Effect of the Macroplastique Implantation System for stress urinary incontinence in women with or without a history of an anti-incontinence operation

Macroplastique Is a Safe and Effective Long-term Surgical Treatment for Stress Urinary Incontinence: Prospective Study with 10-Year Follow-up

BACKGROUND AND OBJECTIVE

Until a few years ago, a midurethral sling was considered the gold standard for the treatment of female stress urinary incontinence (SUI) after failure of conservative therapies. However, criticisms regarding the rate of mesh exposure and lack of long-term efficacy have led to reconsideration of other surgical procedures. Our aim was to investigate long-term subjective and objective outcomes after injection of Macroplastique, a urethral bulking agent.

METHODS

We prospectively enrolled all consecutive women complaining of pure SUI symptoms with urodynamically proven SUI who received a Macroplastique injection. We investigated patient-reported subjective outcomes using International Consultation on Incontinence Questionnaire-Short Form, Urogenital Distress Inventory, Patient Global Impression of Improvement, and Visual Analog Scale (VAS) questionnaires, and the cough stress test to assess objective outcomes. Adverse events were recorded during follow-up.

KEY FINDINGS AND LIMITATIONS

At 10 yr after Macroplastique injection, the objective cure rate was 56% and 71% of patients reported that they were satisfied. Long-term data revealed no significant decline in subjective or objective cure rates. No serious complications were reported. Study limitations include the small sample size and the lack of pad tests and bladder diaries for postoperative evaluations.

CONCLUSIONS AND CLINICAL IMPLICATIONS

Our study shows that Macroplastique injection can be an effective and safe option for the treatment of female SUI in the long term, even when used in the first-line setting.

PATIENT SUMMARY

We evaluated outcomes for women with stress urinary incontinence (SUI) who were treated with an injection of Macroplastique gel into the wall of the urethra to prevent leakage of urine. We found that this is a safe option for treatment of female SUI that is effective in the long term.

Effectiveness and safety of bulking agents versus surgical methods in women with stress urinary incontinence: a systematic review and meta-analysis

INTRODUCTION AND HYPOTHESIS

The objective was to evaluate the efficacy and safety of bulking agents compared with surgical methods for female stress urinary incontinence.

METHODS

Inclusion and exclusion criteria: women with stress urinary incontinence. Bulking agents versus any surgical treatment as a comparison. Patients with other types of incontinence and treatment were excluded. Electronic databases (PubMed, MEDLINE, and the Cochrane Library) were searched from 2000 until 2021 to identify articles evaluating the effectiveness and safety of urethral bulking agents versus surgical methods. Risk-of-bias assessment tools recommended by the Cochrane Society were used to evaluate the risk of bias in the studies included.

RESULTS

Six studies were included in the quantitative synthesis for a total of 710 patients. Our systematic review and meta-analysis showed that bulking agents are less effective than surgical procedures according to subjective improvement after treatment (RR = 0.70, 95% CI: 0.53 to 0.92, p = 0.01). There was no statistically significant difference between these two methods with regard to complications after the intervention (RR = 1.30, 95% CI: 0.30 to 5.66, p = 0.73).

CONCLUSION

The main limitation of this systematic review and meta-analysis was the absence of a common objective outcome measure to evaluate effectiveness. However, it shows that bulking agents are less effective than surgical procedures in subjective improvement. Safety analysis showed no significant difference between these methods. Hence, we believe that the first and final surgery is considered to be the best.

Urethral bulking agents for the treatment of stress urinary incontinence in women: A systematic review

AIMS

To perform a systematic review to assess and compare the efficacy and safety of all urethral bulking agents (UBAs) available for the treatment of stress urinary incontinence (SUI) in women.

METHODS

This systematic review was conducted in accordance with the PRISMA guideline. A systematic search was conducted using the Ovid Medline, Embase and PubMed databases. Studies were included if they involved women who underwent either Bulkamid®, Macroplastique®, Durasphere®, Coaptite®, or Urolastic® injections for the treatment of SUI. A total of 583 articles were screened with 56 articles included. A qualitative analysis was performed.

