Massive prolapse of the urethral mucosa following periurethral injection of calcium hydroxylapatite for stress urinary incontinence

Palma, Paulo César Rodrigues; Riccetto, Cássio; Martins, Mirian Franzoloso Santos; Herrmann, Viviane; Fraga, R.; Billis, Athanase; Netto, Nelson Rodrígues

doi:10.1007/s00192-005-0038-x

Cited by 46 publications

(27 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although urethral bulking is considered to be safe and simple [9,14,31], there are several reports on complications caused by the different bulking agents, such as urethral erosion [15], prolapse [42], and diverticula [43]; periurethral pseudocyst and mass formation [44]; retention; de novo frequency; sterile and nonsterile abscess formation [45]; hypersensitivity and urinary infection [15,43]; granuloma formation and possibly carcinogenesis due to particle migration [43]; need for endoscopic evacuation due to bladder outlet obstruction [46]. Treatment-related (minor) adverse events were found to occur in a range of 22-50 %, with UTI being the most common [15,38].…”

Section: Discussionmentioning

confidence: 99%

Bulking agents: an analysis of 500 cases and review of the literature

et al. 2012

View full text Add to dashboard Cite

Introduction and hypothesis Stress urinary incontinence (SUI) is common, impacts women's quality of life, and generates high costs. Physiotherapy is the first-line therapy, and if it fails, suburethral slings are the gold standard in SUI surgery. Bulking agents injected periurethrally might be a beneficial alternative, but there is a paucity of data on bulking therapy. The aim of this study was to prospectively analyze the efficacy and safety of bulking agents in the setting of a tertiary referral center. Methods In the last 13 years, 514 elderly women with SUI were treated by injection therapy with either collagen (Contigen®), hyaluronic acid (Zuidex®), ethylene vinyl alcohol (Tegress®), or polyacrylamide hydrogel (Bulkamid®). Subjective and objective outcome was recorded at the 12-month postoperative appointment using the King's Health Questionnaire, visual analogue scale (VAS) describing their incontinence severity, standardized pad test, and urethral pressure profile.Results Demographic data were equally distributed in all four groups of agents used. Sixty-one patients were lost to follow-up (10.6 %). Statistically significant changes were found for maximum urethral closure pressure (MUCP), pad weight, and VAS before and after bulking for the four agents used. Pad test was negative in 73.2 % of patients after bulking therapy. Subjective assessment showed improvements in general health and role limitations. The overall complication rate was low for all agents. Conclusions This study shows improvement in incontinence after bulking therapy according to subjective and objective outcomes in an elderly population. In contrast to earlier reports, side effects due to injections were few and mild. We can advocate bulking therapy for treating SUI, as it is simple, safe, and shows both objective and subjective improvement and relief.

show abstract

Section: Discussionmentioning

confidence: 99%

Bulking agents: an analysis of 500 cases and review of the literature

et al. 2012

View full text Add to dashboard Cite

show abstract

“…We have performed more than 80 cases of CaHA injections before this complication was encountered. There is only one report each in the literature of urethral prolapse formation after collagen injection [3], carbon-coated beads injection [4], or CaHA injection [5]. We do not believe that this complication is specific for CaHA, since formation of urethral prolapse has been described with other injectable materials.…”

Section: Discussionmentioning

confidence: 99%

“…Collectively, these experiences suggest that the incidence of local CaHA migration is probably low. Nevertheless, submucosal migration of the bulking agent has been reported in isolated cases [3][4][5]9].…”

Section: Discussionmentioning

confidence: 99%

Large urethral prolapse formation after calcium hydroxylapatite (Coaptite) injection

2008

View full text Add to dashboard Cite

A 67-year-old woman who had failed two prior anti-incontinence surgeries presented with stress urinary incontinence and intrinsic sphincteric deficiency. Calcium hydroxylapatite (Coaptite(R)) was injected cystoscopically into the bladder neck and proximal urethra and resolved her incontinence. Seven months later, she presented with difficulty in voiding and a urethral mass. Physical examination revealed a large prolapse of the urethral mucosa obstructing the external urethral meatus. Surgical exploration revealed local migration of calcium hydroxylapatite particles from the site of injection (bladder neck and proximal urethra) to the distal urethra. The prolapsed urethral mucosa was incised and marsupialized. Improper injection techniques likely contributed to urethral prolapse in this complication. Meticulous attention to injection techniques is the key to treatment success of urethral bulking agents, particularly in patients who have a scarred/fixed urethra or have multiple urethral/vaginal surgeries.

show abstract

“…There are recent published reports of large urethral mucosa prolapses occurring following injection of this material that required surgical intervention. 33 …”

Section: Coaptite (1 Rct)mentioning

confidence: 99%

The treatment of female stress urinary incontinence: an evidenced-based review

Pelletier-Cameron¹,

Haraway²

2011

RRU

View full text Add to dashboard Cite

Objective: To review the literature on the surgical and nonsurgical treatment options for stress urinary incontinence in women, focusing exclusively on randomized clinical trials and high quality meta-analyses. Materials and methods: A computer-aided and manual search for published randomized controlled trials and high quality meta-analyses investigating both conservative and surgical treatment options for stress urinary incontinence. In the case of a treatment that is not studied in these formats large case series have been used. Results: Articles were reviewed and the results summarized on pelvic floor physical therapy, pharmacotherapy, bulking agents, and surgery (open and minimally invasive). Conclusion: There are numerous high quality studies in the literature. It can be difficult to make definitive conclusions on the most appropriate treatment options due to the variability in the outcomes used to define success in these articles. There is also a dire lack of studies evaluating and comparing the surgical options for patients with intrinsic sphincter deficiency.

show abstract

Massive prolapse of the urethral mucosa following periurethral injection of calcium hydroxylapatite for stress urinary incontinence

Cited by 46 publications

References 2 publications

Bulking agents: an analysis of 500 cases and review of the literature

Bulking agents: an analysis of 500 cases and review of the literature

Large urethral prolapse formation after calcium hydroxylapatite (Coaptite) injection

The treatment of female stress urinary incontinence: an evidenced-based review

Contact Info

Product

Resources

About