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Mengerink BB, Nelen WLDM, van Leijsen SAL, Heesakkers JPFA, Kluivers KB. De-implementation of urodynamics in The Netherlands after the VALUE/VUSIS-2 results: a nationwide survey. Int Urogynecol J 2018; 29:1261-1277. [PMID: 29679158 PMCID: PMC6132705 DOI: 10.1007/s00192-018-3648-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 03/28/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We aimed to estimate the level of de-implementation of preoperative routine urodynamics (UDS) before stress urinary incontinence (SUI) surgery in The Netherlands and to analyze facilitators and barriers. Routine UDS was performed by 37% of the medical specialists in 2010. We hypothesized that the recommendations from the recent Value of Urodynamics prior to Stress Incontinence Surgery (VUSIS) and Value of Urodynamic Evaluation (ValUE) studies would have been followed by a reduction of routine UDS. METHODS A national survey was performed among all Dutch gynecologists and urologists dealing with SUI in daily practice. The questionnaire contained two parts: (1) respondents' characteristics and their actual care concerning preoperative UDS, and (2) facilitators and barriers. RESULTS The response rate was 41% (127/308). Of the respondents, 93% (n = 118) did not perform routine UDS in the preoperative workup for women in this group. Professional characteristics associated with not following the recommendations were profession urologist, academic hospital, and a lower number of midurethral sling (MUS) placed yearly. Facilitators to follow the recommendation not to perform routine UDS were adequate design of the VUSIS-II study and outcome and recommendations from the studies. Barriers not to follow the recommendation were believe in the additional value of UDS, especially the pressure transmission ratio, and the presence of detrusor overactivity. CONCLUSION According to respondents to this questionnaire, VUSIS-II and ValUE study results are well implemented in The Netherlands. The vast majority of respondents replied as not performing routine preoperative UDS in women with primary, uncomplicated (predominant) SUI. Therefore, there is no need for a further de-implementation strategy.
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Affiliation(s)
- Bianca B Mengerink
- Department of Obstetrics & Gynecology, Radboud University Nijmegen Medical Center, 791, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Willianne L D M Nelen
- Department of Obstetrics & Gynecology, Radboud University Nijmegen Medical Center, 791, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Sanne A L van Leijsen
- Department of Obstetrics & Gynaecology, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - John P F A Heesakkers
- Department of Urology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Kirsten B Kluivers
- Department of Obstetrics & Gynecology, Radboud University Nijmegen Medical Center, 791, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
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Zhang YG, Song QX, Song B, Zhang DL, Zhang W, Wang JY. Diagnosis and Treatment of Urinary Incontinence after Orthotopic Ileal Neobladder in China. Chin Med J (Engl) 2017; 130:231-235. [PMID: 28091417 PMCID: PMC5282682 DOI: 10.4103/0366-6999.198012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Yao-Guang Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Qi-Xiang Song
- Department of Urology, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Bo Song
- Department of Urology, Southwest Hospital, Chongqing 400038, China
| | - Da-Lei Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Wei Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Jian-Ye Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
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Khayyami Y, Klarskov N, Lose G. The promise of urethral pressure reflectometry: an update. Int Urogynecol J 2016; 27:1449-58. [PMID: 26872643 DOI: 10.1007/s00192-016-2964-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
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Heesakkers J, Gerretsen R, Izeta A, Sievert KD, Farag F. Circumferential urinary sphincter surface electromyography: A novel diagnostic method for intrinsic sphincter deficiency. Neurourol Urodyn 2014; 35:186-91. [DOI: 10.1002/nau.22711] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 10/24/2014] [Indexed: 11/12/2022]
Affiliation(s)
- John Heesakkers
- Department of Urology; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Reza Gerretsen
- Department of Forensic Medicine; Netherlands Forensic Institute; The Hague The Netherlands
| | - Ander Izeta
- Instituto Biodonostia; Hospital Universitario Donostia; San Sebastian Spain
| | | | - Fawzy Farag
- Department of Urology; Radboud University Medical Centre; Nijmegen The Netherlands
- Department of Urology; Sohag University Hospital; Sohag Egypt
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Saaby ML, Klarskov N, Lose G. The impact of tension-free vaginal tape on the urethral closure function: mechanism of action. Neurourol Urodyn 2014; 34:50-4. [PMID: 25296187 DOI: 10.1002/nau.22513] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 09/25/2013] [Indexed: 11/07/2022]
Abstract
AIM To investigate if the tension-free vaginal tape (TVT) works by increasing the abdominal to urethral pressure impact ratio (APIR). METHODS Twenty one women with urodynamically proven stress urinary incontinence (SUI) were assessed by ICIQ-SF, pad-weighing test, incontinence diary and Urethral Pressure Reflectometry (UPR) before and after TVT. UPR was conducted during resting and increased intra-abdominal pressure (P(Abd)) by straining. Related values of P(Abd) and urethral opening pressure (P(o)) were plotted into an abdomino-urethral pressuregram. Linear regression of the values was conducted, and the slope of the line was found. The slope expresses the ratio of pressure increase in the urethra compared to the pressure increase in the abdomen and was called APIR. RESULTS The urethral opening pressure at rest (P(o-rest)) was unchanged after TVT, while APIR increased in all women (from 0.7 to 1.4, P < 0.0001). CONCLUSIONS The TVT seems to strengthen the urethral closure function by increasing the APIR while P(o-rest) is unchanged regardless of the type of pre-operative dysfunction. This confirms the theory of TVT's mechanism of action being mid-urethral support.
