Can stem cells be used to treat incontinence? You may be surprised by the answer!

The following transcript was generated electronically. Please let us know if you see any transcribing errors and we’ll get them corrected immediately. 

Bruce Kassover: Welcome to Life Without Leaks, a podcast by the National Association for Continence. NAFC is America’s leading advocate for people with bladder and bowel conditions, with resources, connections to doctors, and a welcoming community of patients, physicians, and caregivers, all available at NAFC.org. 

Welcome to another episode of Life Without Leaks. I’m your host, Bruce Kassover, and joining us today is Steve Gregg, the Executive Director for the National Association for Continence. Hello, Steve. 

Steve Gregg: Hi, Bruce. I’m really looking forward to our conversation today. We have a really great guest, and I think we’re really going to enjoy this. 

Bruce Kassover: I think so, too. Today’s guest is Dr. Michael Chancellor. He’s a professor of urology. He’s a director of the Aikens Research Center. He’s at the Corewell Health Beaumont University Hospital, Oakland University, William Beaumont School of Medicine, up in Detroit. He’s a pharmaceutical entrepreneur, really has a resume that’s pretty impressive. So, so welcome, Dr. Chancellor. Thanks for joining us today. 

Dr. Chancellor: Oh, thank you so much for having me, Bruce and Steve. 

Bruce Kassover: Excellent. Now, we really wanted to get your thoughts in particular on stress urinary incontinence. I want to start talking about that, but first, you know, people see commercials for incontinence products and they talk about, “If you have leaks, here’s something that you might want to try.”

But in your experience, do you find that patients even know the difference in the sorts of incontinence and the type of leaking they, that they experience, or is it all just sort of a mush when they think about it? “Oh, leaks are all the same thing.” 

Dr. Chancellor: Yeah, I think you hit it right on the button. It’s hard. You gotta learn this in neuromedical and nursing school. So people don’t really understand. They leak urine. You know, “I wear a pad.” But they don’t know that some leakage chould be caused by bladder dysfunction, and yet the other can be due to a weakened sphincter, the valve muscle that supports our bladder to hold our urine in.

So it’s very hard to describe symptoms to your family and your friends to make sense of it. And the stuff you see on the lay media sometimes can be more confusing. Trying to tell you to go to the drugstore to get diapers, to take some homeopathic medicine, and that’s supposed to help every type of bladder problem.

Bruce Kassover: We certainly see a lot of ads for, you know, like, like you said, for absorbent products. There’s also been a lot more ads lately for all sorts of treatments. They don’t really… define what the treatment is, I guess, because the, the FDA would require the commercial to be, you know, three hours long with all of the, the disclaimers they’d have to add.

But, so if I’m somebody and I’m experiencing leaking, what do I look for? To give me an idea of whether or not I have something like an SUI or OAB, or, or how can I tell what’s actually going on? 

Dr. Chancellor: Yeah. And that, so, Dr. Google can be very helpful. Because we all have to urinate six, seven, eight times on a typical day.

But if you get, and if you get up zero to once per night, you know, I am an aging baby boomer myself, so getting up once per night is not that big of a deal. But if you get up three, four, five times in a night, that’s not normal. It’s not a normal part of aging. And also, if you’re physically active, if you’re playing tennis, running and you leak urine when you’re active.

Well, that’s stress incontinence. So, and that is not normal. So it’s, it’s pretty obvious that there’s something isn’t right. You leak urine, you don’t have control of your urination, and you’re looking for every bathroom, and you’re just so embarrassed. On an airplane, you know, for a three hour flight, you know who has the bladder problem – they’re the one that gets up three times to go to the bathroom. 

Bruce Kassover: So, I’m a patient. I’m seeing I have these problems. I decide, okay, you know what? It’s time to go to the doctor. I’m not going to just, you know, sort of drink a magic tea or, or, you know, rub something on, on the top of my head and hope that that makes things go away. I go to the doctor. What sort of treatment options am I going to be presented with?

Dr. Chancellor: Yes, so, and now you made a good point, so, seeking help, talking about it, is probably the biggest barrier, the awareness, because, so, it’s so embarrassing, people don’t talk to even their family, they don’t tell their kids about it, until it’s been years later, and they’re just so fed up, and they’re not going to their granddaughter’s wedding, before this really comes up. So you talk, and there are treatments for it. It’s not the tea and some of the stuff that’s just not appropriate, but there’s the basic exercise, the Kegel exercise can be very helpful for women with stress urinary incontinence, and it’s easy to learn. It’s sort of like adult bladder training. You’re more likely to leak urine than somebody with stress incontinence if the bladder’s full. So get into the habit of urinating every two to three hours and don’t do stuff when you have a full bladder.

