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Fleischmann N, Chughtai B, Plair A, Hurtado E, Jacobson N, Segal S, Panza J, Cichowski SB. Urethral Bulking. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:667-682. [PMID: 39051928 DOI: 10.1097/spv.0000000000001548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
OBJECTIVE This Clinical Practice Statement aims to provide clinicians with evidence-based guidance for the use of urethral bulking agents (UBAs) in the treatment of stress urinary incontinence (SUI). METHODS We conducted a structured search of the English literature published from January 1960 to November 2022. Search terms identified studies of both current and historic UBAs. Data extracted at the time of full-text review included type of study, research setting, number of participants, age group, bulking agent, primary outcome, secondary outcome, efficacy, and complications. RESULTS One thousand five hundred ninety-four nonduplicate articles were identified using the search criteria. After limiting the article types to randomized control led trials, prospective studies, guideline documents, reviews, meta-analyses, and case reports of complications, 395 studies were screened. CONCLUSIONS Based on our findings, we propose the following recommendations for clinicians when considering UBA: First, UBA is indicated in cases of demonstrable SUI. Intrinsic sphincter deficiency is not predictive of patient outcomes. Second, patients should be counseled on the risks, lack of long-term efficacy data, potential need for repeat injections, possible need for surgery for recurrent SUI, implications for future procedures, and pelvic imaging findings that may be observed after UBA. Third, UBA may be considered for initial management of SUI. Fourth, UBA is an option for patients with persistent or recurrent SUI after a sling procedure. Fifth, clinicians may prioritize UBA over surgery in specific patient populations. Sixth, polyacrylamide hydrogel demonstrates marginally improved safety and durability data over other available agents.
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Affiliation(s)
| | | | - Andre Plair
- Stony Brook Medicine University Hospital, Stony Brook, NY
| | | | - Nina Jacobson
- Hackensack Meridian School of Medicine/Jersey Shore University Medical Center, Neptune, NJ
| | - Saya Segal
- Weill Cornell Medical College, New York, NY
| | - Joseph Panza
- University of Rochester Medical Center, Rochester, NY
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Clearwater WL, Panushka K, Najor A, Laudano M, Fleischmann N. Reconstruction of Urethral Sphincter With Polyacrylamide Hydrogel. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:293-299. [PMID: 38484245 DOI: 10.1097/spv.0000000000001470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
IMPORTANCE Urethral bulking is an alternative to synthetic midurethral sling for the treatment of stress urinary incontinence (SUI) in women. Urethral bulking agents, which are injected in the submucosal tissues of the proximal urethra/bladder neck, have demonstrated less adverse effects with similar satisfaction rates but lower subjective and objective cure rates when compared with midurethral sling. Cystoscopic Reconstruction of External Sphincter Technique (CREST) is a novel technique, which reinforces the natural closure mechanism of the external urinary sphincter (EUS). OBJECTIVE The aim of the study was to provide safety and efficacy data for injecting polyacrylamide hydrogel (PAHG) in the components of the female EUS. STUDY DESIGN This was a retrospective chart review of patients using CREST with PAHG as initial treatment for SUI by a single surgeon from January 2022 to October 2022. Exclusion criteria are as follows: younger than 18 years, prior SUI surgery, concomitant pelvic organ prolapse or reconstructive procedure, neurological conditions, or history of radiation. Subjective and objective cure rates were measured by patient-reported symptoms and cough stress test. Urinary retention, postoperative urinary infection, and de novo urinary urgency were assessed. RESULTS One hundred and thirteen consecutive patients met inclusion criteria with median follow-up of 3 months. Eighty-five percent of participants reported subjective improvement, 69% reported subjective cure, and 69% demonstrated objective cure. Nine patients reported transient postoperative retention, 8 reported postoperative urinary tract infections, and 5 reported de novo urgency. There were no serious adverse events. CONCLUSIONS CREST is a novel technique for injection of PAHG, into the EUS to treat SUI. Our data suggest that this technique could improve urethral injection outcomes with minimal complications.
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Affiliation(s)
| | | | - Anna Najor
- Urology, Albert Einstein College of Medicine, Montefiore Hospital
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Itkonen Freitas AM, Isaksson C, Rahkola-Soisalo P, Mentula M, Mikkola TS. Quality of life and sexual function after tension-free vaginal tape and polyacrylamide hydrogel injection for primary stress urinary incontinence: 3-year follow-up from a randomized clinical trial. Int Urogynecol J 2023; 34:2977-2984. [PMID: 37672047 PMCID: PMC10756861 DOI: 10.1007/s00192-023-05626-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/08/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION AND HYPOTHESIS To assess quality of life (QoL) and sexual function outcomes at 3 years after tension-free vaginal tape (TVT) and polyacrylamide hydrogel injection (PAHG) for stress urinary incontinence (SUI). METHODS In this randomized trial comparing TVT (n = 104) and PAHG (n = 108), we assessed changes in QoL and sexuality using the Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire, Short Form (IIQ-7), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and RAND-36 Item Health Survey (RAND-36) at baseline and at 3 years. This is a secondary analysis of a randomized, noninferiority trial comparing patient satisfaction after TVT and PAHG. RESULTS In both groups, incontinence-related QoL improved from the baseline (p < 0.00), except for difficulty emptying the bladder and pain/discomfort. Total scores of UDI-6 and IIIQ-7 were lower for TVT compared to PAHG (p < 0.00) indicating better QoL at 3 years. Urinary incontinence with sexual activity or fear of incontinence restricting sexual activity improved in both groups (p < 0.00), with higher scores for physical section subscale in PISQ-12 (p = 0.02) for TVT. Physical and social functioning (RAND-36) improved from the baseline in both groups (p < 0.01) with a better outcome in the TVT group for physical functioning (p = 0.00). CONCLUSIONS Both TVT and PAHG improve QoL and sexual function in primary SUI with better incontinence and health-related QoL scores in the TVT group compared to the PAHG group at 3 years.
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Affiliation(s)
- Anna-Maija Itkonen Freitas
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, PO BOX 140, 00029 HUS, Helsinki, Finland
| | - Camilla Isaksson
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, PO BOX 140, 00029 HUS, Helsinki, Finland
| | - Päivi Rahkola-Soisalo
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, PO BOX 140, 00029 HUS, Helsinki, Finland
| | - Maarit Mentula
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, PO BOX 140, 00029 HUS, Helsinki, Finland
| | - Tomi S Mikkola
- Department of Obstetrics and Gynaecology, Helsinki University Hospital, PO BOX 140, 00029 HUS, Helsinki, Finland.
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Akinjise-Ferdinand O, Hubbard R, Osman NI, Chapple CR. A diagnostic conundrum: Is it a periurethral diverticulum/cyst or a bulking agent (Bulkamid)? Neurourol Urodyn 2023; 42:547-554. [PMID: 36285552 DOI: 10.1002/nau.25068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/09/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Urethral bulking agents are commonly used to manage female stress urinary incontinence (SUI) as they have been suggested to be safe, efficacious, and a minimally invasive surgical option. Bulkamid is a newer bulking agent that has been introduced and promoted in the market for use. It is non-particulate in nature with high tissue biocompatibility, and consequently, it is difficult to differentiate between Bulkamid and a periurethral cyst on magnetic resonance imaging (MRI). This, therefore, presents a diagnostic dilemma. METHODS AND MATERIALS Here we describe two cases with previous injections of Bulkamid referred to our Centre for management of a presumed periurethral diverticulum based on MRI findings. Both patients were reviewed and examined in outpatient clinics with MRI findings discussed at MDT, further imaging was required. RESULTS We found that a limited noncontrast computed tomography (CT) pelvis, followed by a voiding cystometrogram (VCMG), and then a repeat limited noncontrast CT pelvis effectively differentiated between Bulkamid and these presumed periurethral diverticulae. The theory behind this was that during micturition, the contrast would pass through to the urethral diverticulum and appear as high-density (bright) material within the periurethral region (the pre-VCMG was required to prove that any high-density material was due to the contrast and not pre-existing high-contrast material). CONCLUSION A CT scan done in conjunction with a VCMG is likely to be more effective in differentiating between Bulkamid and a true periurethral diverticulum than an MRI scan. Appropriate diagnostic evaluation of periurethral lesions can lead to time-saving and cost-effective patient management as this will bypass the need for unnecessary investigations and possible unwarranted surgical intervention.
