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Sikora M, Gamper M, Zivanovic I, Münst J, Bischofberger H, Kociszewski J, Viereck V. Current Treatment of Stress Urinary Incontinence by Bulking Agents and Laser Therapy-An Update. J Clin Med 2024; 13:1377. [PMID: 38592248 PMCID: PMC10932143 DOI: 10.3390/jcm13051377] [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: 01/15/2024] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024] Open
Abstract
Stress urinary incontinence (SUI) affects around 20% of women. In addition to the established suburethral sling insertion, two less invasive approaches are of interest today: urethral bulking agents and vaginal laser therapy. This review discusses articles through December 2023 identified by a PubMed literature search using the keywords "incontinence" and "bulking" or "laser". Although the two approaches are less effective than sling insertions, there are specific conditions in which one or the other technique is more advantageous. Injecting bulking agents into the urethra only takes some minutes and works without general anesthesia. The method is particularly suited for elderly, frail, or obese patients with multiple comorbidities, but is also applicable for all patients and in combination with other therapies. Generally, the safety profile is good but differs between bulking materials. Two laser types-the Erbium:YAG laser with SMOOTH-mode and the fractional ablative CO2 laser-deliver heat into the tissue to induce tissue tightening and regeneration. Intravaginal laser therapy improves mild to moderate SUI, while studies describe how intraurethral laser therapy is also beneficial for severe SUI. Young women between childbirths, as well as postmenopausal women, may benefit from laser therapy. The method is safe, can be performed on an outpatient basis, and does not require any artificial material.
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Affiliation(s)
- Michal Sikora
- Department of Gynecology and Obstetrics, Spital Thurgau Frauenfeld, 8501 Frauenfeld, Switzerland; (M.S.); (M.G.); (I.Z.); (J.M.); (H.B.)
| | - Marianne Gamper
- Department of Gynecology and Obstetrics, Spital Thurgau Frauenfeld, 8501 Frauenfeld, Switzerland; (M.S.); (M.G.); (I.Z.); (J.M.); (H.B.)
| | - Irena Zivanovic
- Department of Gynecology and Obstetrics, Spital Thurgau Frauenfeld, 8501 Frauenfeld, Switzerland; (M.S.); (M.G.); (I.Z.); (J.M.); (H.B.)
| | - Julia Münst
- Department of Gynecology and Obstetrics, Spital Thurgau Frauenfeld, 8501 Frauenfeld, Switzerland; (M.S.); (M.G.); (I.Z.); (J.M.); (H.B.)
| | - Helena Bischofberger
- Department of Gynecology and Obstetrics, Spital Thurgau Frauenfeld, 8501 Frauenfeld, Switzerland; (M.S.); (M.G.); (I.Z.); (J.M.); (H.B.)
| | - Jacek Kociszewski
- Department of Gynecology and Obstetrics, Evangelisches Krankenhaus Hagen-Haspe, 58135 Hagen, Germany;
| | - Volker Viereck
- Department of Gynecology and Obstetrics, Spital Thurgau Frauenfeld, 8501 Frauenfeld, Switzerland; (M.S.); (M.G.); (I.Z.); (J.M.); (H.B.)
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Update on Urethral Bulking for Stress Urinary Incontinence in Women. Curr Urol Rep 2022; 23:203-209. [PMID: 35781870 DOI: 10.1007/s11934-022-01099-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Urethral bulking agents are an effective treatment for stress urinary incontinence in select females. The material and techniques used for urethral bulking are constantly evolving. With the introduction of several new agents, there is an ongoing debate over which agent is the most effective, durable, and safe. RECENT FINDINGS Current available bulking agents include Bulkamid®, Macroplastiue®, Durasphere®, Coaptite®, or Urolastic®. Each of these agents has its own biophysical properties that affect its efficacy and safety. Evidence evaluating bulking agents has increased over time but there is no definitive data that suggest superiority of one agent over another. The ideal urethral bulking agent for female stress incontinence has yet been identified. Currently available agents have acceptable short-term and medium-term efficacy with few adverse events.