RESULTS

The newer synthetic UBAs are not inferior to Contigen®, with variable mean success rates of 30%-80% in the short-term. Better long-term success rates were found with Bulkamid® (42%-70%), Coaptite® (60%-75%), and Macroplastique® (21%-80%) on qualitative review. Urinary tract infection rates were similar between bulking agents (4%-10.6%) although temporary acute urinary retention was more commonly associated with Coaptite® (mean: 34.2%), and de novo urgency in Durasphere® (mean: 24.7%). Significant complications such as migration into lymph nodes was reported with Durasphere®. Erosion was reported with Macroplastique®, Coaptite®, and Urolastic®, with a rate as high as 24.6% in one study of Urolastic®.

CONCLUSION

Available data support the use of Bulkamid® and Macroplastique®, which has shown a short-term efficacy of 30%-90% and 40%-85% respectively, and long-term efficacy of 42%-70%, and 21%-80%, respectively. Bulkamid® appears to have a more favorable safety profile, with no cases of erosion or migration of product associated with its use. Direct comparisons of UBAs have not been performed.

Macroplastique for women with stress urinary incontinence secondary to intrinsic sphincter deficiency

Objective

To evaluate the subjective and objective outcomes of Macroplastique® (MPQ) in women with stress urinary incontinence (SUI) secondary to intrinsic sphincter deficiency (ISD).

Materials and Methods

Following Institutional Review Board (IRB) approval, charts of non-neurogenic women with SUI secondary to ISD who underwent MPQ injection and had 6 months minimum follow-up were reviewed from a prospectively maintained database. Patients were divided into 3 groups: Naïve (Group I), Prior Anti-Incontinence Surgery (Group II), and combined Prior Bulking Agent and Anti-Incontinence Surgery (Group III). Data collected included SUI self-report, Urogenital Distress Inventory (UDI-6) Question 3, and VAS Quality of Life (QoL) Questionnaire scores at baseline and in follow-up. Three-dimensional ultrasound (3DUS) evaluated volume/configuration of MPQ. Success was defined after the last MPQ injection as a UDI-6 Question 3 score of 0 (dry) or 1, and no reoperation for SUI.

Results

From 2011-2017, 106 of 142 women met study criteria. At a median follow-up of 20 months (mean=26 months; range: 6-71), success rate was 41% for Group I, 40% for Group II, and 65% for Group III (p = 0.22). QoL scores were significantly improved over baseline in all groups. There was no significant difference in clinical outcome between the asymmetrical and symmetrical group on 3DUS. The completely dry rate was highest in Group III at 29%, compared to 4% for Group I and 15% for Group II (p = 0.05).

Conclusion

Macroplastique® improved subjective and objective outcome measures for SUI secondary to ISD as both a primary and secondary treatment option in women.

The female continence mechanism measured by high resolution manometry: Urethral bulking versus midurethral sling

AIMS

Traditional technology to characterize urethral pressure changes during dynamic conditions is limited by slow response times or artifact-inducing withdrawal maneuvers. The 8F high-resolution manometry (HRM) catheter (ManoScan™ ESO, Covidien) has advantages of fast response times and the ability to measure urethral pressures along the urethral length without withdrawal. Our objective was to determine static and dynamic maximum urethral closure pressures (MUCPs) and resting functional urethral length (FUL) in women using HRM before and after transurethral bulking and compare results to other women who underwent midurethral sling (MUS).

METHODS

We recorded rest, cough, and strain MUCPs and FUL in 24 women before and after transurethral bulking with polydimethylsiloxane (Macroplastique®) using the HRM catheter and compared these changes to HRM values from 26 women who had the same measures before and after MUS.

RESULTS

At rest, MUCPs increased minimally after both urethral bulking and MUS (3 vs 0.4 cm H₂ O respectively, P = 0.4). Under dynamic conditions there were statistically insignificant small increases in MUCP and these increases were markedly less than after MUS (cough: 1.5 vs 63.8 cm H₂ O, P < 0.001 and strain: 11.5 vs 57.7 cm H₂ O, P < 0.001). FUL increased by 0.5 cm after transurethral bulking (P = 0.003), and decreased by 0.25 cm after MUS placement (P = 0.012).

