Patient-perceived outcomes in the treatment of stress urinary incontinence: focus on urethral injection therapy

Abstract

Intervention for stress urinary incontinence (SUI) is generally focused on minimizing urinary leakage. However, the overall impact of SUI therapy on patients' quality of life is, arguably, more important than leakage outcomes. We performed a literature search to investigate the effect of urethral injection therapy on quality of life. Significant quality-of-life improvements have been observed with a number of injectable agents, while there is a distinct lack of correlation between subjective and objective outcomes. Two studies comparing urethral injection therapy with surgical intervention found superior objective efficacy with surgery, but no significant differences in quality-of-life improvements. Personal goals of patients undergoing urethral injection are yet to be explored, but there may be willingness to trade a lower success rate in favor of a more minor treatment procedure. In conclusion, quality-of-life improvements after urethral injection appear significant and comparable to those obtained with surgery. Further study of patients' own perceptions, pre- and posttreatment, would be valuable.

Urethral bulking agents: Techniques and outcomes

“…A literature review by Chapple et al [10] concluded that QOL improvement after urethral injections appears to be signifi cant and comparable to that obtained with surgery, despite observing superior objective surgical effi cacy.…”

Quality Indicators for the Screening and Care of Urinary Incontinence in Vulnerable Elders

“…Complication rates were low. A systematic review of patient perceptions of injection therapy identified a randomized trial comparing polydimethylsiloxane with pubovaginal sling; there were no significant differences in satisfaction (60% of injection vs 81% of surgical patients satisfied, P =.41) 58 …”

Urethral bulking agents for female stress urinary incontinence

“…Traditionally UBAs have been seen as second line to urethral slings and colposuspension, however, with growing concerns about the use of mesh, and an ageing population, it is important to involve the patient in the decision making. Despite research showing that there is a significantly better objective cure in women who have a colposuspension or a sling procedure compared with urethral bulking, 4 other studies have shown that there is no significant difference in quality of life improvements 35 and therefore more women may opt for the latter due to the minimally invasive approach and reduced morbidity. 7 The search for the ideal bulking agent continues.…”