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Affiliation(s)
| | - Rachel Hubbard
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Nadir I Osman
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Serati M, Braga A, Salvatore S, Torella M, Di Dedda MC, Scancarello C, Cimmino C, De Rosa A, Frigerio M, Candiani M, Ruffolo AF. Up-to-Date Procedures in Female Stress Urinary Incontinence Surgery: A Concise Review on Bulking Agents Procedures. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:775. [PMID: 35744038 PMCID: PMC9227870 DOI: 10.3390/medicina58060775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022]
Abstract
To avoid complications related to mid-urethral slings (MUS), alternative procedures to treat stress urinary incontinence (SUI), such as urethral bulking agents (UBAs) have been adopted. The aim of this review is to narratively report the efficacy and safety of UBAs for SUI treatment. For this review, research from PubMed and EMBASE was performed to evaluate relevant studies that were undertaken from January 2012 to January 2022. Nineteen prospective studies were included. Several definitions of subjective and objective success were adopted. At a follow-up of <24 months, significant improvement was widely observed, even if with a heterogeneous rate of success between 32.7−90%, and a reinjection rate of 8.3−77.3%. Compared with other procedures, MUS resulted as significantly superior to UBAs but was balanced by a higher complication rate. Acute urinary retention, urinary tract infection and de novo urgency, and other complications, such as injection site rupture, urethral erosion and particle migration have been described after UBAs. SUI after UBAs treatment resulted in improvements in all studies and can be considered a safe and effective option to treat SUI. However, homogenous and longer-term data lack, limiting general recommendations. Thus, larger RCTs evaluating long-term effects are required.
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Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.S.); (C.C.); (A.D.R.)
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC—Beata Vergine Hospital, 6850 Mendrisio, Switzerland;
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Stefano Salvatore
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milano, Italy; (S.S.); (M.C.); (A.F.R.)
| | - Marco Torella
- Department of Obstetrics and Gynecology, Second Faculty, 80129 Naples, Italy;
| | - Maria Carmela Di Dedda
- Department of Obstetrics and Gynecology, ASST FBF-SACCO Macedonio Melloni Hospital, 20129 Milano, Italy;
| | - Chiara Scancarello
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.S.); (C.C.); (A.D.R.)
| | - Chiara Cimmino
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.S.); (C.C.); (A.D.R.)
| | - Andrea De Rosa
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy; (C.S.); (C.C.); (A.D.R.)
| | | | - Massimo Candiani
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milano, Italy; (S.S.); (M.C.); (A.F.R.)
| | - Alessandro Ferdinando Ruffolo
- Obstetrics and Gynecology Unit, IRCCS San Raffaele Hospital, Vita-Salute University, 20132 Milano, Italy; (S.S.); (M.C.); (A.F.R.)
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Caldwell L, White AB. Stress Urinary Incontinence: Slings, Single-Incision Slings, and Nonmesh Approaches. Obstet Gynecol Clin North Am 2021; 48:449-466. [PMID: 34416931 DOI: 10.1016/j.ogc.2021.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Synthetic midurethral slings offer optimal cure rates for the minimally invasive treatment of stress urinary incontinence in women. Performed via a retropubic or transobturator technique, midurethral sling approaches demonstrate comparable efficacy, with unique adverse event profiles. Single incision slings were introduced to minimize the complication of groin pain with full-length transobturator slings and enhance operative recovery. The earliest therapies for stress urinary incontinence including urethral bulking, retropubic colposuspension, and autologous sling offer alternative methods of surgical management without using synthetic mesh. These methods boast satisfactory efficacy with low rates of complications, and may be ideal for appropriately selected patients.
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Affiliation(s)
- Lauren Caldwell
- Female Pelvic Medicine and Reconstructive Surgery, Department of Women's Health, University of Texas at Austin, Dell Medical School, 1301 West 38th Street, Suite 705, Austin, TX 78705, USA
| | - Amanda B White
- Female Pelvic Medicine and Reconstructive Surgery, Department of Women's Health, University of Texas at Austin, Dell Medical School, 1301 West 38th Street, Suite 705, Austin, TX 78705, USA.
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Viereck V, Gamper M, Walser C, Fesslmeier D, Münst J, Zivanovic I. Combination therapy with botulinum toxin and bulking agent-An efficient, sustainable, and safe method to treat elderly women with mixed urinary incontinence. Neurourol Urodyn 2021; 40:1820-1828. [PMID: 34342363 PMCID: PMC9292298 DOI: 10.1002/nau.24757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/10/2022]
Abstract
Aims To evaluate the efficacy, sustainability and safety of combined botulinum toxin and polyacrylamide hydrogel (PAHG) therapy to treat urgency and stress components of therapy‐refractory mixed urinary incontinence (MUI) in an elderly study population. Methods Fifty‐five women with therapy‐refractory MUI were treated with botulinum toxin and PAHG in one surgical procedure. Urgency urinary incontinence (UUI) and stress urinary incontinence (SUI) outcomes were separately assessed after 4 and 12 months by objective UUI episodes/24 h and cough test, subjective impact of UUI and SUI on quality of life, and subjective International Consultation on Incontinence Questionnaire‐Urinary Incontinence Short Form (ICIQ‐UI SF). MUI outcome was calculated by combining UUI and SUI outcomes. Complications were monitored throughout the study. Results At 4 months, objective cure rates were 73%, 53%, and 42%, and subjective cure rates were 71%, 52%, and 50% for SUI, UUI, and MUI. At 12 months, objective cure rates were 73%, 56%, 50% and subjective cure rates were 78%, 42%, and 40% for SUI, UUI, and MUI. The ICIQ‐UI SF score decreased by 9.0 and 8.7 points after 4 and 12 months. All complications were transient and included 22% clean intermittent catheterization immediately after surgery, 33% postvoid residual volumes >100 ml at 14 days, and 13% symptomatic urinary tract infection within the first postoperative month. Conclusions The combination of botulinum toxin and PAHG is effective, sustainable and safe to treat therapy‐refractory MUI, even in an elderly and frail study population. Patients benefit from the short surgical procedure without the need for general anaesthesia or discontinuation of anticoagulation.
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Affiliation(s)
- Volker Viereck
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Marianne Gamper
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Claudia Walser
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Debra Fesslmeier
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Julia Münst
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Irena Zivanovic
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
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Hoe V, Haller B, Yao HH, O'Connell HE. Urethral bulking agents for the treatment of stress urinary incontinence in women: A systematic review. Neurourol Urodyn 2021; 40:1349-1388. [PMID: 34015151 DOI: 10.1002/nau.24696] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/19/2021] [Accepted: 04/22/2021] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Venetia Hoe
- Department of Urology, Western Health, St Albans, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Britt Haller
- Department of Urology, Western Health, St Albans, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Henry H Yao
- Department of Urology, Western Health, St Albans, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Helen E O'Connell
- Department of Urology, Western Health, St Albans, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
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Abdelaziz A, Dell J, Karram M. Transvaginal radiofrequency energy for the treatment of urinary stress incontinence: A comparison of monopolar and bipolar technologies in both pre- and post-menopausal patients. Neurourol Urodyn 2021; 40:1804-1810. [PMID: 34288106 DOI: 10.1002/nau.24748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/02/2021] [Accepted: 07/02/2021] [Indexed: 11/10/2022]
Abstract
AIM A study to compare the effect of two different radio frequency energy models (mono polar and bipolar) for the treatment of urinary stress incontinence. METHODS Retrospective chart review, which was conducted at 2 sites, 69 patients received treatment with a bipolar radiofrequency device. Out of those 69 patients, 13 patients received bipolar in conjugation with CO2 laser treatment, while 32 patients received monopolar frequency. The study protocol normally consists of three sessions of treatment. Each session was four weeks apart with a whole 6-month duration follow-up. Results were evaluated by urogenital distress inventory (UDI)-6 questionnaire before and after treatment. RESULTS The bipolar group improved UDI-6 scores across time more so than did the monopolar group with some evidence suggesting that the bipolar radiofrequency treatment was more effective compared to the monopolar radiofrequency. Three months after treatment, the bipolar group UDI-6 values were lower than those of the monopolar group. Six months after treatment, the UDI-6 scores increased in both groups, suggesting decrease efficacy with time however, the bipolar group's UDI-6 scores were consistently lower than the monopolar group's scores. CONCLUSION This study shows benefit of both monopolar and bipolar radiofrequency device in patients with stress urinary incontinence and mixed UI, with bipolar RF more efficacious than monopolar RF. More randomized prospective studies are needed to confirm these findings.
