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Chun-Hou LiaoTaiwan
Moderator
Regeneration Medicine in Urology - A Promising Future or Hoax?Regenerative medicine comprises therapeutic strategies aimed at restoring tissue structure and function, rather than merely alleviating symptoms. By deploying cells, biomaterials, bioactive molecules, or combinations thereof, these interventions stimulate the body’s intrinsic repair mechanisms. This paradigm extends beyond traditional symptomatic treatment, offering the potential for true self-healing and organ reconstruction—ultimately prioritizing cure over chronic disease management.
Cell-based therapy has emerged as a promising intervention for various urogenital disorders, including erectile dysfunction (ED), bladder dysfunction, and male infertility. Current clinical research primarily focuses on mesenchymal stem cells (MSCs), investigating their safety, tolerability, and preliminary efficacy. Although early-phase studies suggest functional benefits—such as improved hemodynamics and tissue regeneration—most programs remain in preclinical or early clinical stages. A critical limitation remains the lack of standardization in MSC source, dose, and delivery route.
Among alternative sources, human amniotic fluid-derived stem cells (hAFSCs) have shown particular promise. In preclinical models of cavernous nerve injury, hAFSCs demonstrated prolonged retention in penile tissue and in-situ differentiation into α-smooth muscle actin-positive corporal smooth muscle cells, effectively replacing damaged tissue and restoring function. These findings represent an encouraging step toward curative therapy. However, the mechanisms governing their in vivo behavior—such as engraftment, differentiation, and immunogenicity—will ultimately determine their clinical translatability and therapeutic stability. Whether cell-based approaches can evolve from experimental platforms into routine clinical care remains a central question.
Platelet-Rich Plasma (PRP)
Platelet-rich plasma (PRP) is an autologous biologic product enriched with supraphysiologic levels of platelets, growth factors, chemokines, and extracellular vesicles. Upon activation, PRP releases a bioactive cocktail that promotes angiogenesis, neuroregeneration, and antifibrotic remodeling—key processes in the restoration of urogenital tissues.
In rodent models of cavernous nerve injury, PRP has been shown to preserve corporal sinusoidal endothelial cells and axonal scaffolds, while restoring erectile hemodynamics. Clinical studies further support PRP's safety in humans and report variable but promising improvements in IIEF scores following intracavernous injection. Nevertheless, the therapeutic response appears heterogeneous, likely influenced by patient factors, PRP preparation techniques, and injection protocols. Beyond ED, PRP has shown potential in other urologic indications such as stress urinary incontinence (SUI), interstitial cystitis/bladder pain syndrome (IC/BPS), and chronic pelvic pain, where it may contribute to tissue regeneration and symptom relief. However, broader adoption will require the establishment of individualized blood-quality metrics, standardized preparation methods, and randomized controlled trials demonstrating durable benefit.
Emerging Regenerative Strategies
Beyond cell-based and autologous biologics, a suite of innovative regenerative technologies is progressing from bench to bedside. These include:
Energy-based devices such as low-intensity extracorporeal shock wave therapy (Li-ESWT), which promotes neovascularization and tissue regeneration via mechanotransduction pathways.
Gene therapies, targeting dysfunctional or absent proteins in disorders like overactive bladder.
Smart biomaterials, capable of delivering cells or bioactive molecules in a controlled, responsive manner.
Extracellular vesicle (EV)-based therapeutics, which leverage cell-free vesicles derived from MSCs or urine-derived stem cells. These EVs carry signaling molecules (e.g., microRNAs, cytokines, growth factors) that mimic the paracrine effects of stem cells, offering a potentially safer and more scalable alternative to cell transplantation.
In preclinical models of ED and bladder dysfunction, EVs have demonstrated the capacity to promote smooth muscle regeneration, nerve sprouting, and fibrosis reduction, with functional improvements comparable to stem cell therapy.
Regenerative medicine has propelled the field of urologic tissue repair from theoretical promise to an early clinical reality. While substantial challenges remain—including the need for deeper mechanistic insight, protocol standardization, and regulatory clarity—the field is advancing rapidly. The convergence of cell therapy, PRP, EVs, and device-based modalities is creating a multifaceted toolkit for urologic regeneration. With continued scientific rigor, large-scale clinical trials, and interdisciplinary collaboration, regenerative medicine holds the potential to shift urologic care from chronic symptomatic management to durable, tissue-level cure.Stem Cell Therapy: Advancements and Clinical Insights for Erectile Dysfunction Treatment Erectile dysfunction (ED)—defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity—affects over 150 million men worldwide. While phosphodiesterase-5 inhibitors (PDE5is) remain the first-line treatment, many patients, particularly those with diabetes, age-related vascular decline, or neuropathy following radical prostatectomy, show suboptimal responses. Consequently, regenerative medicine—particularly stem-cell therapy—has gained interest for its potential to address the root causes of ED rather than merely managing symptoms.
