Update: the "Contiform" intravaginal device in four sizes for the treatment of stress incontinence

Compliance with Uresta (CURE) study; a 12 month follow-up of 40 women

INTRODUCTION AND HYPOTHESIS

The Uresta bladder support is an effective management option for women with stress urinary incontinence (SUI), however, there is a lack of data assessing long-term compliance. The aim of this study was to assess compliance at 12 month follow-up in women using the Uresta bladder support for exercise related SUI.

METHODS

This was a prospective study advertised on social media, running clubs and gyms. Participants were fitted with a Uresta bladder support and followed up over a 12 month period. Power calculation recommended a sample size of 43. Ethical approval was obtained. Outcomes were assessed using the PUQ, ICIQ-FLUTS, UDI-6, IIQ-7, QUID and PGI-I questionnaires.

RESULTS

Forty-six women were recruited with an average age, BMI and parity of 42, 24 and 2.3 respectively. The most common activities were running (48%) and CrossFit (22%). Six participants withdrew after 2 weeks. Compliance was 90% at 12 months (n=40). Uresta insertion and removal was 'okay', 'easy' or 'very easy' for 86% and 75% respectively. Leakage was improved (n=13), greatly improved (n=12) or stopped (n=5) for 83% of participants, 75% were 'much better' or 'very much better' on the PGI-I scale, and 94% would recommend Uresta to a friend. There were no adverse events.

CONCLUSIONS

The Uresta bladder support is a safe, effective, user-friendly management option for women who experience SUI during exercise with excellent long-term compliance. Further studies are required to identify predictors of successful fitting and efficacy, compare outcomes with different devices, and develop a validated questionnaire assessing SUI with exercise.

Current State of Non-surgical Devices for Female Stress Urinary Incontinence

PURPOSE OF REVIEW

The purpose of this review is to summarize and assess the current non-surgical devices for the treatment of stress urinary incontinence (SUI).

RECENT FINDINGS

Devices for SUI can generally be divided into two categories. One category is the augmentation of pelvic floor muscle training (PFMT), wherein devices such as vaginal cones, intravaginal biofeedback, and electrical or magnetic stimulation are used to strength the pelvic floor musculature, though none are more effective than traditional PFMT. The second category of devices mechanically occludes the outlet and includes incontinence pessaries, intravaginal occlusion devices, and urethral plugs and patches. While these are palliative rather than curative, they share similar rates of improvement in leakage. A number of novel devices exist for the treatment and management of SUI. Though no single device has been shown to be more effective than PFMT alone, they may be beneficial for women who have difficulty isolating their pelvic floor muscles, desire accountability, or prefer technology-based engagement. Outlet occlusion devices are less comfortable for the patient, but remain an option for women who do not desire surgery.

A Vaginal Inlay for Reduction of Stress Urinary Incontinence: Outcome of a Randomized Clinical Trial and Four User Acceptance Studies

A multicenter, randomized, controlled clinical trial and four postmarket user acceptance investigations were carried out to document the safety, performance, and user acceptance of Efemia Bladder Support, a novel vaginal inlay for the temporary reduction of stress urinary incontinence (SUI). The clinical investigation enrolled 97 women diagnosed with SUI, randomized 3 : 1 to either treatment or standard care (control). The primary endpoint was reduction of urine leakage, measured as change in pad weight baseline week compared with treatment week. Secondary endpoints were treatment success, calculated as the percentage of subjects with >70% reduction in pad weight, reduction in incontinence episodes, and quality of life (QoL). 75 women (77%) completed the clinical investigation. No serious adverse events occurred. The treatment group reached a 55% (p < 0.001) mean reduction of total leakage compared to the control arm. A subanalysis, involving only leakage during provocation testing (coughing and jumping), showed a 67% (p < 0.001) mean reduction of leakage. No significant effect on QoL could be observed. 51% of the women answered “yes” to the question if they would use the device to reduce SUI. The user acceptance of the device was further investigated in four postmarket studies, using an improved device design with a slimmer centerpiece and a thinner handle, while keeping the effect achieving parts of the device unchanged. An average of 74% of the 102 participants in the postmarket studies reported that they were likely to continue using Efemia. The highest user satisfaction was seen in the two studies evaluating the use of Efemia during exercise, where 83% and 88% of the women were likely to continue using Efemia. It can be concluded that Efemia is a safe, well-tolerated, and effective alternative for reducing SUI, both in everyday life and during physical exercise.