Very simple stuff you can do at home that can make it better. And, you know, if you get up four times a night to urinate, well, after dinner, stop drinking the liquid, move your fluid intake into the morning. Very just practical common sense stuff that can make a world of difference. 

Bruce Kassover: You said something that was interesting. You talked about, you know, getting, you getting into the habit of trying to go to the bathroom every couple of hours. One thing, if I remember correctly, and correct me if I’m if I’m just just imagining things, is that there’s also some sort of guidance that you should not train yourself to go to the bathroom at every opportunity just to be safe. Is that right? And what if, that is, what’s sort of the right balance that you should be going for? 

Dr. Chancellor: Right, that… you’re exactly right. And that’s why in the beginning I sort of hinted on what’s the normal range, six seven eight times per day, because if you go to the bathroom at every opportunity, something I personally do out at the airport before I’m going on a flight to California, then you could be putting yourself in a situation where you’re like going to the bathroom a dozen, 15 times a day and your bladder never get a chance to stretch out.

So time voiding every 2 to 3 hours and before you do physical activity, it’s appropriate because you want your bladder to be able to sleep through the night with you and not wake you up. So timed voiding every 2 to 3 hours if you have, if you really have a leakage problem, is much better, and doing the exercises is much better than going there every 5 minutes or every time you’re near a bathroom.

Bruce Kassover: Yeah, well, if you’re in an airplane, just the awkwardness of having to, you know, you’re in the middle row and getting up and you drop something on somebody, you gotta go to the bathroom ahead of time anyway, because otherwise it’s terrible. 

So you mentioned Kegel exercises and you said it’s easy, but I also hear a lot of people say, “I don’t know what I’m doing. I don’t know how to do it. I can’t find the right muscles.” Tell me a little bit about how to do a good Kegel. 

Dr. Chancellor: Yes, and you’re right again there. When you tell people, people would like squeeze down, they’ll squeeze their, they’ll do their, squeeze their stomach muscle, the rectus muscle for sit ups. Well, you know what? That makes you leak worse. So one way for both women and men, the beginning process is to stop your urination in midstream. So if you can stop your urination, you’re turning off the faucet, which is the muscle. The sphincter muscle is small, it’s like the size of a pinky, like a ring, like a ring around your ring finger.

So if you can stop your urination midstream, like if I’m walking my daughter’s dog and such, then I’m not saying you do that because that’s, that’s uncomfortable. But that, you know, you’re squeezing the right muscle and then like physical therapy is not easy, it’s like, but you do that multiple times a day and hold that for a count of 10 and like almost every exercise regime with time, you notice you’re better, you’re not afraid to be active, you leak less and you have better control.

Bruce Kassover: It really does make a difference? I mean, it’s not just sort of like one of those things that they say, try, but you can’t really hope that a lot’s going to happen. It really does generate improvement then? 

Dr. Chancellor: It does, but it’s like going on a diet for a weight loss. It’s, it’s hard. It’s hard to stick with a regimen.

You don’t see the bulging bicep, like if you’re lifting weights at the gym. You’re looking, and it doesn’t happen tomorrow or next week. But if you keep at it, and the more you, it can only help, it does help. So yes, it is effective, but the compliance, the ability to do it on a regular basis, long term, that’s not been so good.

Bruce Kassover: Okay, so if that’s the case, so even if you’re diligent, you, maybe you’re starting to see improvement, what else can be done at the same time to help address some of those symptoms? 

Dr. Chancellor: Yeah, and it goes back to your earlier questions. What is incontinence? I mean, you’ve got your, the National Association for Continence, they probably get these questions all the time, because if you have an overactive bladder, a bladder problem, then there’s very good pills for it.

There’s even neuromodulation and Botox injections. But for stress incontinence, which accounts for about half of all incontinence, there’s no medication for it. There is no pill for it, be it herbal tea or a prescription drug. So that’s where I think it falters, and there’s a major gap. A great unmet need is that we don’t have an effective pill for stress incontinence.

So you do the behavior and you do the exercise, or if you go see a doctor, refer to a specialist, then you’re talking about, right now, it’s like a surgical option. 

Bruce Kassover: That’s not the most heartening news I’ve ever heard. So, if you’re having a problem in behavior and Kegels and things aren’t really making a difference, surgery is probably one of the approaches you might want to consider then.

