Treatment of Postoperative Male Urinary Incontinence Using Transurethral Macroplastique Injections

Kylmälä, Timo; Tainio, Hanna; Raitanen, Mika; Tammela, Teuvo L.J.

doi:10.1089/08927790360587450

Cited by 36 publications

(15 citation statements)

References 19 publications

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“…The Macroplastique used in this study is composed of textured silicon particles (polydimethylsiloxane) in a liquid gel. These particles have a low migration rate because they are larger than 100 µm, the injection material is encapsulated by nearby tissue, and there is a quiescent foreign body reaction that is maintained for 9 months [16]. Compared with other bulking agents, Macroplastique has stable characteristics.…”

Section: Discussionmentioning

confidence: 99%

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Treatment Outcomes of Transurethral Macroplastique Injection for Postprostatectomy Incontinence

et al. 2014

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PurposeWe investigated the efficacy of transurethral injection of Macroplastique bulking agent (Uroplasty) for male stress urinary incontinence (SUI) after prostate surgery.Materials and MethodsThis retrospective review included men with SUI treated by transurethral injection for symptoms resulting from prostate surgery. Patients were evaluated at 1 month and 6 months after injection by determining the number of pads used per day and changes in incontinence symptoms. Treatment success was defined as use of 1 pad or fewer per day combined with subjective symptom improvement.ResultsThe study population comprised 30 men with a mean age of 66.1±5.3 years. Of the 30 patients, 24 (80.0%) underwent prostate cancer surgery and the remaining 6 (20.0%) underwent surgery for benign prostatic hyperplasia. The preinjection pad number was 2.9±1.9 pads per day. After injection treatment, the mean follow-up period was 9.3±12.7 months and the success rate was 43% (13/30) at 1 month and 32% (6/19) at 6 months. Injection was more likely to result in a successful outcome in patients with no preinjection radiation treatment history and higher abdominal leak point pressure (ALPP) than in those with a previous history of radiation treatment and lower ALPP, although this result was not statistically significant. Acute urinary retention occurred in 5 patients (17%).ConclusionsTransurethral Macroplastique injection treatment is a relatively non-invasive treatment method for male SUI with a success rate of 43% at 1 month and 32% at 6 months. Patients with a higher ALPP and no previous history of radiation therapy may experience better treatment outcomes.

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Section: Discussionmentioning

confidence: 99%

“…Studies that have investigated transurethral injection treatment for male SUI have reported widely different success rates [2,12,16-27] (Table 4). This wide variation in success has several possible explanations.…”

Section: Discussionmentioning

confidence: 99%

Treatment Outcomes of Transurethral Macroplastique Injection for Postprostatectomy Incontinence

et al. 2014

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“…11, 25 Early failure rates are approximately 50%, and repeat endoscopic injections are often necessary. 26 Outcomes are generally thought to be inferior to slings. 27 Thus, we were surprised that up to 50% of certifying urologists reported the exclusive use of these procedures.…”

Section: Discussionmentioning

confidence: 99%

Surgical Practice Patterns for Male Urinary Incontinence: Analysis of Case Logs from Certifying American Urologists

et al. 2012

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Purpose Several options exist for the surgical correction of male stress urinary incontinence including periurethral bulking agents, artificial urinary sphincters and the recently introduced male urethral slings. We investigated contemporary trends in the use of these treatments. Materials and Methods Annualized case log data for incontinence surgeries from certifying and re-certifying urologists were obtained from the American Board of Urology, ranging from 2004 to 2010. Chi-squared tests and logistic regression models were used to evaluate the association between surgeon characteristics (type of certification, annual volume, practice type, and practice location) and the use of incontinence procedures. Results Among 2,036 non-pediatric case logs examined, the number of incontinence treatments reported for certification has steadily increased over time (p = 0.008) from 1,936 to 3,366 treatments per year from 2004 to 2010. Nearly one-fifth of urologists reported placing at least one sling. The proportion of endoscopic procedures decreased from 80% of all incontinence procedures in 2004 to 60% in 2010, but they remained the exclusive incontinence procedure performed by 49% of urologists. An urologist’s increased usage of endoscopic treatments was associated with a decreased likelihood of performing a sling procedure (OR=0.5, p<0.0005). Artificial urinary sphincter usage remained stable accounting for 12% of procedures. Conclusions Incontinence procedures are on the rise. Urethral slings have been widely adopted and account for the largest increase among treatment modalities. Endoscopic treatments continue to be commonly performed and may represent over usage in the face of improved techniques. Further research is required to validate these trends.

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“…Recently, several investigators had a consensus for not proceeding further in patients who have not showed any symptomatic improvement despite receiving a second injection. 5,18,19 Similarly, Kageyama et al reported that the volume of collagen injected does not necessarily correlate with the degree of clinical improvement. 20 Despite these limitations, we believe that the two treatment groups are representative of typical patients with post-prostatectomy incontinence and our results showed significant improvement in urinary incontinence following a male sling.…”

Section: Number Of Patientsmentioning

confidence: 99%

Comparison of bone‐anchored male sling and collagen implant for the treatment of male incontinence

Onur

Singla

2006

Int J of Urology

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Aim:To compare the effectiveness of transurethral collagen injection and perineal bone-anchored male sling for the treatment of male stress urinary incontinence (SUI). Methods: Seventy-one men with SUI underwent either transurethral collagen injections (n = 34) or perineal bone-anchored male sling (n = 37) between June 1999 and October 2003. Most of the patients in each group had radical retropubic prostatectomy and/ or external beam radiation therapy (EBRT) in relation to the cause of incontinence. There was one patient in both groups who only had EBRT for the cause. The mean duration of incontinence were 4.2 and 4.4 years, respectively. Collagen injections were carried out transurethrally either under regional or general anesthesia until co-aptation of mucosa was observed. The male sling was placed under spinal anesthesia with a bone drill using either absorbable or synthetic materials. Retrospectively, all patients were assessed for continence status and procedure-related morbidity, if present. The outcome of both procedures was also compared with the degree of incontinence. Results: Ten (30%) patients in the collagen group showed either significant improvement or were cured following injections. Preoperatively, the mean pad use in collagen group was 4.5 (SD 2.8) per day, whereas it was 2.2 (SD 1.1) after the injection(s). Collagen injection failed in 24 (70%) of the patients. Patients who received the male sling had a mean preoperative pad use of 3.7 (SD 1.5) and postoperatively, the number decreased to 1.6 (SD 1.2). Most of the patients in this group were either totally dry or significantly improved (n: 28, 76%). There was a statistically significant difference between two groups in respect to success rate (P < 0.05). Analysis of treatment outcome with the degree of incontinence revealed that the male sling is most effective in patients with minimal-to-moderate incontinence. Conclusions: Our results suggest that the male sling, a minimally invasive procedure, is more effective than collagen implant in the treatment of mild-to-moderate SUI in men.

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Treatment of Postoperative Male Urinary Incontinence Using Transurethral Macroplastique Injections

Abstract: The preliminary results of endoscopic treatment of mild to moderate postoperative SUI in males with outpatient Macroplastique injections are encouraging. To achieve satisfactory results, repeated injections are needed.

Cited by 36 publications

References 19 publications

Treatment Outcomes of Transurethral Macroplastique Injection for Postprostatectomy Incontinence

Treatment Outcomes of Transurethral Macroplastique Injection for Postprostatectomy Incontinence

Surgical Practice Patterns for Male Urinary Incontinence: Analysis of Case Logs from Certifying American Urologists

Comparison of bone‐anchored male sling and collagen implant for the treatment of male incontinence

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