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Affiliation(s)
- Marie-Louise Saaby
- Department of Obstetrics and Gynecology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
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Ignjatovic I, Potic M, Basic D, Dinic L, Medojevic N, Laketic D, Skakic A, Mihajlovic M. Self-created transobturator tape treatment of stress urinary incontinence without prior urodynamic investigation. Eur J Obstet Gynecol Reprod Biol 2014; 182:76-80. [PMID: 25262290 DOI: 10.1016/j.ejogrb.2014.08.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/31/2014] [Accepted: 08/21/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate and compare the results of tension free self-created transobturator tape (SCTOT) with the standard industrially created transobturator tape (ICTOT) in the treatment of stress urinary incontinence (SUI). STUDY DESIGN A prospective study of the treatment of SUI with SCTOT (67 patients) and ICTOT (47 patients) was performed. SCTOT was created from polypropylene mesh and monofilament sutures. The symptoms were evaluated before and after the surgery with the following: the Incontinence Impact questionnaire (IIC-7), the urogenital distress inventory (UDI-6), and the International Continence impact questionnaire short form (ICIQ5-SF). The overactive bladder symptom score (OABSS) was used to classify patients in the SUI or the mixed urinary incontinence (MUI) group. The follow up period was 18 months. Cure was defined as a negative stress test and no need for additional surgery. RESULTS Objective cure was achieved in 56/67 (83.5%) participants in the SCTOT group and in 40/47 (85.1%) participants in the ICTOT group (p>0.05). There was a significant improvement in IIC-7, UDI-6, ICIQ5-SF and OABSS in both groups. Improvement was better in the group with pure SUI than in patients with MUI, but this difference was not significant. Postoperative infection occurred in 5/67 (7.4%) participants and in 5/47 (10.6%) patients in the SCTOT and the ICTOT group, respectively. De novo overactive bladder symptoms occurred in 4/67 (5.9%) of the participants in the SCTOT group and in 3/47 (6.3%) of the patients in the ICTOT group. Operating time was longer in patients with SCTOT compared to those with ICTOT. CONCLUSION The results of the treatment with SCTOT are not inferior to the results of the treatment with ICTOT and other results reported in the literature.
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Affiliation(s)
- Ivan Ignjatovic
- Clinic of Urology, Clinical Center Nis and Faculty of Medicine Nis, Serbia.
