Introduction and hypothesisPolyacrylamide hydrogel (PAHG, Bulkamid®) is a promising urethral bulking agent. This article presents the 2-year follow-up results of a multicenter study of PAHG injections for treating stress and stress-predominant mixed urinary incontinence.MethodsSubmucosal injection of PAHG was performed in 135 women with urinary incontinence, with subjective and objective assessment of the efficacy and safety 24 months postinjection.ResultsAt 24 months, the subjective responder rate was 64 % (a statistically non-significant reduction from 67 % at 12 months). The decreased number of incontinence episodes and urine leakage were maintained compared with the result from the 12-month evaluations, as were objective result rates and quality of life data. No safety issues occurred.ConclusionsPAHG is an effective and safe treatment option for women with stress-predominant mixed urinary incontinence, with maintained medium-term responder rates.

A prospective, single-centre study to assess the outcome of incontinence surgery in the first 120 consecutive patients who had tension-free vaginal tape (TVT) by a single surgeon. All patients were initially seen at 3 months postsurgery, with a cough provocation test, measurement of residual urine volume and a satisfaction survey. At a mean of 26 months (6-42 months) after surgery, a validated telephone interview was performed. The operation was performed in accordance with the original technique described by Ulmsten et al. [Int Urogynecol J Pelvic Floor Dysfunct 1996; 7: 81-5]. A total of 87 of 120 patients completed the study with the others either not complying or having died. Sixty-three (72.4%) patients were completely dry on cough provocation test. Of these, four (4.5%) had a slow stream and 10 (11.4%) suffered persistent urgency. The remaining 24 patients had varying degrees of leakage (operative failure). Sixteen (18.3%) patients subjectively considered the procedure to have failed at 3 months follow-up, either because leakage occurred once or more a day, and/or the persistence of the preoperative frequency/urgency syndrome. Of these 16 TVT failures, two had previous pelvic radiotherapy, two had double incontinence and eight had TVT for recurrent incontinence. Among the failures, 81.3% had mixed incontinence with predominant urge and nocturia three times per twenty four hours. Our study highlights the need for selection when performing TVT. We recommend that TVT be performed for those who have simple stress incontinence failing conservative measures (pelvic floor exercises and physiotherapy), with no history of incontinence surgery, pelvic radiotherapy, faecal or mixed incontinence.

Aim: To assess operative and functional outcomes, including morbidity, after using the trans-obturator tape for stress incontinence. Patients and Methods: The first 24 consecutive patients undergoing trans-obturator tape insertion in a single centre were included in this retrospective study. All patients were female with a mean age of 63 (range 40–83) years. Fifteen patients (62.5%) suffered from pure stress incontinence, and 9 patients (37.5%) had mixed incontinence. Of the latter, 2 patients also had nocturnal enuresis. Each patient was followed up for between 3 and 12 months postoperatively and again at 36 months. The patients were assessed by clinical examination, ultrasound for residual urinary volume, and subjective satisfaction which was assessed at 3 and 12 months. At 36 months, all patients completed a validated incontinence questionnaire (International Consultation on Incontinence Questionnaire: ICIQ) which assessed female lower urinary tract symptoms and their impact on the quality of life. Results: All operations were performed under epidural anaesthesia in day surgery, and the mean operative time was 20 (range 15–38) min. Nineteen patients (79.2%) showed significant improvement postoperatively, with 16 of those (66.6%) being completely cured of their incontinence. The remaining 5 patients (20.8%) were considered to have had failed procedures. There were no vascular, bladder, or urethral injuries. One patient had perforation of the vaginal fornix, and 3 patients developed vaginal erosion. Conclusions: The trans-obturator tape is a safe and effective treatment for stress incontinence and has a low morbidity after a 3-year follow-up period; however, it should only be performed by clinicians with the relevant surgical expertise and experience in treating female incontinence.

Aim: To understand the risk factors associated with the incidence of bladder neck stenosis (BNS) after transurethral prostate surgery. Patients and Methods: We retrospectively reviewed 900 patients who underwent transurethral prostate surgery over a 4-year period. The mean age of the men was 72.3 (47–94) years. The specific outcome data assessed related to BNS, including type of operation performed, resected tissue weight and history of previous surgery in the lower urinary tract. Results: 29 (3.4%) patients developed BNS at a mean of 10.3 (3–33) months, with a mean resected prostatic tissue weight of 11 ± 3.7 g. Four of the 29 patients with BNS were treated with bladder neck resection and re-stenosed. Fifty-four men underwent bladder neck incision for small prostates with a high bladder neck, measured by digital rectal examination and assessed cystoscopically, with no BNS. All the remaining patients from our series did not have a BNS, with a mean resected weight of 28 ± 8.9 g, which is statistically greater than in the BNS group (p < 0.05, unpaired t test). Conclusions: BNS after transurethral prostate surgery is a significant problem. It is clear from our study that resection in small prostates with no sign of a high bladder neck will increase the development of BNS. Thus, small prostates should be managed by an initial bladder neck incision, even if the bladder neck is not high.

METHODS: ISD was created in female NHPs by cutting and then cauterizing the pudendal innervation to the urinary sphincter complex. Chronic fibrotic, muscle poor ISD developed within 6 months post-surgery. Partial bone marrow transplantation with autologous Lenti-GFP bone marrow cells (BMCs) was performed and NHPs (n¼6/ experimental condition) were then given sphincter injections of Lenti-Mcherry-labeled 5 million autologous skMPCs, or SDF-1a. Tissues were removed 6 months later and analyzed for sphincter content of muscle, collagen, BMCs, skMPCs and SDF-1a. RESULTS: When compared to previously studied NHPs with acute ISD (Badra et al, J Urol. 2013;190(5):1938), there was less expression of BMCs and SDF-1a in the urinary sphincter complexes of NHPs with chronic ISD (p<0.05). This correlated with reduced effectiveness of skMPCs to restore sphincter muscle, innervation and vascularization in chronic vs. almost complete restoration in acute ISD (p<0.05). That injection of SDF-1a restores sphincter structure and function in chronic ISD further supports a role of the SDF-1a pathway in sphincter regeneration. CONCLUSIONS: The underlying reason(s) by which SDF-1a can, but skMPC cannot, stimulate sphincter regeneration in chronic ISD remains unclear, but could be related to the reduced capacity of skMPCs to stimulate SDF-1a mediated cell homing to the sphincter complex in chronic ISD. Providing SDF-1a to a fibrotic urinary sphincter may represent a novel approach to treat chronic ISD.