Stress Incontinence Injection Therapy: What is Best for Our Patients?

Chapple, Christopher R.; Wein, Alan J.; Brubaker, Linda; Dmochowski, Roger R.; Pons, Montserrat Espuña; Haab, F.; Hill, Simon

doi:10.1016/j.eururo.2005.06.012

Cited by 53 publications

(57 citation statements)

References 70 publications

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“…18 Some studies reported improvement in 73% and total cure in 24-36% of the cases. 19,20 Long term ef fi ci ency can be pro vi ded with re in jec ti ons. Du rati on of the ef fi ci ency de pends on the qu a lity of injec ti on ma te ri al, age of the pa ti ent, deg re e of uret hral hyper mo bi lity, and se ve rity of in con ti nence.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Periurethral Injection on Stress Urinary Incontinence

Güngören¹,

Dolapçıoğlu²,

Hakverdi³

et al. 2011

Turkiye Klinikleri J Med Sci

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A AB BS S T TR RA AC CT T O Ob b j je ec c t ti i v ve e: : To determine one-year subjective and objective evaluation results of periurethral injection (PUI) applied to women suffering from stress urinary incontinence (SUI). M Ma a t te e r ri i a al l a an nd d M Me et t h ho od ds s: Twenty five patients with complaints of SUI have participated in our study. Preoperative and postoperative results of urinalysis, stress and Q-tip tests, post voiding residual volumes (RV) and survey of incontinence quality of life (I-QOL) criteria were recorded. Later on, Urodex ® (Cross-linked hyaluronic acid, detxranomere) was injected to them. The cases were monitored at regular intervals for a mean of 14 ± 5.84 months. R Re es su ul lt ts s: : Eighteen (72%) out of all cases were encountered during menopausal period. Eight of the patients had previous gynecologic operations. Mean age was 53.97 ± 13.01 years. Mean application period of PUI was 6.95 ± 1.46 minutes. Differences between the preoperative and postoperative results of RV and I-QOL were not statistically significant. From subjective success point of view; 17 (68%) of the patients claimed no change on their incontinence problem, two (8%) of the patients claimed that their conditions were slightly improved, and six (24%) of the patients claimed that their conditions significantly improved. When objective success is considered, there was success in seven (28%) patients, and failure in 18 (72%) patients. C Co on nc cl lu us si io on n: : PUI is a minimally invasive treatment method used in all types of SUI. PUI treatment might be preferred for the old, obese patients with additional health problems, having incontinence dependent on hypermobility at which the open surgery incurs a great risk. However, as the new techniques are not readily available, a periurethral injection technique may still be a valid choice in patients who have poor surgical risks, and to whom the low success rate has been adequately explained.K Ke ey y W Wo or rd ds s: : Urinary incontinence, stress; urinary bladder neck obstruction Ö ÖZ ZE ET T A Am ma aç ç: : Stres üriner inkontinansı (SUI) kadınlarda uygulanan periüretral enjeksiyonun (PUI) sonuçlarının subjektif ve objektif olarak değerlendirilmesi. G Ge e r re eç ç v ve e Y Yö ön n t te em m l le er r: SUI nedeniyle başvuran 25 hasta çalışmaya alındı. Preoperatif ve postoperatif olarak idrar tetkiki, stres ve Q-tip testleri, post-voiding rezidü volümleri (RV) ve inkontinans yaşam kalitesi anket (I-QOL) ölçümleri incelendi. Daha sonra bu hastalarda Urodex ® (Cross-linked hyaluronic acid, dekstranomere) enjeksiyonu uygulandı. Hastalar ortalama 14 ± 5.84 ay süresince düzenli aralıklarla izlendi. B Bu ul l g gu u --l la ar r: Tüm olguların 18'i (%72) menopozal dönemde çalışmaya alınmıştı. Hastaların sekizi daha önceden jinekolojik operasyon geçirmişti. Yaş ortalaması 53.97 ± 13.01 idi. Ortalama PUI uygulama süresi 6.95 ± 1.46 dk. idi. Preoperatif ve postoperatif dönemdeki RV ve I-QOL arasında anlamlı farklılık gözlenmedi. Subjektif yarar açısından b...

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Section: Discussionmentioning

confidence: 99%

Effectiveness of Periurethral Injection on Stress Urinary Incontinence

Güngören¹,

Dolapçıoğlu²,

Hakverdi³

et al. 2011

Turkiye Klinikleri J Med Sci

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“…Macroplastique® is a urethral bulking agent that has been used in the treatment of urodynamic stress incontinence (USI) in adult women for approximately 9 years [2,7,8]. In studies, success rates vary from 58% (long term) to 73% (short term) [9].…”

Section: Introductionmentioning

confidence: 99%

“…However "minimally invasive" is a relative term and can be viewed as minimally invasive from the surgeon's perspective or the patient's. Acceptance for injection therapy as the least invasive of all surgical procedures is progressing [2,3].…”