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Affiliation(s)
- Ahmed Abdelaziz
- Division of Urogynecology, OBGYN Department, The Christ Hospital, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jeffrey Dell
- OBGYN Department, Institute for Female Pelvic Medicine, Knoxville, Tennessee, USA
| | - Mickey Karram
- Division of Urogynecology, OBGYN Department, The Christ Hospital, University of Cincinnati, Cincinnati, Ohio, USA
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Lamblin G, Chene G, Hamid D, Galea M, Lebail-Carval K, Chabert P, Nohuz E. [How I do… an uretral bulk agent injection of polyacrylamide hydrogel (Bulkamid®) under local anesthesia]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2021; 49:635-640. [PMID: 33316437 DOI: 10.1016/j.gofs.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Indexed: 06/12/2023]
Affiliation(s)
- G Lamblin
- Service de chirurgie gynécologique, hôpital Femme-mère enfant, Bron, France; Université Claude-Bernard Lyon 1, 69000 Lyon, France.
| | - G Chene
- Service de chirurgie gynécologique, hôpital Femme-mère enfant, Bron, France; Université Claude-Bernard Lyon 1, 69000 Lyon, France
| | - D Hamid
- Groupe hospitalier Saint-Vincent, clinique Sainte-Barbe, 67000 Strasbourg, France
| | - M Galea
- Service de chirurgie gynécologique, hôpital Femme-mère enfant, Bron, France
| | - K Lebail-Carval
- Service de chirurgie gynécologique, hôpital Femme-mère enfant, Bron, France
| | - P Chabert
- Service de chirurgie gynécologique, hôpital Femme-mère enfant, Bron, France
| | - E Nohuz
- Service de chirurgie gynécologique, hôpital Femme-mère enfant, Bron, France; Université Claude-Bernard Lyon 1, 69000 Lyon, France
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Itkonen Freitas AM, Mikkola TS, Rahkola-Soisalo P, Tulokas S, Mentula M. Quality of life and sexual function after TVT surgery versus Bulkamid injection for primary stress urinary incontinence: 1 year results from a randomized clinical trial. Int Urogynecol J 2021; 32:595-601. [PMID: 33275162 PMCID: PMC7902559 DOI: 10.1007/s00192-020-04618-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/16/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To assess changes in quality of life (QoL) and sexual function outcomes at 1 year after tension-free vaginal tape (TVT) versus polyacrylamide hydrogel injection (PAHG). METHODS In a randomized trial comparing TVT (n = 111) and PAHG (n = 113) treatments of stress urinary incontinence (SUI), we compared urinary incontinence and health-related QoL using the Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire, Short Form (IIQ-7), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and RAND-36 Item Health Survey (RAND-36) at baseline and 1 year. RESULTS UDI-6 and IIQ-7 showed improved incontinence-related QoL (p = 0.001) from baseline in both groups except for difficulty emptying the bladder and pain/discomfort. At 1 year, TVT patients experienced less urinary symptom-related distress compared to PAHG (p < 0.001). Sexual function improved in both groups (p < 0.001 for TVT and p = 0.01 for PAHG) with higher scores for the physical section subscale (p < 0.001) for TVT. Health-related QoL (RAND-36) improved from baseline in both groups in physical and social functioning (p < 0.001) with better outcome in the TVT group for physical functioning (p < 0.001). Increase in pain from baseline (p = 0.02) was detected for TVT, but not for PAHG. However, there was no difference between the groups (p = 0.78). CONCLUSIONS In primary SUI, TVT and PAHG treatments both improved QoL and sexual function at 1 year. However, incontinence and health-related QoL scores were better in the TVT group. More pain compared to the baseline was reported after TVT, although there was no difference between groups. Clinical significance needs to be evaluated in long-term follow-up.
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Affiliation(s)
- Anna-Maija Itkonen Freitas
- Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki University, PO BOX 140, 00029 HUS, Helsinki, Finland
| | - Tomi S. Mikkola
- Department of Obstetrics and Gynecology, Helsinki University Hospital and Folkhälsan Research Center Biomedicum, Helsinki University, Helsinki, Finland
| | - Päivi Rahkola-Soisalo
- Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki University, PO BOX 140, 00029 HUS, Helsinki, Finland
| | - Sari Tulokas
- Doctoral Programme in Clinical Research, Helsinki University, Helsinki, Finland
| | - Maarit Mentula
- Department of Obstetrics and Gynecology, Helsinki University Hospital, Helsinki University, PO BOX 140, 00029 HUS, Helsinki, Finland
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Easy way to treat female stress urinary incontinence with bulking agents (with video). J Gynecol Obstet Hum Reprod 2021; 50:102061. [PMID: 33421626 DOI: 10.1016/j.jogoh.2021.102061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 11/21/2022]
Abstract
Since the recent controversy about vaginal mesh implants, surgeons should use safe and effective devices and procedures to treat female stress urinary incontinence (SUI). We propose to describe the noninvasive and ambulatory technique of the urethral bulking procedure. Bulking agents are a simple, minimally invasive technique that can be offered in the treatment of female SUI.
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Daly CME, Mathew J, Aloyscious J, Hagen S, Tyagi V, Guerrero KL. Urethral bulking agents: a retrospective review of primary versus salvage procedure outcomes. World J Urol 2020; 39:2107-2112. [PMID: 32816136 DOI: 10.1007/s00345-020-03413-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/12/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Urethral bulking agents (UBA) have traditionally been offered as salvage procedures for recurrent stress urinary incontinence (SUI). We compare the success of UBA in patients that had undergone a previous procedure for SUI (Salvage-UBA) to the SUI surgery naïve (Primary-UBA). We hypothesised a positive effect in both Primary and Salvage-UBA with potentially poorer rates of response in the salvage group. METHODS Retrospective case series of patients having their first UBA (2010-2018). Primary outcome was to assess any difference in patient reported success between groups. Patient-reported improvement was assessed on a 4-point scale: 'cured, improved, no change, worse' and treatment 'success' defined as 'cured' or 'improved'. A multivariate analysis, adjusting for plausible differences between groups, was undertaken in IBM SPSS Statistics (2016). RESULTS 135 Primary-UBA and 38 Salvage-UBA were performed. Complete follow-up was obtained for 114 patients (66%): 86 Primary and 28 Salvage. Median follow-up time: 33 months. In 2012, 47% (8/17) of all UBA were Salvage-UBA, whilst in 2018, the majority were Primary-UBA (92%, 46/50). Success was not significantly different between Salvage-UBA 75% (21/28) versus Primary-UBA 67% (58/86) (Wald χ2 = 0.687, df = 1, p = 0.407). Top-up rates were similar: 14% (n = 4/28, Salvage-UBA) versus 15% (n = 13/86, Primary-UBA) (χ2 = 0.011, df = 1, p = 0.914). CONCLUSION The number of women opting for UBA has increased substantially. No significant differences were noted for success with Salvage-UBA compared to Primary-UBA.
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Affiliation(s)
- Ciara M E Daly
- Department of Urogynaecology, Queen Elizabeth University Hospital, Glasgow, Scotland.
| | - Jini Mathew
- Department of Urogynaecology, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Judey Aloyscious
- Department of Urogynaecology, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Suzanne Hagen
- Department of Urogynaecology, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Veenu Tyagi
- Department of Urogynaecology, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Karen L Guerrero
- Department of Urogynaecology, Queen Elizabeth University Hospital, Glasgow, Scotland
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Allan BB, Bell S, Husarek K. A 12-month feasibility study to investigate the effectiveness of cryogen-cooled monopolar radiofrequency treatment for female stress urinary incontinence. Can Urol Assoc J 2020; 14:E313-E318. [PMID: 32017688 DOI: 10.5489/cuaj.6145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The purpose of this early feasibility study was to evaluate the safety and efficacy of a non-ablative, cryogen-cooled, monopolar radiofrequency (CMRF) treatment for female stress urinary incontinence (SUI). METHODS Subjects meeting all the inclusion and exclusion criteria were enrolled and randomized into two groups. Subjects in group 1 received one CMRF treatment and subjects in group 2 received two CMRF treatments six weeks apart. Followup visits were performed at one, four, six, and 12 months post-treatment. At each study visit, subjects performed an objective, standardized one-hour pad weight test and completed several patient-reported outcome measures, a seven-day bladder voiding diary, and safety assessments. RESULTS Data indicate an improvement in SUI symptoms and quality of life for subjects, as determined by validated SUI-related patient-reported outcomes and the objective one-hour pad weight test, with a >50% reduction in pad weight from baseline for 52% of the subjects at 12 months. In addition to efficacy, the CMRF treatment was well-tolerated and safe. CONCLUSIONS The outcome measures evaluated indicate an improvement in SUI symptoms and quality of life. The sustained benefit of the CMRF vaginal treatment at 12 months suggests potential use as an office-based, non-surgical approach to treat mild to moderate SUI.
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Chapple C, Dmochowski R. Particulate Versus Non-Particulate Bulking Agents In The Treatment Of Stress Urinary Incontinence. Res Rep Urol 2019; 11:299-310. [PMID: 31815111 PMCID: PMC6858835 DOI: 10.2147/rru.s220216] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 09/24/2019] [Indexed: 12/13/2022] Open
Abstract
Stress urinary incontinence (SUI) has been treated surgically with the midurethral sling but in recent years, this option has come under scrutiny and the risk-benefit balance continues to be reviewed. The low-risk alternative for women with uncomplicated SUI is the bulking agent, which aims to achieve continence through coaptation of the urethra. Two classes of bulking agents can be identified: those made from solid microparticles in an absorbable liquid or gel carrier (particulate agents) and those comprising a homogenous gel (non-particulates) that resists absorption. Polydimethylsiloxane®, carbon-coated zirconium oxide®, calcium hydroxyapatite® and polyacrylate polyalcohol copolymer® are currently marketed particulate agents. With the exception of calcium hydroxyapatite, the particles are non-degradable. Each agent achieves its long-term bulking effect through reactive changes around the persisting particles while the carrier volume is lost. Bulkamid® is a non-particulate agent with the bulking effect resulting from the volume of gel injected. The lasting network of fine fibers formed by the host tissue anchors the gel in situ. Foreign-body granulomas, erosion and migration/material extrusion and loss of bulk have been observed in connection with the particle-based products. Bulkamid may be mechanistically less liable to these events; however, there are minimal data directly comparing the two types of bulking agent. The question of durability is inevitable based on their differing modes of action.
