Periurethral injection therapy for urinary incontinence in women

Abstract

Despite five additional trials, this updated review is still an unsatisfactory basis for practice. The trials were small and generally of moderate quality. The only evidence of benefit comes for within-group short-term changes following injection. The finding that placebo saline injection was followed by a similar symptomatic improvement questions the mechanism of any effects. There were no trials in comparison with pelvic floor muscle training -the obvious non-surgical comparator. Greater symptomatic improvement was observed after surgery, although these advantages need to be set against likely higher risks. No clear-cut conclusions could be drawn from trials comparing alternative agents; one small trial suggests that periurethral injection may carry more risks than transurethral injection. The single trial of autologous fat provides a reminder that periurethral injections can occasionally cause serious side-effects. Pending further evidence, injection therapy may represent a useful option for short-term symptomatic relief amongst selected women with co-morbidity that precludes anaesthesia - two or three injections are likely to be required to achieve a satisfactory result.

Systematic review and economic modelling of the effectiveness and cost-effectiveness of non-surgical treatments for women with stress urinary incontinence

“…This treatment modality will not therefore be included in treatment pathways, but a summary of a recently updated Cochrane review of the subject is included here for completeness. 71 This review looked at the effects of periurethral or transurethral injection therapy for the treatment of women with urinary incontinence. It identified 12 relevant trials, including 1318 participants in total, and examined eight types of injectable material (Box 6) along with one dummy injection (saline).…”

“…50,56,60,64,68,71,[83][84][85]87,88,106,201,[224][225][226][227][228] What our study has added is the systematic review and overview of the treatments relevant to the NHS, where evidence on the relative effectiveness has been derived using more advanced methods of meta-analysis than have been used previously. These methods have allowed us to provide clearer evidence about which treatments work and how well they work than was hitherto available.…”

Efficiency of Injection Therapy for Stress Incontinence:a Retrospective Evaluation of 8 Years Results

“…Even though TOT and TVT are still considered the most affective treatment methods in female urinary incontinence [16], transurethral injection is still a promising method for a significant patient population-elders for whom these surgeries can not be performed, and patients with co-morbid diseases [7;17]. In a systematic review paper in Cochrane Database, it is indicated that injection treatment provides an option, which may be useful for short term symptomatic recovery in selected female patients with high co-morbidity [18]. There are many publications searching the efficiency of the injection therapy, however there does not exist any publication indicating the long term efficiency in a selected patient population.…”

The management of urinary incontinence in the male neurological patient

“…Although bulking agents have been mainly used for the treatment of SUI in women, there are also studies in men with rather discouraging results, especially in the long term [78,79]. RCT are lacking and from the available data, bulking agents cannot be considered a durable treatment especially for more severe forms of SUI, which may be the reason that there are no current data in adult male neurological patients.…”