Dr. Chancellor: Yes, but then that’s one reason why people don’t want to bring it up because, you know, nobody wants to go see a doctor and the first thing out of his or her mouth is, “Oh, you know, you leak urine, you need surgery.” That’s, that, people want to try to really see if there’s something else they can do. So they refrain.

They think, “Oh, I’ll live with it with a diaper from CVS or Walgreens because if I go see a doctor and they’re going to do a surgery on me…” and there are stories with, like, surgery, some, it can be very effective. But there’s, like, horror stories also. 

Bruce Kassover: How invasive, how involved is the surgery? I mean, are we talking about open heart level stuff, or is it sort of much milder in comparison?

Dr. Chancellor: It is much milder in comparison. And it’s gotten way better over the time. So, but essentially, it’s using a bulking agent. Like if the washer in your faucet is cracked, you can bulk it up with a filler to get a better seal. Or you can do… Let’s call it a slim procedure or a small band of tissue or or material to sort of lift up the sphincter muscle to tighten it up some to repair the washer to get it a seal.

These can be done in either 10, 15 minutes or an hour and most people can go home the same day or stay overnight. So these are, ballpark, it’s like from the surgical, surgeons end, it’s like removing an appendix or gallbladder, but with a very distant analogy. 

Bruce Kassover: Yeah, but that sounds like a heck of a lot better than, you know, living the rest of your life worrying about leaks. In fact, if you talk about 15 minutes and, you know, out the same day, that makes the word “surgery” seem like it’s a little more dramatic than it actually is. 

Dr. Chancellor: Yes, and surgery for stress urinary incontinence, because the disease is so common, we’re talking like one out of every six women. It’s so common. Surgery, which includes the bulking agent injection, is one of the most common surgeries that’s performed across all medical specialties. So yes, if you’re a woman in your 50s and you’re leaking urine, do you really want to have to be in diapers for the next 30, 40 years of your life, if a surgery can fix it? So I think there’s a compelling reason to seek treatment, to be aware of treatment because treatment can help or cure the problem. 

Bruce Kassover: Now, what about the risk profile for surgeries like this? I mean, I know that every surgery has a degree of risk, but, you know, how, how would you characterize it? 

Dr. Chancellor: Yeah, yeah, I think that the characterization first is with the bulking agent. It’s minimally invasive, but the effective rate, how curing it is and how long it lasts, just like with the caulking agent if you need it around your faucet around the house, is not as good as we like, so the cure rate is not ideal and the persistence rate is less than we like. And with the sling type of surgery, it’s much better at persistent surgery, but most people have heard of the mesh mess where all that, the legal issues when material was used in the past that caused erosion and pain.

So people, it’s just, there’s a hesitation when you look up the sling type of surgery, you see the problems that has, have been with the medical devices, the meshes that were previously approved by the FDA and then ran into erosion problems. 

Bruce Kassover: Now, I’m wondering, I’m also getting the sense from what you’re saying that, that, you know, well, let me put it this way, if you are a woman who’s in her 50s right now, if you remember back what medicine was like when you were in your 20s, it was like an entirely different world, I mean, you might as well be, you know, we’d be having, you know, medieval doctors doing bloodletting and, you know, using , you know, leeches and well, I guess we still use leeches in some cases, but yeah, but it was sort of like medieval in comparison.

Where is surgery or where – not, not even surgery – where are treatments for SUI going? What sort of innovations do you see down the road? 

Dr. Chancellor: Yeah, and this was me, a younger me, I was doing that, definitely was doing a lot of the slings, pelvic prolapse, the bulking agent injection, and in fact, where I trained in urology was at the University of Michigan, and that’s where the first bulking agent, the collagen injection, was first developed, so I was aware with it from the get go in the mid 1980s.

So, but then as doing this, I realized there are shortcomings. It’s, it’s stitches and, and tapes to cinch off to tighten up and at the inception of the wave of medicine, that’s just incredible, which is tissue engineering, regenerative medicine and gene therapy. Coming up with the idea that, can we, since this is a weakened, damaged muscle, can we not fix this with just stitches and tape, but can we actually just regenerate, repair the muscle? That’s what we want, a better sphincter muscle. And that’s what led me on my path, is by doing these surgeries and seeking something better. And the patient talking, if there’s some way that they can just repair the sphincter, how I went down the path of the regenerative medicine research and where we are today.

Bruce Kassover: And now, regenerative medicine. I mean, it sounds like, you know, like when a lizard loses its tail, it grows another one; are we talking about something like that? What do you mean by regenerative medicine?