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Affiliation(s)
| | - Roger Dmochowski
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
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Tejavibulya N, Colburn DAM, Marcogliese FA, Yang KA, Guo V, Chowdhury S, Stojanovic MN, Sia SK. Hydrogel Microfilaments toward Intradermal Health Monitoring. iScience 2019; 21:328-340. [PMID: 31698247 PMCID: PMC6889782 DOI: 10.1016/j.isci.2019.10.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/03/2019] [Accepted: 10/18/2019] [Indexed: 10/25/2022] Open
Abstract
Digital health promises a paradigm shift for medicine where biomarkers in individuals are continuously monitored to improve diagnosis and treatment of disease. To that end, a technology for minimally invasive quantification of endogenous analytes in bodily fluids will be required. Here, we describe a strategy for designing and fabricating hydrogel microfilaments that can penetrate the skin while allowing for optical fluorescence sensing. The polyacrylamide formulation was selected to provide high elastic modulus in the dehydrated state and optical transparency in the hydrated state. The microfilaments can be covalently tethered to a fluorescent aptamer to enable functional sensing. The microfilament array can penetrate the skin with low pain and without breaking, contact the dermal interstitial fluid, and be easily removed from the skin. In the future, hydrogel microfilaments could be integrated with a wearable fluorometer to serve as a platform for continuous, minimally invasive monitoring of intradermal biomarkers.
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Affiliation(s)
- Nalin Tejavibulya
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, NY 10027, USA
| | - David A M Colburn
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, NY 10027, USA
| | - Francis A Marcogliese
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, NY 10027, USA
| | - Kyung-Ae Yang
- Division of Experimental Therapeutics, Department of Medicine, Columbia University, New York, NY 10032, USA
| | - Vincent Guo
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, NY 10027, USA
| | - Shilpika Chowdhury
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, NY 10027, USA
| | - Milan N Stojanovic
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, NY 10027, USA; Division of Experimental Therapeutics, Department of Medicine, Columbia University, New York, NY 10032, USA
| | - Samuel K Sia
- Department of Biomedical Engineering, Columbia University, 351 Engineering Terrace, 1210 Amsterdam Avenue, New York, NY 10027, USA.
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Starmer B, McAndrew F, Corbett H. A review of novel STING bulking agents. J Pediatr Urol 2019; 15:484-490. [PMID: 31591047 DOI: 10.1016/j.jpurol.2019.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 08/28/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of this study was to review the literature to compare the efficacy and complications of polyacrylate-polyalcohol copolymer (PPC) and polyacrylamide hydrogel (PAHG) with the current standard of care, dextranomer/hyaluronic acid (Dx/HA), when used to treat VUR in the paediatric population. METHODS PubMed, Embase and Cochrane databases were searched. Keywords included Vesicoureteral reflux (VUR), endoscopic; endoscopic injection, endoscopic treatment, dulking material, dextranomer/hyaluronic acid copolymer, polyacrylate-polyalcohol copolymer, Deflux, Dexell, Vantris, Bulkamid, outcome, treatment and children. Prospective or retrospective studies comparing PAHG/PPC directly with Dx/HA were included for review. RESULTS Four studies were identified comparing PPC with Dx/HA. All studies showed superior efficacy (on micturating cystourethrogram (MCUG) at 3 months) of PPC over Dx/HA. However, 1 study identified a significantly higher rate of vesicoureteric junction obstruction (VUJO) in the PPC group. One study was identified comparing PAHG with Dx/HA which showed similar efficacy on 3-month MCUG. CONCLUSIONS Current data suggest PPC confers a higher resolution rate of VUR and PAHG confers comparable resolution rates for VUR compared with Dx/HA in the paediatric population. However, the incidence of late-onset VUJO in one study is concerning, and high-quality randomised controlled trials with long-term follow-up are needed before making further recommendations.
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Affiliation(s)
- Benjamin Starmer
- Alder Hey Children's Hospital NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, United Kingdom.
| | - Fiona McAndrew
- Alder Hey Children's Hospital NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, United Kingdom
| | - Harriet Corbett
- Alder Hey Children's Hospital NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, United Kingdom
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Allan BB, Bell S, Husarek K. Early Feasibility Study to Evaluate the Viveve System for Female Stress Urinary Incontinence: Interim 6-Month Report. J Womens Health (Larchmt) 2019; 29:383-389. [PMID: 31464548 PMCID: PMC7097686 DOI: 10.1089/jwh.2018.7567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: The purpose of this prospective, investigator-initiated feasibility study is to evaluate the efficacy and safety of nonablative, cryogen-cooled, monopolar radiofrequency (CMRF) treatment for stress urinary incontinence (SUI). Materials and Methods: Subjects meeting all the inclusion and exclusion criteria were enrolled and divided into two groups. Subjects in Group 1 received a single SUI treatment, and subjects in Group 2 received two SUI treatments ∼6 weeks apart. Follow-up visits are planned for 1, 4, 6, and 12 months post-treatment. At each study visit, subjects are asked to perform a 1-hour pad-weight test (PWT) and to complete the Urogenital Distress Inventory-6 (UDI-6), Incontinence Impact Questionnaire-Short Form (IIQ-7), and International Consultation on Incontinence Modular Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) questionnaires. In addition, subjects completed 7-day bladder voiding diary and safety assessments. Results: Preliminary data indicate an improvement in SUI symptoms and quality of life for subjects, as determined by validated SUI-related patient-reported outcomes and the objective 1-hour PWT, with a >50% reduction in pad weight for 68.8% of the Group 1 subjects and 69.2% of the Group 2 subjects at 6 months. Initial review of the bladder voiding diaries suggests that subjects are having fewer urine leakage episodes per day. In addition to efficacy, the CMRF Viveve System was well tolerated and safe. Conclusions: The endpoints evaluated indicate an improvement in SUI symptoms and quality of life. The sustained benefit of the CMRF vaginal treatment at 6 months suggests potential use as a nonsurgical approach to treat SUI.
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Adverse Events Associated with Nonsurgical Treatments for Urinary Incontinence in Women: a Systematic Review. J Gen Intern Med 2019; 34:1615-1625. [PMID: 31062225 PMCID: PMC6667523 DOI: 10.1007/s11606-019-05028-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/06/2019] [Accepted: 03/28/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Urinary incontinence (UI) is a common malady in women. Numerous nonsurgical treatments are available, each associated with risk of adverse events (AEs). METHODS We systematically reviewed nonsurgical interventions for urgency, stress, or mixed UI in women, focusing on AEs. We searched MEDLINE®, Cochrane Central Trials Registry, Cochrane Database of Systematic Reviews, and Embase® through December 4, 2017. We included comparative studies and single-group studies with at least 50 women. Abstracts were screened independently in duplicate. One researcher extracted study characteristics and results with verification by another independent researcher. When at least four studies of a given intervention reported the same AE, we conducted random effects model meta-analyses of proportions. We also assessed the strength of evidence. RESULTS There is low strength of evidence that AEs are rare with behavioral therapies and neuromodulation, and that periurethral bulking agents may result in erosion and increase the risk of voiding dysfunction. High strength of evidence finds that anticholinergics and alpha agonists are associated with high rates of dry mouth and constitutional effects such as fatigue and gastrointestinal complaints. Onabotulinum toxin A (BTX) is also associated with increased risk of urinary tract infections (UTIs) and voiding dysfunction (moderate strength of evidence). DISCUSSION Behavioral therapies and neuromodulation have low risk of AEs. Anticholinergics and alpha agonists have high rates of dry mouth and constitutional effects. BTX is associated with UTIs and voiding dysfunction. Periurethral bulking agents are associated with erosion and voiding dysfunction. These AEs should be considered when selecting appropriate UI treatment options. AE reporting is inconsistent and AE rates across studies tended to vary widely. Trials should report AEs more consistently.
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20
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Kocjancic E, Mourad S, Acar Ö. Complications of urethral bulking therapy for female stress urinary incontinence. Neurourol Urodyn 2019; 38 Suppl 4:S12-S20. [PMID: 31066956 DOI: 10.1002/nau.23877] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/17/2018] [Indexed: 11/06/2022]
Abstract
AIMS To review, report, and discuss the complications associated with urethral bulking therapy in female stress urinary incontinence. METHODS An extensive nonsystematic literature review on complications associated with injectable bulking agents used in the clinical practice was conducted. We reviewed articles published in English and indexed in the PubMed, Embase, and Google Scholar databases. Original articles, case reports, and case series were taken into consideration. Data regarding the safety of injectable bulking agents and the complications associated with their utility within the context of urethral bulking therapy for female stress urinary incontinence were extracted and discussed. RESULTS Approximately, 1/3 of the patients experience some type of a complication after urethral bulking therapy. The majority of these complications are of low grade, transient, do not necessitate additional surgical intervention, and amenable to treatment with conservative measures such as clean intermittent catheterization and antibiotics. However, more serious complications such as abscess formation, delayed hypersensitivity reactions, and vaginal erosion have been reported. Some of the injectable bulking agents have been withdrawn from the market because of their unfavorable adverse effect profile. CONCLUSIONS Urethral bulking therapy can be considered as a low-risk procedure. However, it is not without complications which can be severe in rare instances. The search for the ideal urethral bulking agent is ongoing and future comparative studies assessing the safety and efficacy of these compounds in randomized controlled settings are warranted.