Section: Introductionmentioning

confidence: 99%

Effects of Macroplastique® Implantation System for stress urinary incontinence and urethral hypermobility in women

et al. 2008

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A study was carried out to evaluate efficacy of Macroplastique® (MPQ) Implantation System (MIS) in women with urodynamic stress urinary incontinence (SUI) and urethral hypermobility after an unsuccessful conservative treatment. This is a prospective randomized controlled trial in women without previous incontinence surgery. Twenty-four women received MPQ. Twenty-one controls underwent a pelvic floor muscle exercises home program. Follow-up was at 3 months and the MPQ group also at 12 months. At 3 months, pad usage decreased significantly more in the MPQ group than in the control group (p= 0.015). According to physician and patient self-assessment, respectively, 71% and 63% women in the MPQ group were considered cured or markedly improved. This was significantly higher compared to controls. There was a significant higher increase of Incontinence Quality-of-Life questionnaire score in the MPQ group compared to controls (p= 0.017). Improvements in MPQ group at 3 months are sustained to 12 months. Adverse events were mild and transient. MIS is an acceptable option for women with SUI and urethral hypermobility.

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“…Injection therapy is not as effective as surgery, whether measured in terms of objective cure or improved quality of life; however, it presents fewer risks to the patient. 21,22 Although a recent randomized prospective study showed total 1-year costs of injection therapy to be greater than surgery costs, 23 there are insufficient data on which to base cost comparisons.…”

mentioning

confidence: 99%

“…In a recent review of the history and current state of injection therapy, Chapple and colleagues 21 concluded that therapy with currently available agents is safe and effective, regardless of urethral mobility or urodynamic assessments of urethral function, and therefore may be considered as a first-line treatment for uncomplicated stress incontinence. There are no data indicating the superiority of any particular agent, although collagen must be regarded as temporary because the substance degrades over time.…”

mentioning

confidence: 99%

Current trends in the evaluation and management of female urinary incontinence

Smith¹,

McCrery²,

Appell³

2006

Canadian Medical Association Journal

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U rinary incontinence is a common problem, affecting up to two-thirds of all women. Its prevalence is easily underestimated in the clinical setting, since patients will often fail to bring the condition to the attention of their physician; it is estimated that only 1 in 4 symptomatic women seek help for this problem.1 By recent estimate, the total annual cost of urinary incontinence in the United States is about US$19.5 billion.2 In addition to affecting quality of life, complications of urinary incontinence include urinary retention, chronic lower urinary tract infection and vesicoureteral reflux, all of which affect health greatly. The aim of this review is to give primary care practitioners an overview of the current understanding of the taxonomy, pathophysiology, evaluation and treatment of female urinary incontinence. PathophysiologyPatients present with symptoms rather than diagnoses -an important distinction in the discussion of female urinary incontinence. Most patients with any degree of urinary incontinence will have symptoms that point to stress incontinence, urge incontinence or mixed incontinence. The symptom of stress urinary incontinence is the involuntary loss of urine accompanying sudden increases in intra-abdominal pressure (i.e., "stress"); this loss is sudden, coincident with the stressor and usually without warning. Urge incontinence occurs when an overwhelming urge to void results in leakage of urine; about half of all patients with overactive bladder syndrome experience urge incontinence.3 Mixed incontinence is the concurrence of stress and urge incontinence symptoms.As the bladder fills, sensory afferent signals are carried via the pelvic and hypogastric nerves to the spinal cord ( Fig. 1), where they are relayed to the pontine micturition centre via the lateral spinothalamic tracts and dorsal columns. Sympathetic tonus via the hypogastric nerve maintains smooth musclebased activity of the urethral sphincter and aids in detrusor relaxation, which thus promotes urine storage. Somatic efferent signals to the striated muscle of the pelvic floor via the pudendal nerve provide voluntary urethral sphincter activity, as well as momentary augmentation of urethral resistance in response to sudden increases in bladder pressure. As afferent signaling increases in intensity with bladder filling, a threshold of consciousness is reached, at which point a socially appropriate opportunity to void is sought. With permission to void, pontine signaling to the sacral cord via reticulospinal and corticospinal tracts results in parasympathetic cholinergic activation of the detrusor and reflex relaxation of the striated muscle of the pelvic floor, which allows pressurized urine flow. 4Neurologic insults commonly cause involuntary detrusor contractions and urinary incontinence by interrupting the pathways that control and coordinate the micturition reflex. Although lesions and conditions may vary in their effect on voiding dysfunction and incontinence, central nervous system lesions at or above the thoracic spin...

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Stress Incontinence Injection Therapy: What is Best for Our Patients?

Cited by 53 publications

References 70 publications

Effectiveness of Periurethral Injection on Stress Urinary Incontinence

Effectiveness of Periurethral Injection on Stress Urinary Incontinence

Effects of Macroplastique® Implantation System for stress urinary incontinence and urethral hypermobility in women

Current trends in the evaluation and management of female urinary incontinence

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