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Patel S, Lazarowicz H, Hamm R. Long-term complications of bulking agents in the treatment of stress urinary incontinence: Results of a national survey. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221086405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction and Objectives: Bulking agents have been used for decades as an alternative treatment for patients with stress urinary incontinence who are not appropriate for surgery. Despite this their long-term complications are poorly documented and can be misdiagnosed. This paper presents a literature review and the results of a national survey of members of the Section of Female, Neurological and Urodynamic Urology (FNUU) of the British Association of Urological Surgeons (BAUS) identifying the common long-term complications of widely used bulking agents in clinical practice. Methods: Following a comprehensive literature review an electronic survey was sent to members of the BAUS Section of FNUU. Data included hospital trust, use of urethral bulking agents (including type), the approximate number of procedures performed and whether any long-term complications had been observed and managed in their practice. Long-term complications were defined as those arising more than 12 months after treatment. Results: The literature review revealed multiple case reports of complications secondary to bulking agent injection but no high-level evidence regarding frequency or severity. The survey revealed complications including granulomas, erosions, abscesses and misdiagnoses of urethral diverticula and calculi formation. 88% of urologists who responded to the survey had performed a urethral bulking agent injection and 51% of urologists had observed or treated a long-term complication, some many decades after injection. Conclusion: Patients should be made aware of possible long-term complications of what appears to be a minimally invasive procedure in order for them to make an informed choice about treatment options. Level of evidence: Not applicable
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Affiliation(s)
- Sana Patel
- School of Medicine, University of Liverpool, UK
| | - Henry Lazarowicz
- Gow Gibbon Department of Urology, Broadgreen Hospital, Liverpool University Hospitals Foundation Trust, UK
| | - Rebecca Hamm
- School of Medicine, University of Liverpool, UK
- Gow Gibbon Department of Urology, Broadgreen Hospital, Liverpool University Hospitals Foundation Trust, UK
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Urethral Bulking in the Treatment of Stress and Mixed Female Urinary Incontinence: Results from a Multicenter Cohort and Predictors of Clinical Outcomes. J Clin Med 2022; 11:jcm11061569. [PMID: 35329895 PMCID: PMC8950172 DOI: 10.3390/jcm11061569] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/05/2022] [Accepted: 03/09/2022] [Indexed: 02/01/2023] Open
Abstract
The aim of the present study is to analyze the outcomes of urethral bulking in the treatment of non-neurogenic female stress and mixed urinary incontinence and to assess predictors of clinical outcomes. We retrospectively included all consecutive patients affected by stress or mixed urinary incontinence and treated with urethral bulking. Outcomes were evaluated via the PGI-I questionnaire and the 24-h pad test. Between January 2010 and January 2020, we treated 216 patients (Bulkamid n = 206; Macro-plastique n = 10). The median age at surgery was 66 years (IQR 55−73.75). The median follow-up was 12 months (IQR 12−24). In total, 23.8% of patients were subjected to prior incontinence surgery, 63.8% of patients were affected by genuine stress urinary incontinence, 36.2% reported mixed urinary incontinence, whereas detrusor overactivity was confirmed in only 24.9%. The dry rate was 32.9%; nevertheless, 69.9% of patients declared themselves “very improved” or “improved” (PGI-I1-2). Low complications were observed, mostly classified as Clavien I. After univariate and multivariate analyses, the only statistically significant independent predictor of “dry” outcome was the 24 h pad test, p < 0.001. Urethral bulking could be proposed with more expectations of success in patients with mild urinary incontinence. Patients affected by moderate−severe incontinence are less likely to obtain clinical success; therefore, they should be carefully counselled about clinical expectations before the procedure.