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Affiliation(s)
- Ervin Kocjancic
- Department of Urology, University of Illinois at Chicago (UIC), Chicago, Illinois
| | - Sherif Mourad
- Department of Urology, Ain Shams University, Cairo, Egypt
| | - Ömer Acar
- Department of Urology, University of Illinois at Chicago (UIC), Chicago, Illinois
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21
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Vardar E, Vythilingam G, Pinnagoda K, Engelhardt EM, Zambelli PY, Hubbell JA, Lutolf MP, Frey P, Larsson HM. A bioactive injectable bulking material; a potential therapeutic approach for stress urinary incontinence. Biomaterials 2019; 206:41-48. [PMID: 30925287 DOI: 10.1016/j.biomaterials.2019.03.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 03/19/2019] [Indexed: 12/17/2022]
Abstract
Stress urinary incontinence (SUI) is a life changing condition, affecting 20 million women worldwide. In this study, we developed a bioactive, injectable bulking agent that consists of Permacol™ (Medtronic, Switzerland) and recombinant insulin like growth factor-1 conjugated fibrin micro-beads (fib_rIGF-1) for its bulk stability and capacity to induce muscle regeneration. Therefore, Permacol™ formulations were injected in the submucosal space of rabbit bladders. The ability of a bulking material to form a stable and muscle-inducing bulk represents for us a promising therapeutic approach to achieve a long-lasting treatment for SUI. The fib_rIGF-1 showed no adverse effect on human smooth muscle cell metabolic activity and viability in vitro based on AlamarBlue assays and Live/Dead staining. Three months after injection of fib_rIGF-1 together with Permacol™ into the rabbit bladder wall, we observed a smooth muscle tissue like formation within the injected materials. Positive staining for alpha smooth muscle actin, calponin, and caldesmon demonstrated a contractile phenotype of the newly formed smooth muscle tissue. Moreover, the fib_rIGF-1 treated group also improved the neovascularization at the injection site, confirmed by CD31 positive staining compared to bulks made of PermacolTM only. The results of this study encourage us to further develop this injectable, bioactive bulking material towards a future therapeutic approach for a minimal invasive and long-lasting treatment of SUI.
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Affiliation(s)
- E Vardar
- Experimental Pediatric Urology, Laboratory for Regenerative Medicine and Pharmacobiology, Institute for Bioengineering, School of Life Sciences and School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, 1015, Switzerland; Department of Pediatrics, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - G Vythilingam
- Experimental Pediatric Urology, Laboratory for Regenerative Medicine and Pharmacobiology, Institute for Bioengineering, School of Life Sciences and School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, 1015, Switzerland; Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - K Pinnagoda
- Department of Pediatrics, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - E M Engelhardt
- Experimental Pediatric Urology, Laboratory for Regenerative Medicine and Pharmacobiology, Institute for Bioengineering, School of Life Sciences and School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, 1015, Switzerland
| | - P Y Zambelli
- Department of Pediatrics, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - J A Hubbell
- Institute for Molecular Engineering, University of Chicago, Chicago, IL, 60637, USA
| | - M P Lutolf
- Laboratory of Stem Cell Bioengineering, Institute of Bioengineering, School of Life Sciences and School of Engineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, 1015, Switzerland
| | - P Frey
- Experimental Pediatric Urology, Laboratory for Regenerative Medicine and Pharmacobiology, Institute for Bioengineering, School of Life Sciences and School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, 1015, Switzerland
| | - H M Larsson
- Experimental Pediatric Urology, Laboratory for Regenerative Medicine and Pharmacobiology, Institute for Bioengineering, School of Life Sciences and School of Engineering, École Polytechnique Fédérale de Lausanne, Lausanne, 1015, Switzerland; Laboratory of Stem Cell Bioengineering, Institute of Bioengineering, School of Life Sciences and School of Engineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, 1015, Switzerland.
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Abstract
Urethral injection is a safe and minimally invasive method of treating female stress urinary incontinence with multiple bulking agents currently commercially available. Although there are numerous studies that demonstrate efficacy, long-term success is not yet proven. This article aims to describe the mechanism of action and properties of various agents, patient selection factors, available techniques for injection, outcomes of urethral injections, and complications associated with the procedure.
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Affiliation(s)
- Hanhan Li
- Department of Urology, MD Anderson Cancer Center, Unit 1373, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Ouida Lenaine Westney
- Urinary Tract and Pelvic Reconstruction, Department of Urology, MD Anderson Cancer Center, Unit 1373, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Amin K, Lucioni A. Stress Urinary Incontinence Management in the Patient With Overactive Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0470-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Jepsen MS, Sellathurai J, Conti A, Schrøder HD, Lund L. Treatment of Vesicovaginal Fistulas With Autologous Cell Injections—A Randomized Study in an Animal Model. Technol Cancer Res Treat 2017. [PMCID: PMC5762034 DOI: 10.1177/1533034617691615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: Materials and Methods: Results: Conclusion:
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Affiliation(s)
- Marianne S. Jepsen
- Department of Urology, Odense University Hospital, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jeeva Sellathurai
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Pathology, Odense University Hospital, Odense C, Denmark
| | - Alessandro Conti
- Department of Urology, Odense University Hospital, Odense C, Denmark
- Department of Clinical and Specialist Sciences, Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Henrik D. Schrøder
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Pathology, Odense University Hospital, Odense C, Denmark
| | - Lars Lund
- Department of Urology, Odense University Hospital, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Mamut A, Carlson KV. Periurethral bulking agents for female stress urinary incontinence in Canada. Can Urol Assoc J 2017; 11:S152-S154. [PMID: 28616117 DOI: 10.5489/cuaj.4612] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Urethral bulking aims to improve urethral mucosal coaptation, and thus outlet resistance, in an effort to limit stress-induced leakage. While efforts have been made to employ bulking agents to treat stress urinary incontinence (SUI) for more than 100 years, we remain wanting for the perfect injectable. Regardless of the agent studied, efficacy is modest at best, repeat injections are the norm, and long-term followup is conspicuously lacking. This treatment, however, fills an important need in our armamentarium against SUI, serving those patients who are not candidates for more invasive interventions and those with multiple prior failed surgeries. This review offers a contemporary discussion on the role of periurethral bulking therapy in Canada, along with practical aspects of its application.
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Affiliation(s)
- Adiel Mamut
- Section of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Kevin V Carlson
- Section of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
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Mohr S, Marthaler C, Imboden S, Monga A, Mueller MD, Kuhn A. Bulkamid (PAHG) in mixed urinary incontinence: What is the outcome? Int Urogynecol J 2017; 28:1657-1661. [DOI: 10.1007/s00192-017-3332-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Accepted: 03/29/2017] [Indexed: 11/27/2022]
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Khoo CCK, Kujawa M, Reid S, Sahai A. Mixed urinary incontinence- what should we treat first? JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415817693466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Mixed urinary incontinence (MUI) is defined as ‘the involuntary loss of urine associated with urgency and also with effort or physical exertion, or on sneezing or coughing’. It is highly prevalent, increases with age and affects women more than men. It has a significant negative impact on health-related quality of life (HRQL). Additionally, treatment of mixed urinary incontinence places a large financial burden on both individuals and the NHS. Optimal management of this common condition is contested – should we treat the urge urinary incontinence (UUI), stress urinary incontinence (SUI) or predominant symptom first? At the 2015 BAUS Section of Female, Neurological and Urodynamic Urology this subject was debated. Based on a common scenario, the authors of the debate present the arguments for treating the urge urinary incontinence component, stress urinary incontinence component or the predominant symptom of mixed urinary incontinence first, before making recommendations for current practice.