Stem-cell therapy offers a multifaceted approach to treating ED through neuroregeneration, angiogenesis, anti-apoptotic signaling, and fibrosis inhibition. Once introduced into the target tissue, stem cells can differentiate into specific cell types or exert paracrine effects via secretion of growth factors and extracellular vesicles. Among the various sources studied, bone marrow-derived mesenchymal stem cells (BM-MSCs), adipose-derived stem cells (ADSCs), and umbilical cord-derived MSCs (UC-MSCs) have been most extensively explored.
Preclinical studies consistently demonstrate that MSC-based therapies enhance cavernous nerve regeneration, suppress fibrosis, and preserve endothelial integrity. In rat models of diabetes- or nerve-injury-induced ED, intracavernosal injections of ADSCs or BM-MSCs significantly restore intracavernosal pressure (ICP) and improve corpus cavernosum histology. Phase I/II clinical trials also support the safety and preliminary efficacy of stem-cell approaches. For example, in men with diabetic ED treated with autologous BM-MSCs, significant improvements in International Index of Erectile Function-5 (IIEF-5) scores and penile arterial flow have been reported without major adverse events. Similarly, ADSC therapy in post-prostatectomy ED has shown encouraging short-term results. However, large-scale trials are needed to clarify long-term efficacy, immune responses, and safety profiles.
Human amniotic fluid stem cells (hAFSCs) represent a promising alternative, offering characteristics that bridge embryonic and adult stem-cell profiles. These include broad multipotency, high proliferation, and low immunogenicity—traits ideal for allogeneic use and neuroregenerative purposes. Notably, hAFSCs secrete potent regenerative mediators such as brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF), and insulin-like growth factor-1 (IGF-1), all of which support neurovascular repair and smooth muscle integrity. Our recent studies demonstrate, for the first time, that hAFSCs persist long-term in penile tissue and can differentiate into cavernous smooth-muscle cells, effectively replacing damaged tissue and improving erectile function even in chronic neurogenic ED models.
Despite these advantages, our findings did not reveal in-vivo homing of hAFSCs to nerve injury sites or differentiation into neural tissue. This suggests a need for future studies to identify the specific microenvironmental cues required to induce such responses. Additionally, combining hAFSCs with platelet-rich plasma (PRP) may provide synergistic benefits—enhancing stem-cell homing, paracrine signaling, and in-vivo differentiation—thereby advancing a more effective, scalable, and safe therapeutic strategy.
Hann-Chorng KuoTaiwan
Speaker
ACU Lecture: Videourodynamic Study for Precision Diagnosis and Management of Lower Urinary Tract DysfunctionVideourodynamic Study in the Precision Diagnosis and Management of Lower Urinary Tract Dysfunctions
Hann-Chorng Kuo, M.D.
Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien, Taiwan
As a urologist, we are dealing with patients with lower urinary tract symptoms everyday. We did transurethral resection of the prostate (TURP) for elderly men with bothersome lower urinary tract symptoms (LUTS). We put a suburethral sling for women with stress urinary incontinence (SUI). We prescribed alpha-blocker for those who had difficulty in urination. We add antimuscarinics for patients with urgency urinary incontinence. Our seniors always told us these treatments are effective in treating patients with LUTS. However, patients still had LUTS after TURP, women still complained of urgency and dysuria after anti-incontinence surgery. Medication based on storage or emptying LUTS do not work all the time. Why? Because symptoms are not reliable, a large prostate does not indicate bladder outlet obstruction (BOO), and SUI is not solely a result of urethral incompetence. Therefore, in diagnosis and management of LUTS, we need precision medicine to direct an accurate pathophysiology of LUTS, and to guide an appropriate management based on the bladder and bladder outlet dysfunction. When we encounter patients who have LUTS refractory to the treatment based on our initial diagnosis, when we are treating patients who have complicated storage and emptying LUTS, when we are not sure patients could benefit from the invasive procedures for their LUTS, or patients who had both lower and upper urinary tract dysfunctions, videourodynamic study (VUDS) is an essential investigation for diagnosis and management of LUTS. In additional to benign prostate hyperplasia (BPH) and BOO, male patients with emptying LUTS might result from detrusor underactivity (DU), bladder neck dysfunction (BND), urethral sphincter dysfunction, or a hypersensitive bladder, which is not related with the prostate. Patients with BPH and LUTS might have latent neurogenic lesion, such as minor stroke, Parkinson's disease, or early dementia, causing LUTS. TURP without known the neurological disease might exacerbate LUTS after surgery. Mixed SUI comprises intrinsic sphincter deficiency (ISD) and detrusor overactivity (DO). The overactive bladder (OAB) symptoms may also result from an incompetent bladder outlet. Without comprehensive VUDS, we might cure the SUI, but OAB remains after placing a