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de Vries AM, Casteleijn FM, Roovers JPW, Heesakkers JP, Fütterer JJ. Imaging findings of vinyl dimethyl polydimethylsiloxane used as a paraurethral injectable for female stress urinary incontinence. Ther Adv Urol 2021; 13:17562872211060909. [PMID: 35173814 PMCID: PMC8842146 DOI: 10.1177/17562872211060909] [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] [Received: 05/27/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives: Vinyl dimethyl polydimethylsiloxane (VDPDMS) is a urethral bulking agent used
for female stress urinary incontinence (SUI), that is clearly visible on
computed tomography (CT). Clinical effects are promising, but it remains
difficult to identify factors predicting clinical success. Clinical outcome
might depend on the shape and position of the implants after injection.
Objective of this study is to analyze the appearance and position of bulk
material on CT scans and to see whether it is delivered the intended
circumferential and mid-urethral position. Methods: A single-center retrospective study was performed in 20 women, treated with
VDPDMS for SUI. A senior radiologist analyzed all CTs, using an assessment
scheme. This scheme describes whether the bulk is scattered, mid-urethral,
and/or circumferentially distributed. The imaging findings were subsequently
correlated to the patient global impression of improvement (PGI-I) and the
percentage of subjective improvement experienced 6 weeks
post-operatively. Results: The patient’s mean age was 61 years, and they underwent median 2.0 previous
surgical treatments for SUI. Three patients reported no improvement, 9
patients had 20–90% improvement and 8 reported >90% improvement of their
SUI. In 17/74 (24%) positions, the implant was scattered rather than
spherical. In 9/20 (45%), the implants were not located in the intended
mid-urethral position. In 8/20 patients (40%), the material was distributed
circumferentially. Conclusion: This is the first study describing the position and shape of VDPDMS in
patients after treatment. The appearance and position of the implants
appears to be variable, but optimal positioning or shape seems to be no
absolute requisite for success.
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Affiliation(s)
- Allert M. de Vries
- Department of Urology – Experimental Urology (Route 267), Radboud University Medical Centre, Geert Grooteplein 10, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Fenne M. Casteleijn
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Amsterdam, The Netherlands
| | | | | | - Jurgen J. Fütterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
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Anand A, Khan SM, Khan AA. Stress urinary incontinence in females. Diagnosis and treatment modalities – past, present and the future. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211044583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Stress urinary incontinence (SUI) can be defined as involuntary and unintentional loss of urine through the urethra when vesical pressure exceeds the urethral sphincter pressure during instances of coughing, sneezing or physical exercise. Stress urinary incontinence is the most common form of incontinence in females with an estimated prevalence of 4.5–53% in adult women with urinary incontinence. Yet despite its distressing nature and a negative impact on quality of life, very few women present with their symptoms to a urologist. Materials and methods: A literature search of the MEDLINE, Cochrane Library, Embase, NLH, ClinicalTrials.gov and Google Scholar databases was done up to November 2020, using terms related to SUI, medical therapy, surgical therapy and treatment options. The search terms included female stress urinary incontinence, mid-urethral sling, tension-free vaginal tape and trans obturator tape. The search included original articles, reviews and meta-analyses. Conclusion: Current guidelines for the management of stress urinary incontinence propose a step-ladder pattern, based on treatment invasiveness starting from conservative therapies, then drugs followed by minimally invasive procedures and culminating in invasive surgeries. The surgical approach is to be considered only after conservative therapies fail. The recent advances in the treatment of stress urinary incontinence have brought to light newer modalities and newer technologies that can be utilized which include laser therapy, stem cell therapy, intravesical balloon and others that show a lot of promise. This paper provides an in-depth analysis and reviews the literature on the current modalities and the future prospects of female stress urinary incontinence. Level of evidence: Not applicable for this review article.