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Affiliation(s)
- CCK Khoo
- Department of Urology, Guy’s and St. Thomas’ NHS Foundation Trust, Guy’s Hospital, London, UK
| | - M Kujawa
- Department of Urology, Stockport NHS Foundation Trust, Stepping Hill Hospital, Stockport, Cheshire, UK
| | - S Reid
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, UK
| | - A Sahai
- Department of Urology, Guy’s and St. Thomas’ NHS Foundation Trust, Guy’s Hospital, King’s Health Partners, London, UK
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A national population-based cohort study of urethral injection therapy for female stress and mixed urinary incontinence: the Danish Urogynaecological Database, 2007–2011. Int Urogynecol J 2017; 28:1309-1317. [DOI: 10.1007/s00192-017-3265-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
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Transurethral Polyacrylamide Hydrogel Injection Therapy in Women Not Eligible for Midurethral Sling Surgery. Female Pelvic Med Reconstr Surg 2017; 23:318-323. [DOI: 10.1097/spv.0000000000000385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Çekmez Y, Angın P, Tufan G, Kıran G. Re:Urethral bulking for recurrent stress urinary incontinence after midurethral sling failure. Neurourol Urodyn 2016; 36:1218. [PMID: 27400167 DOI: 10.1002/nau.23070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 06/03/2016] [Indexed: 11/07/2022]
Abstract
The Integral Theory consists of nine specific sites three main compartments which are supporting the female pelvis. Stress urinary incontinence (SUI) is caused due to laxity in the vaginal supporting ligaments in especially anterior pelvic compartment which consists of pubourethral ligament, external urethral ligament, and hammock. The diagnose of each failure should be distinguished for the choose of the most effective treatment. Neurourol. Urodynam. 36:1218-1218, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Yasemin Çekmez
- Department of Urogyneacology, Umraniye Medical and Research Hospital, İstanbul, Turkey
| | - Pınar Angın
- Department of Urogyneacology, Umraniye Medical and Research Hospital, İstanbul, Turkey
| | - Gül Tufan
- Department of Urogyneacology, Umraniye Medical and Research Hospital, İstanbul, Turkey
| | - Gürkan Kıran
- Department of Urogyneacology, Umraniye Medical and Research Hospital, İstanbul, Turkey
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Abstract
Urinary incontinence (UI) is more common than any other chronic disease, such as hypertension, depression or diabetes, with the prevalence estimated between 9 and 74%. Among the various forms of urinary incontinence, stress incontinence (SUI) is the most prevalent (50%), with urgency incontinence (UUI) representing 11% and mixed type (MUI) 36% (3% not classified). Nowadays, the restoration of urinary continence is one of the greatest challenges for the well-being and quality of life of women. The introduction of minimally invasive surgical procedures changed the anti-incontinence surgery, leading to similar, or even better results as traditional, invasive techniques. The development of the mid-urethral slings offers a viable alternative to surgical correction of SUI. These further developments of mini-sling procedures are appropriate for local anesthesia, less traumatic, 'tension-free' (to ensure continence without obstruction), simple, rapid and repeatable. The latest minimally invasive approaches can be performed in day surgery, with clear advantages compared to traditional procedures. A novel approach through the use of vaginal laser techniques could represent an additional opportunity, as a non-invasive, outpatient method to treat SUI.
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Affiliation(s)
- M Cervigni
- a Department of Women's Health and New Life , Catholic University , Rome , Italy
| | - M Gambacciani
- b * Department of Obstetrics and Gynecology , Pisa University Hospital , Pisa , Italy
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Zivanovic I, Rautenberg O, Lobodasch K, von Bünau G, Walser C, Viereck V. Urethral bulking for recurrent stress urinary incontinence after midurethral sling failure. Neurourol Urodyn 2016; 36:722-726. [DOI: 10.1002/nau.23007] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 03/09/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Irena Zivanovic
- Department of Gynecology and Obstetrics; Cantonal Hospital; Frauenfeld Switzerland
| | - Oliver Rautenberg
- Department of Gynecology and Obstetrics; Cantonal Hospital; Frauenfeld Switzerland
| | - Kurt Lobodasch
- Department of Gynecology; German Red Cross Hospital Chemnitz-Rabenstein; Chemnitz Germany
| | | | - Claudia Walser
- Department of Gynecology and Obstetrics; Cantonal Hospital; Frauenfeld Switzerland
| | - Volker Viereck
- Department of Gynecology and Obstetrics; Cantonal Hospital; Frauenfeld Switzerland
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Altman D, Hjern F, Zetterström J. Transanal submucosal polyacrylamide gel injection treatment of anal incontinence: a randomized controlled trial. Acta Obstet Gynecol Scand 2016; 95:528-33. [PMID: 26866933 DOI: 10.1111/aogs.12866] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/06/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The efficacious and safe use of transurethral injections of polyacrylamide hydrogel (Bulkamid(®)) in women with stress urinary incontinence suggests that it may be suitable also for treatment of anal incontinence. We aimed to determine the effectiveness and safety of polyacrylamide hydrogel when used as a transanal submucosal bulking agent in women with anal incontinence. MATERIALS AND METHODS Thirty women with a diagnosis of anal incontinence and a Cleveland Clinic Incontinence Score (CCIS) >10 were randomized to three different techniques of transanal submucosal injections using polyacrylamide hydrogel. Follow up was performed at 2, 6 and 12 months using CCIS and the Fecal Incontinence Quality of Life scale (FIQL). RESULTS In all, 29 of the 30 women completed the follow up. Approximately half of the women requested a re-injection at the 6-month visit. The overall CCIS improved significantly from baseline (14.7. SD 2.5) to 1 year (12.4. SD 3.1) (p = 0.003). There was a significant improvement with regard to the occurrence of loose fecal incontinence (p = 0.014) but not for solid fecal incontinence (p = 0.28). At 1 year the FIQL domains of coping-behavior, depression, and embarrassment showed significant improvements (p = 0.012, p = 0.007 and p = 0.007, respectively). We recorded no adverse events related either to the injection technique or the biomaterial. There were no significant differences between the treatment groups in either CCIS or FIQL scores. CONCLUSION Transanal submucosal injection of polyacrylamide hydrogel resulted in a modest although significant overall improvement in anal incontinence symptom scores with corresponding improvements in several domains of quality of life, regardless of injection volume.
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Affiliation(s)
- Daniel Altman
- Stockholm Urogynecological Clinic, Stockholm, Sweden.,Department of Clinical Sciences, Karolinska Institute Danderyd Hospital, Danderyd, Sweden.,Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Fredrik Hjern
- Division of Surgery, Department of Clinical Sciences, Karolinska Institute, Danderyd Hospital, Danderyd, Sweden
| | - Jan Zetterström
- Department of Clinical Sciences, Karolinska Institute Danderyd Hospital, Danderyd, Sweden.,Gynecological Clinic, Sophiahemmet Hospital, Stockholm, Sweden
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Matsuoka PK, Locali RF, Pacetta AM, Baracat EC, Haddad JM. The efficacy and safety of urethral injection therapy for urinary incontinence in women: a systematic review. Clinics (Sao Paulo) 2016; 71:94-100. [PMID: 26934239 PMCID: PMC4760362 DOI: 10.6061/clinics/2016(02)08] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 11/27/2015] [Accepted: 11/27/2015] [Indexed: 11/18/2022] Open
Abstract
To evaluate the efficacy and safety of different bulking agents for treating urinary incontinence in women, a systematic review including only randomized controlled trials was performed. The subjects were women with urinary incontinence. The primary outcomes were clinical and urodynamic parameters. The results were presented as a weighted mean difference for non-continuous variables and as relative risk for continuous variables, both with 95% confidence intervals. Initially, 942 studies were identified. However, only fourteen eligible trials fulfilled the prerequisites. Altogether, the review included 1814 patients in trials of eight different types of bulking agents, and all studies were described and analyzed. The measured outcomes were evaluated using a large variety of instruments. The most common complications of the bulking agents were urinary retention and urinary tract infection. Additionally, there were certain major complications, such as one case of death after use of autologous fat. However, the lack of adequate studies, the heterogeneous populations studied, the wide variety of materials used and the lack of long-term follow-up limit guidance of practice. To determine which substance is the most suitable, there is a need for more randomized clinical trials that compare existing bulking agents based on standardized clinical outcomes.
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Affiliation(s)
- Priscila Katsumi Matsuoka
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Departamento de Obstetrícia e Ginecologia, Disciplina de Ginecologia, Divisão de Uroginecologia, São Paulo/SP, Brazil
| | - Rafael Fagionato Locali
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Departamento de Cirurgia, Disciplina de Urologia, São Paulo/, SP, Brazil
| | - Aparecida Maria Pacetta
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Departamento de Obstetrícia e Ginecologia, Disciplina de Ginecologia, Divisão de Uroginecologia, São Paulo/SP, Brazil
| | - Edmund Chada Baracat
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Departamento de Obstetrícia e Ginecologia, Disciplina de Ginecologia, São Paulo/, SP, Brazil
| | - Jorge Milhem Haddad
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Departamento de Obstetrícia e Ginecologia, Disciplina de Ginecologia, Divisão de Uroginecologia, São Paulo/SP, Brazil
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Translational approaches to the treatment of benign urologic conditions in elderly women. Curr Opin Urol 2016; 26:184-92. [PMID: 26814884 DOI: 10.1097/mou.0000000000000261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Pai A, Al-Singary W. Durability, safety and efficacy of polyacrylamide hydrogel (Bulkamid(®)) in the management of stress and mixed urinary incontinence: three year follow up outcomes. Cent European J Urol 2015; 68:428-33. [PMID: 26855795 PMCID: PMC4742441 DOI: 10.5173/ceju.2015.647] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/14/2015] [Accepted: 09/07/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction There are a myriad of treatment options available for patients suffering with the increasingly prevalent condition of stress urinary incontinence (SUI). The minimally invasive nature of periurethral bulking agents makes them an attractive proposition in the correctly selected patient. There is, however, limited data available on the medium to long term safety and efficacy of this procedure. The aim of our study is to evaluate the outcomes of Polyacrylamide Hydrogel (PAHG) (Bulkamid®) as a periurethral bulking agent at our institution. Material and methods From 2006 to 2011, two hundred and fifty six women underwent periurethral bulking with PAHG in the management of SUI or mixed urinary incontinence (MUI). Women were assessed with at least yearly quality of life and ICIQ questionnaires. Results The majority of patients had the procedure under a local anaesthetic, with a median operative time of 9 minutes. Median follow up was 38 months. 82% of patients reported cure/significant improvement at 3 months. Importantly, this high satisfaction rate was maintained at final follow up and was reflected in both VAS and ICIQ scores. There were no reported adverse reactions and no significant safety concerns. Conclusions We conclude that Bulkamid® injection is an efficacious, minimally invasive, and safe procedure for a selected group of patients with stress incontinence. In our study, PAHG has been shown to be durable and safe.