Dr. Chancellor: Yes, that is like a starfish losing one of its stars. You are right. That is stem cell, right? That’s, that’s how I got started when I got read about it.

I was just so fascinated. Like, how is it possible that a stem cell, I mean, not as a baby forming different, uh, developing, but how can an adult have, we still have these stem cells, the cells, they’re able to regenerate an organ, a muscle, a nerve that resides in our body to help us heal up. And can we harness that for something as common and not as exciting as curing cancer, but something just to affect the quality of life like stress urinary incontinence. So that’s how, that’s the pathway I went down. 

Bruce Kassover: So how does this work then? What’s the process that, that, that they’re, they’re investigating right now? 

Dr. Chancellor: Yeah. So how I got started is that’s why I, I wanted to regenerate the sphincter and I was, I needed a muscle stem cell to do that. So, you know, I’m a physician, a doctor that does surgery and sees patients that gradually transitioned over to a researcher, a physician scientist.

So I found a bright young scientist, a PhD, who is trying to harvest a muscle stem cell to cure kids with muscular dystrophy, Dr. Johnny Huard, so, you know, I called him up and I, if he would, if I could talk him into working with me to bring his research into trying to cure, to improve the sphincter muscle function. And that’s how we went down that path. We were able to achieve some really exciting early preclinical research in the rat and mice model that we really think we developed something exciting. So we were able to patent that through the University of Pittsburgh and that led to Cook, one of the largest and important global medical device technology company, felt they, this was an opportunity for them to get into regenerative medicine and they were, they licensed the muscle cell therapy idea we had, and then that’s how we got started. 

Bruce Kassover: That’s very cool. So where do you stand right now? 

Dr. Chancellor: Yeah, well, it takes a long time. So where we stand right now is if you come to Pittsburgh. for a Steelers game, not a Pirates game, but you would see that in the suburb of Pittsburgh, there is a really incredible state-of-the-art, world-class self-regenerative medicine manufacturer facility where about 150, 200 people work, and they can take a simple muscle biopsy done anywhere in the world, ship it FedEx to Pittsburgh, and they can find the cells with the regenerative property and grow that out over approximately three months and then put it on dry ice and ship it back to the doctors anywhere in the world and that doctor can inject that patient’s own regenerative muscle stem cell back into her.

Bruce Kassover: They’re doing this right now? You could actually get this done? 

Dr. Chancellor: Yes, we can. And we know this for sure is because our 1st study site was at the University of Toronto, when we started it, it was so new that the FDA was very hesitant because, you know, the FDA is careful, but they don’t like new things. But the FDA of Canada, called HealthCanada, was really wanted to make Canada a leader in the stem cell regenerative medicine.

So, the trial, the first human trial was approved at the University of Toronto. So, I flew up there several times. They did the biopsy as just a small needle biopsy of a muscle from the thigh and shifted across the border even, to Pittsburgh. It arrived a day or two later, and then 3 months later, as a simple outpatient procedure the cell was shipped back up to Sunnybrook Hospital in Toronto. And they injected back into, to the woman with stress incontinence. That’s how we got started. 

Bruce Kassover: So that’s very cool. And what sort of results are you seeing so far? 

Dr. Chancellor: Well, the published results, I think that It speaks for itself. It’s at Phase 3 trial. There’s three phases of the FDA, one, two and three.

The Phase 3, or called the pivotal trial, which is the trial that would decide if the FDA approves it or not. So. Cook Myosite has gone through Phase 1 and 2, and it’s now halfway through their Phase 3 Cellebrate trial. So the results, it showed a significant safety and highly promising efficacy that the FDA is allowing the Phase 3 trial and It granted like a fast track mechanism, the Regenerative Medicine Advanced Initiative Technology.

So it, it’s like deciding this is an important new things of priority in regenerative medicine, and we will give you a special, like the TSA pre type of thing that we want, we need. This is an important thing for, you have to prove your work, but this is important for the future of medicine and help a great on that need and you’ll get this RMAT designation so we can work together and to deliver a safe and effective trial.

Steve Gregg: Dr. Chancellor, two things. One, I want you to speak a little bit more to one of the questions I know our listeners and people will want to know more about. And you’ve said it, I think, nice and clearly. So, an individual has a biopsy of their tissue. And then that tissue is grown, and that tissue, their own tissue, is replaced in them.

So, it’s not foreign tissue, it’s not something new, it’s not genetically modified, like the stuff we see on packages. It’s their own tissue, which says there shouldn’t be rejection problems, I’m only growing my own cells. And so people should be comforted in that. Is that correct? 