CONCLUSIONS

The mechanism of continence after urethral bulking differs from MUS. While MUS increases dynamic MUCP, bulking may rely on increasing the length of the continence zone.

Translational approaches to the treatment of benign urologic conditions in elderly women

PURPOSE OF REVIEW

Stress urinary incontinence, overactive bladder, interstitial cystitis/painful bladder syndrome, and underactive bladder are highly prevalent among elderly women, and have significant impact on quality of life; however, existing treatments are limited and are not always successful for all patients. Researchers are investigating a multitude of new therapies to treat these conditions. This review will summarize the recent literature on investigative therapies for these conditions.

RECENT FINDINGS

Multiple new treatments are being developed for lower urinary tract dysfunction. Some of these treatments, including balloon therapy and muscle-derived stem cells for stress urinary incontinence, could provide alternatives to existing therapies. Others require further research before being used in patients, such as pudendal nerve stimulation for overactive bladder and intravesical liposomes for drug delivery in interstitial cystitis/painful bladder syndrome.

SUMMARY

Multiple new therapies are being investigated that could provide clinicians with additional tools to treat lower urinary tract disorders in millions of elderly women.

Incontinence and Chronic Illness

Objetivo: explorar la producción y contenido de la información disponible a nivel mundial sobre el abordaje de la incontinencia urinaria (IU) e incontinencia fecal (IF) y su relación con la enfermedad crónica (EC). Materiales y métodos: a partir de una revisión de literatura en las bases de datos Cinahl, Ovid, Scielo, Medline y Psychoinfo, entre los años 2009 y 2012, bajo los descriptores de incontinencia urinaria e incontinencia fecal, en combinación con enfermedad crónica, con su traducción al inglés, se identificaron, analizaron y clasificaron los planteamientos sobre el tema de la incontinencia según relevancia para la comprensión de la misma en la situación de EC. Resultados: se presentan los estudios encontrados clasificados en cinco grandes grupos sobre IU e IF que incluyen los que ilustran la magnitud del problema por su frecuencia y tipología, los que establecen relación directa entre la incontinencia y la EC, los que describen otros factores asociados con la incontinencia y con la EC, los que abordan la forma de valorar la incontinencia y los que dan aportes respecto al manejo de la IU o IF en la EC. Conclusiones: la literatura tiene abundante producción científica en sus dos últimos años y a nivel mundial sobre la IU pero no en igual proporción sobre la IF. Existen modelos para la valoración, medición y comprensión del fenómeno así como para la intervención y atención puntual sobre la misma. No se reportan abordajes integrales al problema de la IU e IF en personas con EC.

Recurrent stress urinary incontinence after synthetic mid-urethral sling procedures

PURPOSE OF REVIEW

Synthetic mid-urethral slings (MUSs) have been widely adopted for female stress urinary incontinence (SUI). Practitioners are encountering increasing numbers of women with recurrent SUI after a failed MUS. Several studies over the past 18 months have reported outcomes for secondary continence procedures in this context and form the basis of this review.

RECENT FINDINGS

Expert consensus supports a trial of conservative therapy for recurrent SUI, although a sound evidence base is lacking. As regards repeat surgical intervention, retrospective studies on repeat synthetic MUSs have demonstrated medium-term cure rates of 60-70%, which is lower than that achieved with primary surgery. Secondary transobturator tape appears inferior to secondary retropubic tape in women with intrinsic sphincteric deficiency. Promising early results have been reported with spiral slings and the adjustable continence procedures, although these interventions are technically more challenging and longer-term follow-up is warranted. Artificial urinary sphincters show high efficacy rates for severe, refractory SUI, although complication rates are higher in women with prior failed MUS.

SUMMARY

Repeat synthetic MUSs are likely to form the mainstay of secondary continence procedures presently. Longer-term follow-up of promising newer modalities, including adjustable continence therapies, is required. Above all, there is an urgent need for good quality, prospective data to guide practitioners in this growing clinical challenge.