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Affiliation(s)
- Aakash Pai
- Worthing Hospital, Department of Urology, Worthing, United Kingdom
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Zajda J, Farag F. Urolastic for the treatment of women with stress urinary incontinence: 24-month follow-up. Cent European J Urol 2015; 68:334-8. [PMID: 26568877 PMCID: PMC4643696 DOI: 10.5173/ceju.2015.541] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/26/2015] [Accepted: 06/23/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction To evaluate the efficacy and durability of Urolastic, a new urethral bulking agent in women with stress urinary incontinence (SUI), after a follow-up of 24-months. Material and methods A follow-up study of women with SUI who received a Urolastic injection and successfully passed the 12-month follow-up. Assessment included the Stamey Grade, 1-h Pad weight test, and the International quality of life (I-QoL) score. Results Nineteen women who completed the 12-month follow-up were invited for the 24-month follow-up study. One patient did not respond to the correspondence. Four of the 18 patients who responded to the correspondence reported removal of the Urolastic implant at another facility, based on their desire. The explanation for this removal was painful intercourse (n = 1) or less than optimal dryness (n = 3). The overall objective improvement in continence status at 24-months was 66% compared to the 89% at the 12-month follow-up, while in addition the 1-h pad weight test showed >50% reduction in pad weight in 66% of patients compared to 84% at the 12-month follow-up. Adverse events reported were urinary tract infection (n = 1), local genital infection with erosion into the vagina (n = 1), painful intercourse (n = 2), and urgency (n = 4). Conclusions Urolastic is comparable to other bulking agents in terms of durability, efficacy, and complications.
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Affiliation(s)
- Janusz Zajda
- MOCONTI Ltd, Urological Office, Warsaw, Poland ; IATROS NZOZ, Department of Urology Warsaw, Poland ; First two authors equally contributed to the manuscript
| | - Fawzy Farag
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
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Blais AS, Morin F, Cloutier J, Moore K, Bolduc S. Efficacy of dextranomer hyaluronic acid and polyacrylamide hydrogel in endoscopic treatment of vesicoureteral reflux: A comparative study. Can Urol Assoc J 2015. [PMID: 26225173 DOI: 10.5489/cuaj.2964] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Various bulking agents are available for vesicoureteral reflux (VUR) endoscopic treatment, but their inconsistent success rates and costs are concerns for urologists. Recently, polyacrylamide hydrogel (PAHG) has been shown to have a good overall success rate, which seems comparable to dextranomer hyaluronic acid (Dx/HA), currently the most popular bulking agent. Our objective was to compare the short-term success rate of PAHG and Dx/HA for VUR endoscopic treatment in children. METHODS We performed a prospective non-randomized study using PAHG and Dx/HA to treat VUR grades I to IV in pediatric patients. All patients underwent endoscopic sub-ureteric injection of PAHG or Dx/HA, using the double-HIT technique, followed by a 3-month postoperative renal ultrasound and voiding cystourethrogram. Treatment success was defined as the absence of de novo or worsening hydronephrosis and absence of VUR. RESULTS A total of 90 pediatric patients underwent an endoscopic injection: 45 patients (78 ureters) with PAHG and 45 patients (71 ureters) with Dx/HA. The mean injected volume of PAHG and Dx/HA was 1.1 mL and 1.0 mL, respectively. The overall success rate 3 months after a single treatment was 73.1% for PAHG and 77.5% for Dx/HA. Postoperatively, 1 patient in each group presented with acute pyelonephritis and 2 patients in the Dx/HA group developed symptomatic ureteral obstruction. CONCLUSION Success rates of PAGH and Dx/HA in endoscopic injections for VUR treatment were comparable. The rate of resolution obtained with Dx/HA was equivalent to those previously published. The lower cost of PAHG makes it an interesting option.
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Affiliation(s)
| | - Fannie Morin
- Department of Urology, CHU de Québec-Université Laval, Quebec, QC
| | | | - Katherine Moore
- Department of Urology, CHU de Québec-Université Laval, Quebec, QC
| | - Stéphane Bolduc
- Department of Urology, CHU de Québec-Université Laval, Quebec, QC
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Kasi AD, Pergialiotis V, Perrea DN, Khunda A, Doumouchtsis SK. Polyacrylamide hydrogel (Bulkamid®) for stress urinary incontinence in women: a systematic review of the literature. Int Urogynecol J 2015. [DOI: 10.1007/s00192-015-2781-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cour F, Le Normand L, Lapray JF, Hermieu JF, Peyrat L, Yiou R, Donon L, Wagner L, Vidart A. [Intrinsic sphincter deficiency and female urinary incontinence]. Prog Urol 2015; 25:437-54. [PMID: 25864653 DOI: 10.1016/j.purol.2015.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 03/12/2015] [Accepted: 03/16/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Stress urinary female incontinence (SUI) is primary due to intrinsic sphincter deficiency (ISD) and urethral hypermobility. Despite a lack of standardised international definition, ISD needs to be clearly diagnosed in order to be correctly treated. This work is an update about the female ISD produced from a review of a published article. MATERIAL AND METHODS This review of article published on this subject in the Medline (Pubmed database), selected according to their scientific relevants, of consensus conferences and published guidelines, has been performed by the committee for women pelvic floor surgery of the French Urological Association. RESULTS Although there is no international consensus definition, we can consider that the ISD is a composite concept combining urodynamic data (MUCP < 20 or 30 cmH20) and one or more clinical information (no urethral mobility, negative urethral support test, failure of a first surgery, leakage during abdominal straining, high stress incontinence scores). Imaging can provide additional evidence for intrinsic sphincter deficiency diagnosis, but the correlation between imaging and function remains low. By standardizing methodology and interpretations to better diagnose women with ISD, it may be possible to improve preoperative planning and outcomes for these patients. A retropubic midurethral sling can be performed as a first surgery. In case of a lack of urethral mobility, the artificial urinary sphincter (AUS) remains the gold standard. Adjustable continence therapy (ACT(®)) can be proposed as an alternative option. The efficacy and safety of muscle-derived cell therapy in ISD needs more studies. Injection of bulking agents may be an option according to the severity and the expectations of the patient. Bladder overactivity needs to be treated as first-line in case of mixed urinary incontinence. In elderly women, a careful evaluation of the bladder contractility and comorbidity must be performed. A geriatric evaluation can be necessary. CONCLUSION Clinical and paraclinical assessment allow to confirm the diagnosis of female ISD, to estimate its severity, and to identify associated mechanisms of incontinence (urethral hypermobility, bladder overactivity) to choose the most adapted treatment.
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Affiliation(s)
- F Cour
- Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Université de Versailles-Saint-Quentin-en-Yvelines, 55, avenue de Paris, 78035 Versailles cedex, France
| | - L Le Normand
- Service d'urologie, CHU de Nantes, place A.-Ricordeau, 44093 Nantes cedex 01, France.
| | - J-F Lapray
- Centre de radiologie, 151, avenue de Saxe, 69003 Lyon, France
| | - J-F Hermieu
- Service d'urologie, CHU Bichat, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - L Peyrat
- Service d'urologie, CHU Tenon, 4, rue de la Chine, 75020 Paris, France
| | - R Yiou
- Service d'urologie, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
| | - L Donon
- Service d'urologie, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - L Wagner
- Service d'urologie, CHU de Nîmes, place du Pr-Debré, 30065 Nîmes cedex 09, France
| | - A Vidart
- Service d'urologie, hôpital Foch, 40, rue Worth, 92150 Suresnes, France; Université de Versailles-Saint-Quentin-en-Yvelines, 55, avenue de Paris, 78035 Versailles cedex, France
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Bayrak O, Mock S, Dmochowski RR. Injectable treatments for female stress urinary incontinence. World J Clin Urol 2014; 3:209-217. [DOI: 10.5410/wjcu.v3.i3.209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 05/13/2014] [Accepted: 07/15/2014] [Indexed: 02/06/2023] Open
Abstract
The use of injectable agents for the treatment of stress urinary incontinence (SUI) is an option for female patients who are unwilling to undergo surgery, or have concurrent conditions or diseases that render surgical treatment unsuitable. To be effective for SUI, an injectable agent must be nonimmunogenic, hypoallergenic, biocompatible, permanent, nonerosive, nonmigratory and painless. It must also heal with minimal fibrosis, possess a long-term bulking effect, and be easily stored and handled. Glutaraldehyde cross-linked bovine collagen (Contigen), silicone polymers (Macroplastique), Durasphere, calcium hydroxyapatite (Coaptite), polyacrylamide hydrogel (Aquamid, Bulkamid), Permacol, and stem cell therapy have been used as injectable agents. Patients must be informed that treatment with injectable agents is not as effective as surgical treatment, and that such agents might necessitate additional and repeated administrations in order to achieve the desired therapeutic effect.