| | - Milan Potic
- Clinic of Urology, Clinical Center Nis and Faculty of Medicine Nis, Serbia
| | - Dragoslav Basic
- Clinic of Urology, Clinical Center Nis and Faculty of Medicine Nis, Serbia
| | - Ljubomir Dinic
- Clinic of Urology, Clinical Center Nis and Faculty of Medicine Nis, Serbia
| | - Nina Medojevic
- Clinic of Urology, Clinical Center Nis and Faculty of Medicine Nis, Serbia
| | | | - Aleksandar Skakic
- Clinic of Urology, Clinical Center Nis and Faculty of Medicine Nis, Serbia
| | - Marija Mihajlovic
- Clinic of Urology, Clinical Center Nis and Faculty of Medicine Nis, Serbia
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Vecchioli-Scaldazza C, Morosetti C, Azizi B, Giannubilo W, Ferrara V. Polyacrylamide Hydrogel (Bulkamid) in Female Patients of 80 or More Years with Urinary Incontinence. Int Braz J Urol 2014; 40:37-43. [DOI: 10.1590/s1677-5538.ibju.2014.01.06] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 01/16/2014] [Indexed: 11/22/2022] Open
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Value of urodynamics before stress urinary incontinence surgery: a randomized controlled trial. Obstet Gynecol 2013; 121:999-1008. [PMID: 23635736 DOI: 10.1097/aog.0b013e31828c68e3] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To estimate whether a strategy of immediate surgery was noninferior to a strategy based on discordant urodynamic findings followed by individually tailored therapy in women with stress urinary incontinence (SUI). METHODS A multicenter diagnostic cohort study with an embedded noninferiority randomized controlled trial was conducted in six academic and 24 nonacademic Dutch hospitals. Women with predominant SUI eligible for surgical treatment based on clinical assessment were included between January 2009 and November 2010. All patients underwent urodynamics. In patients in whom urodynamics were discordant with clinical assessment, participants were randomly allocated to receive either immediate surgery or individually tailored therapy based on urodynamics. The primary outcome was clinical improvement assessed by the Urogenital Distress Inventory 12 months after baseline. Analysis was by intention to treat; a difference in mean improvement of 5 points or less was considered noninferior. RESULTS Five hundred seventy-eight women with SUI were studied, of whom 268 (46%) had discordant findings. One hundred twenty-six patients gave informed consent for randomization and were allocated to receive immediate surgery (n=64) or individually tailored therapy (n=62). The mean improvement measured with the Urogenital Distress Inventory after 1 year was 44 points (±24) in the group receiving immediate surgery and 39 (±25) points in the group receiving individually tailored treatment. The difference in mean improvement was 5 points in favor of the group receiving immediate surgery (95% confidence interval -∞ to 5). There were no differences with respect to cure or complication rate. CONCLUSION In women with uncomplicated SUI, an immediate midurethral sling operation is not inferior to individually tailored treatment based on urodynamic findings. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT00814749. LEVEL OF EVIDENCE I.
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Glancz LJ, Cartwright R, Cardozo L. Inter- and intra-rater reliability of fluoroscopic cough stress testing. J OBSTET GYNAECOL 2010; 30:492-5. [DOI: 10.3109/01443615.2010.482680] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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van Leijsen SAL, Kluivers KB, Mol BWJ, Broekhuis SR, Milani FL, van der Vaart CH, Roovers JPWR, Bongers MY, den Boon J, Spaans WA, de Leeuw JW, Dietz V, Kleinjan JH, Brölmann HAM, Roos EJ, Schaafstra J, Heesakkers JPFA, Vierhout ME. Protocol for the value of urodynamics prior to stress incontinence surgery (VUSIS) study: a multicenter randomized controlled trial to assess the cost effectiveness of urodynamics in women with symptoms of stress urinary incontinence in whom surgical treatment is considered. BMC WOMENS HEALTH 2009; 9:22. [PMID: 19622153 PMCID: PMC2722584 DOI: 10.1186/1472-6874-9-22] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 07/21/2009] [Indexed: 11/23/2022]
Abstract
Background Stress urinary incontinence (SUI) is a common problem. In the Netherlands, yearly 64.000 new patients, of whom 96% are women, consult their general practitioner because of urinary incontinence. Approximately 7500 urodynamic evaluations and approximately 5000 operations for SUI are performed every year. In all major national and international guidelines from both gynaecological and urological scientific societies, it is advised to perform urodynamics prior to invasive treatment for SUI, but neither its effectiveness nor its cost-effectiveness has been assessed in a randomized setting. The Value of Urodynamics prior to Stress Incontinence Surgery (VUSIS) study evaluates the positive and negative effects with regard to outcome, as well as the costs of urodynamics, in women with symptoms of SUI in whom surgical treatment is considered. Methods/design A multicentre diagnostic cohort study will be performed with an embedded randomized controlled trial among women presenting with symptoms of (predominant) SUI. Urinary incontinence has to be demonstrated on clinical examination and/or voiding diary. Physiotherapy must have failed and surgical treatment needs to be under consideration. Patients will be excluded in case of previous incontinence surgery, in case of pelvic organ prolapse more than 1 centimeter beyond the hymen and/or in case of residual bladder volume of more than 150 milliliter on ultrasound or catheterisation. Patients with discordant findings between the diagnosis based on urodynamic investigation and the diagnosis based on their history, clinical examination and/or micturition diary will be randomized to operative therapy or individually tailored therapy based on all available information. Patients will be followed for two years after treatment by their attending urologist or gynaecologist, in combination with the completion of questionnaires. Six hundred female patients will be recruited for registration from approximately twenty-seven hospitals in the Netherlands. We aspect that one hundred and two women with discordant findings will be randomized. The primary outcome of this study is clinical improvement of incontinence as measured with the validated Dutch version of the Urinary Distress Inventory (UDI). Secondary outcomes of this study include costs, cure of incontinence as measured by voiding diary parameters, complications related to the intervention, re-interventions, and generic quality of life changes. Trial registration Clinical Trials NCT00814749.