Dr. Chancellor: Yeah, and that started right from day one, because the very first research, and there’s ethical concerns in using the embryonic stem cells.

And if you use somebody else’s cell, there could be rejection. What if it causes your own tumor? So, right from day one, this has to be your person’s own cell. And we found that women from the age of 18 up to the age of 85, 90 years old still have these cells. From their big thigh muscles, just like a little needle, a biopsy that has the ability to grow and expand and repair.

So it’s, it’s a grown person’s own muscle cell, a good muscle cell from a leg – because they can walk into a weak muscle area of weak muscle, which is the deficient sphincter. That’s causing the stress incontinence. 

Steve Gregg: The other piece is, while this sounds so scientific, you know, futuristic, it’s really the state of where medicine and science is going, right?

So it’s not really quite as sci fi as you would imagine, that people have been working on this kind of technologies for years, and so it’s just obvious that this is going to be therapy that’s going to be available when the FDA sees all of the hurdles are passed and cleared for safety and efficacy.

Dr. Chancellor: Yeah, and following the trends in the medicine and regenerative medicine fits with that. Look at the success with bone marrow transplant, the success with these, the immune therapies that’s curing many types of cancer. Or the gene therapy for sickle cell disease and blindness. This is where we’re at, and in fact, transplanting your own good cells into a bad muscle weakness is on the much simpler side than some of these, the frontiers of medicine that, that we’re, you know, we’re seeing excitement and results with every day.

Bruce Kassover: So, now tell me this, if I’m, so I’m hearing what you’re saying, I’m getting very excited about this. If I wanted to try and take advantage of this myself, can I participate in this right now? 

Dr. Chancellor: Well, the trial is for women with stress incontinence. 

Bruce Kassover: Yes, exactly. If I were a woman, could I take advantage of this?

Dr. Chancellor: Yes, yes, if you have… so, women with stress incontinence, we talked about that, you leak urine and such. The current trial, the Phase 3 trial, is called Cellebrate. And it really is, it’s stepping up to meet the hardest challenge. Which is like, for women that has incontinence, but even more so, they, they’ve been treated before in the past.

They had surgery. They had, they had the bulking agent injections and they’re just so fed up with it, frustrated because it didn’t work. And we talked about the limitations of current standard of care, the grade on that need. And they really resign. Oh, my God, I have this problem for a dozen year and the surgeries didn’t help.”

So now I am going to live with 30 years, 40 years with bad leakage and worsening leakage, which I envision, you know, that I’m going to have as I get older. This is where the future of regenerative medicine can potentially help is, you know, the toughest cases. This, that’s what all the stuff we talked about for cancer, for blindness, sickle cell.

That’s why it deserves the RMAT designation. It’s a big step forward and it’s for a real, real serious condition that we want to make a difference for. And regenerative medicine is so powerful that the same cell that we’re talking here for female stress incontinence, that they’re actually going to start a trial for women with fecal incontinence.

You know, such as like the sphincter there, their anal sphincters tore up during childbirth. That’s a muscle that’s distinct, but similar in area to the urinary sphincter. So the product is a platform that’s safe, and I think it will be starting trials for the treatment of fecal incontinence in the near future.

Bruce Kassover: So I understand that it’s at the Phase 3 stage right now with the FDA, and I know that, of course, you need to demonstrate the efficacy and the outcomes that you’re hoping for, but do you have any sense of how long things typically go through stage three before they get approved? Assuming everything works out right, is it, is it still a very long road ahead? Or is this sort of relatively close to the end of things? 

Dr. Chancellor: I think I believe it’s closer to the end of things. Just because it’s shown significant safety and the manufacturer, how the process is done, it’s all been worked out. It’s just that the rigor of the FDA, because when you regenerate a, a sphincter muscle, it takes time to show that it works.

So, you have to follow the patient for a year. So, and that’s why it’s taking longer than say, if you just take a medicine and you see 3 months later, if they lost 20 pounds or not, for regenerative medicine, and in the gene therapy, you have to check, make sure it’s safe and effective for 1 or 2 year in, in every patient that entered the study. And that’s what’s taking the time.

Steve Gregg: I think, Dr. Chancellor, that we may have listeners that are interested, females, that are suffering from stress urinary incontinence that are interested in the study and maybe participate to see if they’re candidates, and I believe we’re going to have some information around the clinical trial at NAFC.org, so in the future, people, after hearing you talk about what a great opportunity this is, there is a chance that they may be able to go and sign up and if they are in the right locations, potentially participate in this study. 

