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Meta-Analysis
. 2015 Mar 17;10(3):e0113491.
doi: 10.1371/journal.pone.0113491. eCollection 2015.

Bladder recovery by stem cell based cell therapy in the bladder dysfunction induced by spinal cord injury: systematic review and meta-analysis

Jae Heon Kim  1 , Sung Ryul Shim  2 , Seung Whan Doo  1 , Won Jae Yang  1 , Byung Wook Yoo  3 , Joyce Mary Kim  4 , Young Myoung Ko  5 , Eun Seop Song  6 , Ik Sung Lim  7 , Hong Jun Lee  8 , Yun Seob Song  1
Affiliations
Meta-Analysis

Bladder recovery by stem cell based cell therapy in the bladder dysfunction induced by spinal cord injury: systematic review and meta-analysis

Jae Heon Kim et al. PLoS One. .

Abstract

Background: Bladder dysfunction induced by spinal cord injury (SCI) can become problematic and severely impair the quality of life. Preclinical studies of spinal cord injury have largely focused on the recovery of limb function while neglecting to investigate bladder recovery.

Objective: The present study was performed to investigate and review the effect of stem cell-based cell therapy on bladder recovery in SCI.

Methods: We conducted a meta-analysis of urodynamic findings of experimental trials that included studies of stem cell-based cell therapy in SCI. Relevant studies were searched using MEDLINE, EMBASE and Cochrane Library (January 1990 - December 2012). Final inclusion was determined by a urodynamic study involving detailed numerical values. Urodynamic parameters for analysis included voiding pressure, residual urine, bladder capacity and non-voiding contraction (NVC). Meta-analysis of the data, including findings from urodynamic studies, was performed using the Mantel-Haenszel method.

Results: A total of eight studies were included with a sample size of 224 subjects. The studies were divided into different subgroups by different models of SCI. After a stem cell-based cell therapy, voiding pressure (-6.35, p <0.00001, I2 = 77%), NVC (-3.58, p <0.00001, I2 = 82%), residual urine (-024, p = 0.004, I2 = 95%) showed overall significant improvement. Bladder capacity showed improvement after treatment only in the transection type (-0.23, p = 0.0002, I2 = 0%).

Conclusion: After stem cell-based cell therapy in SCI, partial bladder recovery including improvement of voiding pressure, NVC, and residual urine was demonstrated. Additional studies are needed to confirm the detailed mechanism and to obtain an ideal treatment strategy for bladder recovery.

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Conflict of interest statement

Competing Interests: The authors have declared no competing interests exist.

Figures

Fig 1
Fig 1. Method for study search and selection for inclusion.
Fig 2
Fig 2. Risk of bias summary.
A review of the author’s judgments about each risk of bias item for each included study. “+”is “low risk”, “-“is “high risk”, “?” is “unclear”.
Fig 3
Fig 3. Forest plot diagram showing the effect of stem cell-based cell transplantation on voiding pressure.
The black diamond signifies the mean difference is in favor of voiding pressure. The size of each square depends on the weight of each study. All data provided are for continuous outcomes.
Fig 4
Fig 4. Forest plot diagram showing the effect of stem cell-based cell transplantation on residual urine.
The black diamond signifies that the mean difference is in residual urine. The size of each square depends on the weight of each study. All data provided are for continuous outcomes.
Fig 5
Fig 5. Forest plot diagram showing the effect of stem cell-based cell transplantation on non-voiding contraction (NVC).
The black diamond signifies the mean difference is in favor of NVC. The size of each square depends on the weight of each study. All data provided are for continuous outcomes.
Fig 6
Fig 6. Forest plot diagram showing the effect of stem cell-based cell transplantation on bladder capacity.
The black diamond signifies the mean difference is in favor of bladder capacity. The size of each square depends on the weight of each study. All data provided are for continuous outcomes.
Fig 7
Fig 7. Funnel plot with peusdo 95% confidence limit.
See this image and copyright information in PMC

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