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Affiliation(s)
- Ajay Anand
- Department of Urology, Government Medical College Jammu, India
| | | | - Azhar Ajaz Khan
- Department of Urology, Indraprastha Apollo Hospital, Delhi, India
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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] [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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Campillo-Cañete MN, González-Tamajón RM, Berlango-Jiménez J, Crespo-Montero R. Incontinencia urinaria: causas y cuidados de enfermería. Una revisión bibliográfica. ENFERMERÍA NEFROLÓGICA 2021. [DOI: 10.37551/s2254-28842021003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
frecuencia en el sexo femenino y conforme aumenta la edad, provocando una disminución de la calidad de vida.Objetivo: Sintetizar la evidencia científica relacionada con las causas, tratamiento y cuidados de enfermería en la incontinencia urinaria.Metodología: Se ha realizado una revisión bibliográfica sistematizada en las bases de datos Proquest, Pubmed, Google Académico y Scielo, utilizando como términos "incontinencia urinaria" (urinary incontinence), "factoresde riesgo" (risk factor), "intervenciones de enfermería"(nursing intervention) y "procedimientos terapeúticos"(therapeutics), con una limitación de 5 años en la búsqueda. Se incluyeron estudios experimentales y de revisión.Resultados: Se incluyeron 26 artículos: 5 estudios experimentales,18 revisiones sistemáticas y 3 metaanálisis.La incontinencia urinaria está relacionada con la edad, sexo y factores de riesgo, dependiendo del tipo e intensidad de la incontinencia, y características propias del paciente. El abordaje es interdisciplinar, con técnicasmenos invasivas al principio, entre las que destacan la terapia conductual y los ejercicios del suelo pélvico; necesitándose cirugía en algunos casos, según las circunstanciasindividuales de los pacientes y/o la no existenciade mejoría con las técnicas menos invasivas.Conclusiones: La incontinencia urinaria se encuentra estrechamente relacionada con la edad y el sexo; sin embargo, la existencia de factores de riesgo y algunas causas pueden contribuir a aumentar las probabilidadesde su establecimiento. La labor enfermera resulta prometedora en el establecimiento de una detección y actuación precoz ante el problema, teniendo como base siempre para el tratamiento el menor grado de invasión.
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Affiliation(s)
| | | | - José Berlango-Jiménez
- Departamento de Enfermería. Facultad de Medicina y Enfermería. Universidad de Córdoba. Córdoba. Servicio de Nefrología. Hospital Universitario Reina Sofía de Córdoba
| | - Rodolfo Crespo-Montero
- Departamento de Enfermería. Facultad de Medicina y Enfermería. Universidad de Córdoba. Servicio de Nefrología. Hospital Universitario Reina Sofía de Córdoba. Instituto Maimónides de Investigación Biomédica de Córdoba. Córdoba. España
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Casteleijn FM, Kowalik CR, Berends C, Blaganje M, Lasić Pecev M, van der Linden E, Zwolsman SE, Roovers JPWR, Minnee P. Patients' satisfaction and safety of bulk injection therapy Urolastic for treatment of stress urinary incontinence: A cross-sectional study. Neurourol Urodyn 2020; 39:1753-1763. [PMID: 32526063 PMCID: PMC7497040 DOI: 10.1002/nau.24417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/24/2020] [Indexed: 11/28/2022]
Abstract
Aims Primary outcome was to evaluate patients' satisfaction after being treated with bulk injection therapy polydimethylsiloxane Urolastic (PDMS‐U) for stress urinary incontinence (SUI). Secondary outcomes were: subjective cure, objective cure, severity of SUI symptoms, complications, reintervention rate, and disease‐specific quality of life. Furthermore, to determine if outcomes worsened during time‐after‐treatment (time‐frames: 0‐12, 13‐24, and ≥25 months). Methods In a cross‐sectional design, patients treated with PDMS‐U were recruited for hospital revisit. The primary outcome, patients' satisfaction, was assessed by the surgical satisfaction questionnaire. Subjective cure, objective cure, and severity of symptoms were assessed by the patients global impression of improvement, standardized cough stress test, and Sandvik severity scale, respectively. Medical charts and face‐to‐face interviews were used to determine complications and reinterventions. Results About 110 patients participated, 87 revisited the hospital. Median follow‐up was 25 months (interquartile range: 14;35 months). Patients' satisfaction rate was 51%. Subjective and objective cure were respectively 46% and 47%. Most prevalent complications were: urinary retention (22%), pain (15%), and dyspareunia (15%). Exposure and erosion occurred in 7% and 5%, respectively. Reintervention rate of reinjection and excision of bulk material was 6% and 18.0%, respectively. Objective cure significantly worsened during time‐after‐treatment (P = < .05). Conclusions About half of the patients being treated with PDMS‐U were satisfied and subjectively cured 2 years after treatment, although the majority still experienced symptoms of SUI. Most complications were mild and transient, however, in 18% excision of bulk material was indicated for severe or persistent complications such as pain, exposure, or erosion.
