Biological Materials for Treatment of Urinary Incontinence

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Massachusetts General Hospital's Ajay Singla, MD, urologist and director of the Harvard Urologic Surgery Residency Program, discusses his research on the use of biological materials to treat urinary incontinence and the changes he and his team have implemented to ensure his patients' care is efficacious and durable.

Transcript

The focus of my research in the last few years has been on biological materials. These materials are used in sling surgery, which is designed for the treatment of urinary incontinence in men and women.

We did animal model research way back in 2010: We used about 64 mice and tested different types of biological materials, including the xenograft—which is the source of the animal tissue. We also tested allograft from human cadavers, and we tested the activity of patients on autologous materials. We tried to find the best material to be used in sling surgery.

So, my interest then was to find out the best biological material, which would be very efficacious as well as is durable in the long run. We started using and trying to find the best material since we are going back to the use of biological material in these patients.

That's probably what was the biggest change. In the last decade, there was a push both by the industry, as well as by the patients, to use minimally invasive procedures for the treatment of stress urinary incontinence in both men and women. But over time, we saw that there could be a potential complication and potential issues with the use of mesh. That's why what is changing is [we are] actually going back to the more open old-fashioned or historical procedures for stress incontinence.

My other area of research has been post-prostatectomy incontinence in men following radical prostatectomy, or the treatment for patients who are diagnosed with prostate cancer. The exciting part of that is we are also using a biological material in patients who have undergone multiple surgeries for their urinary incontinence, because some of these patients do develop severe urinary incontinence following the radical prostatectomy procedures for prostate cancer.

I've been using dermal grafts in these patients because some of them actually have had multiple procedures done in the past, which makes it very technically difficult, and because of the urethral atrophy they develop. So there is really no good option for them without using a dermal graft. That [is what] we have instituted at Mass General Hospital; I have performed a few procedures using a dermal graft in those patients.

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