Bruce Kassover: Yeah, that’s a great idea, Steve, and I’m going to make sure to put a link in the show notes, so anybody who’s listening to this now, you should should be able to find a link to go visit it directly and see if you might qualify to participate.

So, tell me this, I suppose that there’s still a little bit of time before that becomes a therapy that’s available everywhere, but when it is, who would you go to for that? Would you just go to a urologist? Would you have to go to a surgeon of some sort for it? Who’s going to be able to administer this, this treatment when it is approved? 

Dr. Chancellor: Yes, the actual procedure and we worked on this from the get go. It’s not hard. It’s my, you guys are familiar with like the bladder Botox injection for overactive bladder. It’s about like that in degrees of complexity. So the biopsy is done in an office of a urologist or a urogynecologist.

They should be trained in this matter, but the procedure is not hard. It’s like numbing up the skin and using a needle to get a small sliver of muscle. And then three months later, you come back and you use a needle and inject your own cells, your own muscle derived cells, back into the sphincter area.

Once again, that’s an office procedure. It doesn’t require you to go in a hospital. So, board certified urologists, gynecologists who are, have received training in this matter, like those doctors that do Botox injections, I believe can all do this procedure very well. And we made it straightforward and location agnostic.

Just like our first patient was in Toronto. It can be. , it’s very important to me that, you know, oh, “I developed this, so I’m the only one that can do it.” Well, that’s crazy. That’s selfish. That’s… job is to be able to help thousands of doctors to help millions of patients anywhere in the world. And that’s where, it’s all ready to do that. After approval, it’s ready for that. Anywhere FedEx can get between Pittsburgh and to and from in 72 hours. And that’s every corner of the world, wherever it’s approved that treatment can be available for. 

Bruce Kassover: Of course, I guess, you know, like people do Botox parties. I don’t want to imagine that one day there’s going to be sphincter parties, though.

Dr. Chancellor: Well, you can get double. How’s that, Steve, that we can… because if somebody with overactive bladder and stress incontinence, we can do a little cell therapy, a little Botox. 

Bruce Kassover: So now when you have this done, how long do you expect that it takes before people actually see meaningful results once they’ve had the injection?

Dr. Chancellor: Yes. It’s not like a pill. It takes several weeks to three months. Botox takes about a week or two before you notice an improvement. With cells, since we’re regenerating a damaged sphincter, it’s much like letting a bone heal. It’ll take a few weeks before it gets better and heals. 

Bruce Kassover: Very cool. Okay. That’s probably not such a bad trade off for, you know, preventing, you know, decades of having leaks. It certainly sounds a lot more pleasant than, than surgery. So, we’ve heard a lot about the fact that SUI doesn’t always have the enormous range of treatment options that some other incontinence conditions might have, but there are some promising things coming down the road.

If I am a woman today, and I have… I’m experiencing the symptoms of SUI. What can you tell me? What, what would the future be like for me, assuming that I decide to take an active role in my incontinence care? 

Dr. Chancellor: I think the first thing is, you can talk about it. You know, it’s not a natural part of aging. It is common. And you can make it better. And the second is, look up, work with a physical therapist to do the behavior modification, the timed voiding and the exercise, and in your area, find a good urologist, urogynecologist who really specializes in this area to see if you are a candidate for the bulking agent or the surgery today, or perhaps to be in a clinical trial and knowing that there is great unmet need and the FDA is devoting attention to this, to your problem.

And that there will be advances. So you are not, there’s no reason that you’re going to have to live with this for the rest of your life. And my third point is the National Association for Continence is a great resource for the entire population with bladder control problems. So thank you for your work.

Steve Gregg: Thank you very much, Dr. Chancellor. I was going to say that we work very hard to try to encourage women and men to seek care, and it is very difficult for a lot of them to find quality care from someone like you, but we encourage them to have those conversations with the primary care and then hopefully talk to a specialist, a urologist or urogyn, but most importantly, to not give up.

There are options and there are solutions and working with a physician like you is really critical to helping them achieve some degree of reduction in leaking. And hopefully these regenerative medicine techniques will come around sooner rather than later. But until then, don’t give up.

Dr. Chancellor: Well, thank you for having me, Bruce and Steve.

Bruce Kassover: Life Without Leaks has been brought to you by the National Association for Continence. Our music is Rainbows by Kevin MacLeod. More information about NAFC is available online at NAFC. org.