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Affiliation(s)
- Fenne M Casteleijn
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Claudia R Kowalik
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Claudia Berends
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mija Blaganje
- Department of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Mateja Lasić Pecev
- Department of Obstetrics and Gynecology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Sandra E Zwolsman
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan-Paul W R Roovers
- Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Pieter Minnee
- Department of Urology, Langeland Hospital, Zoetermeer, The Netherlands
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Efficacy and effectiveness of bulking agents in the treatment of stress and mixed urinary incontinence: A systematic review and meta-analysis. Maturitas 2020; 133:13-31. [DOI: 10.1016/j.maturitas.2019.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/04/2019] [Accepted: 12/10/2019] [Indexed: 11/21/2022]
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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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12
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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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Hussain SM, Bray R. Urethral bulking agents for female stress urinary incontinence. Neurourol Urodyn 2019; 38:887-892. [DOI: 10.1002/nau.23924] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/10/2018] [Indexed: 01/19/2023]
Affiliation(s)
- Sadiya M. Hussain
- Department of UrogynaecologyKingston HospitalKingston upon ThamesLondon
| | - Rhiannon Bray
- Department of UrogynaecologyKingston HospitalKingston upon ThamesLondon
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de Vries AM, Heesakkers JP. Contemporary diagnostics and treatment options for female stress urinary incontinence. Asian J Urol 2018; 5:141-148. [PMID: 29988831 PMCID: PMC6033196 DOI: 10.1016/j.ajur.2017.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/13/2017] [Accepted: 07/03/2017] [Indexed: 11/28/2022] Open
Abstract
Stress urinary incontinence is not a deadly disease, but for the large population of women suffering from it, it is a very important issue. Especially in the continuously aging population all over the world, there is more and more need for treatment of this serious medical condition. Treatment of female stress urinary incontinence exists already for ages. In the 20th century invasive treatments like Burch colposuspension and pubovaginal slings were the mainstay of surgical treatments. The introduction of the midurethral sling made the procedure less invasive and accessible for more caregivers. Luckily there are many options available and the field is developing quickly. In recent years many new medical devices have been developed, that increase the number of treatment options available and make it possible to find a suitable solution for the individual patient based on subjective and objective results and the chances of complications. This manuscript provides an introduction to the therapeutical options that are available nowadays for female stress urinary incontinence.
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Affiliation(s)
- Allert M. de Vries
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
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15
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Urolastic®, a new bulking agent for treatment of stress urinary incontinence: a systematic review and meta-analysis. Int Urogynecol J 2018; 29:1239-1247. [DOI: 10.1007/s00192-018-3703-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 06/18/2018] [Indexed: 10/28/2022]
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16
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Capobianco G, Madonia M, Morelli S, Dessole F, De Vita D, Cherchi PL, Dessole S. Management of female stress urinary incontinence: A care pathway and update. Maturitas 2018; 109:32-38. [DOI: 10.1016/j.maturitas.2017.12.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 11/28/2017] [Accepted: 12/07/2017] [Indexed: 01/12/2023]
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