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Kammerer-Doak D, Rizk DEE, Sorinola O, Agur W, Ismail S, Bazi T. Mixed urinary incontinence: international urogynecological association research and development committee opinion. Int Urogynecol J 2014; 25:1303-12. [PMID: 25091925 DOI: 10.1007/s00192-014-2485-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 07/13/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM The definition as well as the treatment of women with mixed urinary incontinence (MUI) is controversial. Since women with MUI are a heterogeneous group, the treatment of MUI requires an individual assessment of the symptom components: stress urinary incontinence, urinary urgency, urgency urinary incontinence, urinary frequency, and nocturia. The purpose of this paper is to summarize the current literature and give an evidence-based review of the assessment and treatment of MUI. METHODS A working subcommittee from the International Urogynecological Association (IUGA) Research and Development (R&D) Committee was formed. An initial document addressing the diagnosis and management of MUI was drafted based on a literature review. After evaluation by the entire IUGA R&D Committee, revisions were made, and the final document represents the IUGA R&D Committee Opinion on MUI. RESULTS This R&D Committee Opinion reviews the literature on MUI and summarizes the assessment and treatment with evidence-based recommendations. CONCLUSIONS The diagnosis of MUI encompasses a very heterogeneous group of women. The evaluation and treatment requires an individualized approach. The use of validated questionnaires is recommended to assess urinary incontinence symptoms and effect on quality of life. Conservative therapy is suggested as a first-line approach; if surgery is contemplated, urodynamic investigation is recommended. Women undergoing surgical treatment for MUI need to be counselled about the possibility of persistence of urinary urgency, frequency and urge incontinence even if stress urinary incontinence is cured.
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Affiliation(s)
- Dorothy Kammerer-Doak
- Women's Pelvic Specialty Care P.C, University of New Mexico Hospital, Albuquerque, NM, USA
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Transurethral injection of polyacrylamide hydrogel (Bulkamid®) for the treatment of female stress or mixed urinary incontinence. Eur J Obstet Gynecol Reprod Biol 2014; 178:199-202. [DOI: 10.1016/j.ejogrb.2014.03.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 03/20/2014] [Accepted: 03/31/2014] [Indexed: 11/22/2022]
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Efficacité des injections péri-urétrales de polyacrylamide hydrogel (Bulkamid®) et qualité de vie de patientes souffrant d’incontinence urinaire d’effort par insuffisance sphinctérienne (IUE-IS). Prog Urol 2014; 24:501-10. [DOI: 10.1016/j.purol.2014.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 02/13/2014] [Accepted: 02/14/2014] [Indexed: 11/20/2022]
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Sokol ER, Karram MM, Dmochowski R. Efficacy and safety of polyacrylamide hydrogel for the treatment of female stress incontinence: a randomized, prospective, multicenter North American study. J Urol 2014; 192:843-9. [PMID: 24704117 DOI: 10.1016/j.juro.2014.03.109] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2014] [Indexed: 12/15/2022]
Abstract
PURPOSE Bulkamid® is a new polyacrylamide hydrogel bulking agent for stress urinary incontinence that is injected in the urethral submucosa using a specifically designed device. We evaluated the safety and efficacy of Bulkamid vs Contigen® collagen gel for stress urinary incontinence or stress predominant mixed urinary incontinence. MATERIALS AND METHODS This was a single-blind, randomized, prospective, 33-center, 2-arm parallel study of hydrogel vs collagen gel with followup to 1 year. At baseline patients underwent physical examination and bladder testing, and completed quality of life questionnaires and bladder diaries. After randomization patients could receive up to 3 injections at 1-month intervals. Patients were assessed 3, 6, 9 and 12 months after bulking. They completed bladder diaries and quality of life questionnaires, and pad weight was tested. At the last visit Valsalva leak point pressure was measured. Subjective and objective incontinence outcomes and adverse events were compared. RESULTS Of the 345 women 229 were randomized to hydrogel and 116 were randomized to collagen gel. At 12 months a 50% or greater decrease in leakage and incontinence episodes was seen in 53.2% and 55.4% of patients who received hydrogel and collagen gel, respectively. At 12 months 47.2% of patients with hydrogel and 50% with collagen gel reported zero stress incontinence episodes, and 77.1% and 70%, respectively, considered themselves cured or improved. Major adverse events were rare in each group. CONCLUSIONS Bulkamid is not inferior to Contigen. It has a favorable, persistent effect on stress urinary incontinence with a low risk of serious adverse events. Bulkamid is a new, simple, office based bulking system that shows promise as a treatment in women with stress urinary incontinence, particularly since Contigen is no longer commercially available.
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Affiliation(s)
- Eric R Sokol
- Departments of Obstetrics and Gynecology, Stanford University, Stanford, California
| | | | - Roger Dmochowski
- Department of Urology, Vanderbilt University, Nashville, Tennessee.
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MacLachlan LS, Rovner ES. Current Status of Bulking Agents for Urinary Incontinence. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-013-0216-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Mouritsen L, Lose G, Møller-Bek K. Long-term follow-up after urethral injection with polyacrylamide hydrogel for female stress incontinence. Acta Obstet Gynecol Scand 2013; 93:209-12. [PMID: 24372312 DOI: 10.1111/aogs.12283] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 10/09/2013] [Indexed: 11/30/2022]
Abstract
Urethral injection therapy for treatment of stress urinary incontinence has been in use for years, but only a few long-term follow-up studies have been published. Twenty-five women, injected with polyacrylamide hydrogel 8 years earlier, were invited for follow-up. Twenty-four could be contacted; 15 had had no further treatment, seven had been re-operated with placement of mid-urethral slings, and two had been re-injected with polyacrylamide hydrogel. Eleven women attended for objective examination; all non-attenders were interviewed by telephone. Subjectively, in 44% the stress incontinence was cured or much improved, with a positive outcome according to the King's Health Questionnaire. Objectively, all patients had visible polyacrylamide hydrogel deposits on vaginal ultrasonography. No local adverse reactions were seen in the vaginal mucosa. The results of a later mid-urethral sling were unaffected by previous polyacrylamide hydrogel injection.
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Affiliation(s)
- Lone Mouritsen
- Department of Gynecology and Obstetrics, Herlev Hospital, University of Copenhagen, Copenhagen
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Rothschild J, Thompson IM, Concepcion RS, Shore ND. Infusion therapy and implantables for the urologist. Urol Clin North Am 2013; 40:591-8. [PMID: 24182978 DOI: 10.1016/j.ucl.2013.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The specialty of urology has historically adapted to the changing health care environment. Urologists have been quick to adopt new technology, new therapeutics, and devices to render state-of-the-art patient care with improved clinical outcomes. The busy urology practice is now in the position to deliver many novel and unique therapies across multiple disease states. As a result, clinicians can provide state-of-the-art care in a clinic setting and potentially reduce the overall costs of health care delivery. This article reviews some of these potential new opportunities available to the practicing urologist.
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Affiliation(s)
- Jennifer Rothschild
- Department of Urology, University of California at Davis Medical Center, 4806 Y Street, Suite 2200, Sacramento, CA 95817, USA
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Krause HG, Lussy JP, Goh JTW. Use of periurethral injections of polyacrylamide hydrogel for treating post-vesicovaginal fistula closure urinary stress incontinence. J Obstet Gynaecol Res 2013; 40:521-5. [PMID: 24118674 DOI: 10.1111/jog.12176] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 05/07/2013] [Indexed: 12/31/2022]
Abstract
AIMS Following successful closure of obstetric genitourinary fistula, stress urinary incontinence (SUI) is a common and challenging problem. Despite many decades of various treatment options, the effective management of post-fistula SUI remains unresolved. This study aims to assess the feasibility of periurethral injections of polyacrylamide hydrogel, commonly used for urinary stress incontinence in non-fistula women, in women with post-fistula closure SUI. MATERIAL AND METHODS Women with urinary incontinence following successful fistula closure were assessed to exclude detrusor overactivity and urinary residual volumes of more than 100 mL. The urethrovesical junction was identified and polyacrylamide hydrogel was injected through the periurethral skin and vaginal epithelium at three sites. RESULTS Four women with post-fistula SUI were treated with polyacrylamide hydrogel injections. Three of the four women were dry post-operatively and remained continent at discharge. CONCLUSION In the short-term, periurethral injections of polyacrylamide hydrogel appears to be a promising method to treat post-obstetric fistula urinary stress incontinence.
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Affiliation(s)
- Hannah G Krause
- Greenslopes Private Hospital, Brisbane, Australia; Gynaecology Department, QEII Hospital, Brisbane, Australia; School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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