mid-urethral sling. Bladder pain is the cardinal symptoms of interstitial cystitis. However, bladder pain perceived by the patient might also originate from BOO or pelvic floor fascitis. VUDS can help in discrimination. DU and low compliant bladder and ISD could result in complicated storage and emptying LUTS. Large post-void residual (PVR) should alert us to investigate whether it is originated from low compliance or ISD. Dysfunctional voiding (DV) and BND in women with emptying LUTS. OAB symptoms are not always coming from the DO. BOO such as BND, DV, or urethral stricture might exist in men and women without voiding symptoms. Urinary difficulty in women is usually a result from low detrusor contractility, due to DU, or through inhibitory effect from a poorly relaxed pelvic floor or urethral sphincter. A simple bladder neck incision can effectively restore spontaneous voiding in men or women with dysuria due to DU or BND. However, a tight BN is necessary to predict a successful treatment outcome. Patients with central nervous system (CNS) disorders or spinal cord injury usually have complicated LUTD, including DO, BND, DV, detrusor sphincter dyssynergia (DSD), and vesicoureteral reflux (VUR). Management of LUTS in CNS disorders or SCI patients should know the current bladder and bladder outlet dysfunctions. Pediatric incontinence, children with myelomeningocele, DV, or recurrent urinary tract infection are complicated and need precision diagnosis before treatment. Especially when surgery is planned. Lower urinary tract dysfunctions is a dynamic condition. The bladder and bladder outlet dysfunction might change with time. Although VUDS is considered as an invasive investigation with radiation exposure, the advantages in accurate diagnosis and guiding management outweigh these disadvantages.
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Andrew HungUnited States
Speaker
Future Direction of AI Application in UrologyDr. Hung will share the contemporary applications of AI in Urology, and how it will be utilized in the near future.
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Mahendra BhandariUnited States
Speaker
Predictive Intelligence in Motion: Enabling Surgical Automation in Urologic RoboticsArtificial intelligence is rapidly transforming urologic robotic surgery, not by replacing the surgeon, but by enhancing anticipation, precision, and intraoperative decision-making. This talk focuses on how high-fidelity predictive models serve as the computational core of surgical automation enabling intelligent systems to respond to anatomical variation, predict surgical planes, and adapt in real time.
I will highlight the evolving landscape of AI-driven assistance in procedures like robotic prostatectomy and partial nephrectomy, where predictive analytics and multimodal data (vision, force, motion) converge to guide dissection and preserve function. A special emphasis will be placed on the emerging and underutilized concept of "no-fly zones “predefined anatomical areas digitally fenced off to prevent inadvertent damage. Widely applied in ophthalmology and orthopedic robotics, this concept has yet to be integrated into urologic surgical platforms, despite its potential to enhance safety during nerve-sparing or vascular dissection.
The presentation will explore:
• AI-based risk prediction and intraoperative guidance
• Learning from large, annotated video and sensor datasets
• A proposed roadmap to introduce “no-fly zones” in urologic procedures
Ultimately, the talk advocates for a future where predictive AI not only guides the hand but safeguards the intent, making surgery smarter, safer, and more consistent.
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Isaac KimUnited States
Speaker
Update on the Apa Neoadjuvant TrialIn patients with high-risk prostate cancer (PCa), neoadjuvant androgen deprivation therapy (ADT) is not an accepted standard of care. However, we hypothesize that neoadjuvant ADT may result in improved quality of life by down-staging prostate cancer and thereby, permitting a better quality of nerve sparing. has demonstrated benefit in surgical outcomes after radical prostatectomy (RP). To test this hypothesis, we conducted a prospective randomized trial evaluating the effect of neoadjuvant Apalutamide (Apa) +/- abiraterone acetate/prednisone (AAP) and a gonadotropin-releasing hormone (GnRH) agonist on nerve sparing during RP in men with high-risk PCa. Update on the Results of SIMCAP StudyApproximately 7% of new prostate cancer (PCa) patients in the US will be diagnosed with metastatic disease. The role of surgery in this population remains unclear. To investigate the therapeutic value of radical prostatectomy in men with de novo metastatic prostate cancer, we are conducting the phase 2.5 randomized clinical trial SIMCAP (NCT03456843).
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John YuenSingapore
Speaker
Technical Pearls: Total Extraperitoneal TechniquePractice-Changing Development in RaLRP
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Vipul R. PatelUnited States
Speaker
Lessons from 20,000 Robotic Prostatectomies: A Global Expert’s PerspectiveTechnical Considerations for Large Prostates over 100gmsTelesurgery: The Future of Surgery
TICC - 3F Plenary Hall
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