ESWT and MAP work through stages: they initiate mechanical effects on tissues, promote cellular responses, and activate biological pathways involved in tissue repair. The article identifies specific signaling pathways, including Wnt/β-catenin and PERK, that are activated in response to these therapies, driving stem cell proliferation and muscle repair. For instance, MAP therapy in animal models improved muscle thickness and neural regeneration, showcasing its regenerative potential for pelvic floor muscles affected by SUI.
Clinical Studies and Future Directions
Clinical trials on Li-ESWT have shown reductions in urine leakage and improvements in urinary symptoms. Ongoing research suggests that both therapies could be effective, minimally invasive alternatives to surgery, though more studies are needed to refine protocols and understand the therapies' full effects on the urethral sphincter, pelvic muscles, and nerves. The authors call for further research to validate these promising findings and expand our understanding of these therapies' regenerative mechanisms.
In this scenario, it is interesting, that we could recently find similar findings of stem cell stimulation postoperative treatment of Fournier`s gangrene (Rassweiler JJ., Scheitlin W, Agatep J, Condeno C, Schaden W (2024). Low-intensity extracorporeal shock wave therapy in the postoperative management of Fournier's gangrene - a case series of a new concept. Medical Research Archives, 2024 [online] 12(10). https://doi.orq/10.18103/mra.v12110.5801

Jens Rassweiler

This article reviews microenergy shockwave therapies, specifically low-intensity extracorporeal shock wave therapy (Li-ESWT) and microenergy acoustic pulse (MAP) therapy, as emerging regenerative treatments for female stress urinary incontinence (SUI). SUI is marked by involuntary urine leakage during activities that increase abdominal pressure, such as coughing or physical exertion, due to dysfunction in the urethral sphincter and pelvic floor muscles. Traditional treatments have included surgical approaches, but concerns about complications have spurred interest in regenerative solutions, such as stem cell therapy, though it still faces practical challenges.
Shockwave Therapies for SUI
The article discusses Li-ESWT and MAP as non-invasive options to stimulate urethral and pelvic floor regeneration by activating local stem cells. Initially tested in animal models, Li-ESWT has shown promising results in increasing leak-point pressure (LPP) and improving muscle regeneration in rats subjected to SUI models. MAP therapy, particularly effective in cases of obesity-associated SUI, has demonstrated positive effects on muscle function and neuromuscular junction integrity in the urethral sphincter. Studies indicate these therapies enhance the recruitment and differentiation of muscle progenitor cells, support angiogenesis, and reduce nerve damage, ultimately improving sphincter function.
Mechanisms of Action
Both Li-ESWT and MAP work through stages: they initiate mechanical effects on tissues, promote cellular responses, and activate biological pathways involved in tissue repair. The article identifies specific signaling pathways, including Wnt/β-catenin and PERK, that are activated in response to these therapies, driving stem cell proliferation and muscle repair. For instance, MAP therapy in animal models improved muscle thickness and neural regeneration, showcasing its regenerative potential for pelvic floor muscles affected by SUI.
Clinical Studies and Future Directions
Clinical trials on Li-ESWT have shown reductions in urine leakage and improvements in urinary symptoms. Ongoing research suggests that both therapies could be effective, minimally invasive alternatives to surgery, though more studies are needed to refine protocols and understand the therapies' full effects on the urethral sphincter, pelvic muscles, and nerves. The authors call for further research to validate these promising findings and expand our understanding of these therapies' regenerative mechanisms. 
In this scenario, it is interesting, that we could recently find similar findings of stem cell stimulation postoperative treatment of Fournier`s gangrene (Rassweiler JJ., Scheitlin W, Agatep J, Condeno C, Schaden W (2024). Low-intensity extracorporeal shock wave therapy in the postoperative management of Fournier's gangrene - a case series of a new concept. Medical Research Archives, 2024 [online] 12(10). https://doi.orq/10.18103/mra.v12110.5801

Jens Rassweiler

This article reviews microenergy shockwave therapies, specifically low-intensity extracorporeal shock wave therapy (Li-ESWT) and microenergy acoustic pulse (MAP) therapy, as emerging regenerative treatments for female stress urinary incontinence (SUI). SUI is marked by involuntary urine leakage during activities that increase abdominal pressure, such as coughing or physical exertion, due to dysfunction in the urethral sphincter and pelvic floor muscles. Traditional treatments have included surgical approaches, but concerns about complications have spurred interest in regenerative solutions, such as stem cell therapy, though it still faces practical challenges. Shockwave Therapies for SUI The article discusses Li-ESWT and MAP as non-invasive options to stimulate urethral and pelvic floor regeneration by activating local stem cells. Initially tested in animal models, Li-ESWT has shown promising results in increasing leak-point pressure (LPP) and improving muscle regeneration in rats subjected to SUI models. MAP therapy, particularly effective in cases of obesity-associated SUI, has demonstrated positive effects on muscle function and neuromuscular junction integrity in the urethral sphincter. Studies indicate these therapies enhance the recruitment and differentiation of muscle progenitor cells, support angiogenesis, and reduce nerve damage, ultimately improving sphincter function. Mechanisms of Action Both Li-ESWT and MAP work through stages: they initiate mechanical effects on tissues, promote cellular responses, and activate biological pathways involved in tissue repair. The article identifies specific signaling pathways, including Wnt/β-catenin and PERK, that are activated in response to these therapies, driving stem cell proliferation and muscle repair. For instance, MAP therapy in animal models improved muscle thickness and neural regeneration, showcasing its regenerative potential for pelvic floor muscles affected by SUI. Clinical Studies and Future Directions Clinical trials on Li-ESWT have shown reductions in urine leakage and improvements in urinary symptoms. Ongoing research suggests that both therapies could be effective, minimally invasive alternatives to surgery, though more studies are needed to refine protocols and understand the therapies' full effects on the urethral sphincter, pelvic muscles, and nerves. The authors call for further research to validate these promising findings and expand our understanding of these therapies' regenerative mechanisms. In this scenario, it is interesting, that we could recently find similar findings of stem cell stimulation postoperative treatment of Fournier`s gangrene (Rassweiler JJ., Scheitlin W, Agatep J, Condeno C, Schaden W (2024). Low-intensity extracorporeal shock wave therapy in the postoperative management of Fournier's gangrene - a case series of a new concept. Medical Research Archives, 2024 [online] 12(10). https://doi.orq/10.18103/mra.v12110.5801 Jens Rassweiler

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