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Affiliation(s)
- Sanne A L van Leijsen
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
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Abstract
PURPOSE OF REVIEW This article reviews the literature from the last 12 months in the context of our existing knowledge base and reviews the contentious issue of the role of preoperative urodynamics for stress urinary incontinence, with particular reference to the choice of urodynamic investigations for diagnostic differentiation between intrinsic sphincter deficiency and urethral hypermobility, assessing symptom severity and predicting postoperative prognosis. RECENT FINDINGS While there are significant conflicting data regarding the role of urodynamics, particularly in the functional assessment of the urethra, it is clear that these diagnostic techniques can provide clinically useful data. It is in this context that recent guidelines advising on restricted use of invasive urodynamics preoperatively should be carefully reviewed. SUMMARY There is a pressing need for randomized controlled trials to be performed to fully assess the role of urodynamics in the preoperative assessment of stress urinary incontinence, especially at this time of rapid change in the surgical treatments available.
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Naoemova I, De Wachter S, Wyndaele JJ. Comparison of sensation-related voiding patterns between continent and incontinent women: A study with a 3-day sensation-related bladder diary (SR-BD). Neurourol Urodyn 2008; 27:511-4. [DOI: 10.1002/nau.20545] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Treadway AK, Canales AE. New Options and Strategies for the Treatment of Urinary Incontinence. J Pharm Pract 2007. [DOI: 10.1177/0897190007304836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Urinary incontinence is a prevalent, although often unreported, disease within the elderly population, with consequences spanning many aspects of the patient's life. Treatments differ for each subtype of urinary incontinence: urge incontinence, stress incontinence, and incontinence associated with bladder outlet obstruction and lower urinary tract symptoms in men. Limitations in current therapies have negatively affected care for each of these subtypes, particularly in the vulnerable elderly population. An emergence of new treatment options and strategies has created opportunities to optimize care for the general population. These include the use of trospium, darifenacin, solifenacin, and duloxetine as well as the strategic use of antimuscarinic agents in conjunction with alpha adrenergic blockade in men with bladder outlet obstruction. Yet, the literature regarding use of these agents and strategies in the elderly should be carefully evaluated to determine the benefits and the unique risks posed by their use in this vulnerable population.
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Affiliation(s)
- Angela K. Treadway
- Department of Pharmacy Practice at Texas Tech Health Sciences Center School of Pharmacy, Dallas/Fort Worth Center, Dallas, Texas,
| | - Ann E. Canales
- Department of Pharmacy Practice at Texas Tech Health Sciences Center School of Pharmacy, Amarillo, Texas
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Jünemann KP, Palmtag H, Hampel C, Heidler H, Naumann G, Kölbl H, van der Horst C, Schultz-Lampel D. [Urinary incontinence and urodynamics]. Urologe A 2006; 45 Suppl 4:106-21. [PMID: 16944079 DOI: 10.1007/s00120-006-1192-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Incontinence can be the result of impaired functioning of the detrusor muscle and/or the sphincter mechanism. For this reason, the pathomorphology and the pathophysiology should be documented before surgery, so that if it is not successful it is possible to deduce what alterations have been caused by an operation and the reason why the treatment has not been successful. Vaginal reconstruction of the pelvic floor following vaginal prolapse is a safe, effective surgical procedure, particularly for older women. Abdominal fixation of the vaginal stump through open or laparoscopic sacrocolpopexy gives long-lasting and anatomically favourable results especially for younger women who are sexually active, but is associated with a higher mortality rate. Incontinence treatment in men is itself gradually becoming accepted as a subspecialty. Pharmacological treatment that is used for urge incontinence takes the form of substances that relax or desensitize the detrusor (antimuscarinics, oestrogens, alpha-blockers, beta-mimetics, botulinum toxin A, resiniferatoxin, vinpocetin), while stress incontinence requires stimulation of the sphincter and pelvic floor (alpha-mimetics, oestrogens, duloxetin). Bladder function disturbances in children can be classified by noninvasive methods, but the therapy remains a difficult endurance test for the children, their parents and the doctor, often extending over years.
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Affiliation(s)
- K-P Jünemann
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, 24105 Kiel.
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Chapple CR, Wein AJ, Brubaker L, Dmochowski R, Pons ME, Haab F, Hill S. Stress incontinence injection therapy: what is best for our patients? Eur Urol 2006; 48:552-65. [PMID: 16118034 DOI: 10.1016/j.eururo.2005.06.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2005] [Accepted: 06/14/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Urethral injection (periurethral/intraurethral bulking) is an established, minimally invasive therapy for stress urinary incontinence (SUI). This review aims to determine which women should potentially benefit from, and be considered as candidates for, injection therapy and to elucidate what we are trying to achieve. METHODS Based on MEDLINE database searches, all aspects of urethral injection were examined, including patient selection, safety, injection technique, efficacy, quality of life, goals and cost. RESULTS Such therapy has a low complication rate, improves or cures about 3 out of 4 women, as shown in mainly short-term studies, and improves patients' quality of life. It can be used in the majority of patients with uncomplicated SUI. Therefore, injection therapy may be considered as a first-line treatment option for patients who have failed conservative therapy such as pelvic floor exercises and who decline or have a contraindication for pharmacological treatment. However, the decision of whether to use this type of treatment must be based on an informed discussion between the physician and patient--this dialogue should incorporate questions about patients' own treatment goals. Injection therapy appears to have the profile required to meet patients' goals, based on the findings that a procedure with an improvement in incontinence, minimal short-term risk, no long-term risk, and performed in a clinic, would be acceptable. CONCLUSION Investigating and trying to achieve patients' own treatment goals will ultimately enable us to do what is best for our patients, but current evidence suggests that injection therapy is a valid option worth discussing with many patients.
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Affiliation(s)
- Christopher R Chapple
- Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Glossop Road, Sheffield, South Yorkshire S10 2JF, UK.
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Affiliation(s)
- Pierre Costa
- Service Urologie, Hôpital Caremeau, Mimes, France.
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Chapple CR, Haab F, Cervigni M, Dannecker C, Fianu-Jonasson A, Sultan AH. An open, multicentre study of NASHA/Dx Gel (Zuidex) for the treatment of stress urinary incontinence. Eur Urol 2005; 48:488-94. [PMID: 15967568 DOI: 10.1016/j.eururo.2005.05.007] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2005] [Accepted: 05/10/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The Zuidex system facilitates non-endoscopic urethral injection for stress urinary incontinence (SUI). It comprises four pre-filled syringes of non-animal stabilised hyaluronic acid/dextranomer (NASHA/Dx) gel and an Implacer device. This open, 12-month study was performed to evaluate the safety and efficacy of this system in women with SUI. METHODS Patients were aged > or =18 years with a history of SUI for > or =12 months (hypermobility and/or intrinsic sphincter deficiency), had failed prior non-invasive therapy and were invasive-therapy naïve. Up to two treatments with NASHA/Dx gel were permissible (re-treatment was offered at week 8). Positive response to treatment was defined as a reduction in provocation test leakage of > or =50% compared with baseline. Efficacy was also measured by 24-hour pad weight test leakage, and number of incontinence episodes/24 hours. RESULTS A total of 142 patients were enrolled, with a mean age of 55.7 years. The response rate was 78% at week 12, and 77% at month 12. Significant reductions in median provocation test leakage, 24-hour pad-weight test leakage and number of incontinence episodes/24 hours were observed at all time-points. At month 12, the median decreases from baseline in these three variables were 93%, 89% and 67%, respectively. Treatment-related adverse events were of a nature expected with urethral injection - most were transient, and of mild or moderate intensity. CONCLUSIONS Treatment with NASHA/Dx gel produced large, statistically significant reductions in urinary leakage sustained over 12 months and was well tolerated. These findings suggest that NASHA/Dx gel could be considered as an early intervention in treatment-naïve cases of SUI.
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Affiliation(s)
- Christopher R Chapple
- Sheffield Teaching Hospitals NHS Trust, Urology Research, Royal Hallamshire Hospital, South Yorkshire, UK.
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Moore KN. Barriers to Funding Research in Urinary Incontinence. J Wound Ostomy Continence Nurs 2005; 32:219-21. [PMID: 16030459 DOI: 10.1097/00152192-200507000-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Current World Literature. Curr Opin Urol 2005. [DOI: 10.1097/01.mou.0000172405.15632.cb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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