Urethral Bulking in the Treatment of Stress and Mixed Female Urinary Incontinence: Results from a Multicenter Cohort and Predictors of Clinical Outcomes

Giammò, Alessandro; Geretto, Paolo; Ammirati, Enrico; Manassero, Alberto; Squintone, L.; Falcone, Marco; Costantini, Elisabetta; Popolo, Giulio Del; Agrò, Enrico Finazzi; Giannantoni, Antonella; Marzi, Vincenzo Li; Mancini, Vito; Musco, Stefania; Pastorello, Mauro; Pistolesi, Donatella; Risi, Oreste; Gontero, P.

doi:10.3390/jcm11061569

Cited by 7 publications

(4 citation statements)

References 18 publications

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“…A subsequent 7-year follow-up study has demonstrated cure rates of 67.1% [78]. Cure rates were worse for those with strong urinary urgency symptoms [77,79].…”

Section: Urethral Bulking Agentsmentioning

confidence: 97%

Management of mixed urinary incontinence: IUGA committee opinion

Jha,

Jeppson,

Dokmeci

et al. 2024

Int Urogynecol J

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Introduction and hypothesis Mixed urinary incontinence (MUI) is defined by the International Urogynecology Association (IUGA) and International Continence Society as the complaint of involuntary leakage of urine associated with urgency and also with exertion, effort, sneezing or coughing. It therefore implies the coexistence of both stress urinary incontinence (SUI) and urgency urinary incontinence (UUI). MUI is a heterogeneous diagnosis that requires an assessment of its individual components of SUI and UUI. Management requires an individualised approach to the symptom components. The aim of this review is to identify the assessment/investigations and management options for MUI. Methods A working subcommittee from the IUGA Research & Development (R&D) Committee was created and volunteers invited from the IUGA membership. A literature review was performed to provide guidance focused on the recommended assessment and management of MUI. The document was then evaluated by the entire IUGA R&D Committee and IUGA Board of Directors and revisions made. The final document represents the IUGA R&D Committee Opinion. Results The R&D Committee MUI opinion paper provides guidance on the assessment and management of women with MUI and summarises the evidence-based recommendations. Conclusions Mixed urinary incontinence is a complex problem and successful management requires alleviation of both the stress and urge components. Care should be individualised based on patient preferences. Further research is needed to guide patients in setting goals and to determine which component of MUI to treat first. The evidence for many of the surgical/procedural treatment options for MUI are limited and needs to be explored in more detail.

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“…A subsequent 7-year follow-up study has demonstrated cure rates of 67.1% [78]. Cure rates were worse for those with strong urinary urgency symptoms [77,79].…”

Section: Urethral Bulking Agentsmentioning

confidence: 97%

Management of mixed urinary incontinence: IUGA committee opinion

Jha,

Jeppson,

Dokmeci

et al. 2024

Int Urogynecol J

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“…A retrospective dataset analysis of women over 65 years showed that patients receiving bulking agents were notably sicker and have a shorter life expectancy compared to those undergoing sling insertion, suggesting these factors guide patient selection [ 55 ]. Bulking therapy is more successful for patients with mild SUI [ 45 , 56 , 57 ] or with ISD [ 58 ]. Patients younger than 60 years preferred an office setting rather than an operation theatre [ 59 ].…”

Section: Bulking Agents To Treat Suimentioning

confidence: 99%

Current Treatment of Stress Urinary Incontinence by Bulking Agents and Laser Therapy—An Update

Sikora,

Gamper,

Zivanovic

et al. 2024

JCM

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Stress urinary incontinence (SUI) affects around 20% of women. In addition to the established suburethral sling insertion, two less invasive approaches are of interest today: urethral bulking agents and vaginal laser therapy. This review discusses articles through December 2023 identified by a PubMed literature search using the keywords “incontinence” and “bulking” or “laser”. Although the two approaches are less effective than sling insertions, there are specific conditions in which one or the other technique is more advantageous. Injecting bulking agents into the urethra only takes some minutes and works without general anesthesia. The method is particularly suited for elderly, frail, or obese patients with multiple comorbidities, but is also applicable for all patients and in combination with other therapies. Generally, the safety profile is good but differs between bulking materials. Two laser types—the Erbium:YAG laser with SMOOTH-mode and the fractional ablative CO2 laser—deliver heat into the tissue to induce tissue tightening and regeneration. Intravaginal laser therapy improves mild to moderate SUI, while studies describe how intraurethral laser therapy is also beneficial for severe SUI. Young women between childbirths, as well as postmenopausal women, may benefit from laser therapy. The method is safe, can be performed on an outpatient basis, and does not require any artificial material.

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“…As such, much of the recent literature has focused on the use of PAHG, and many of the trials on PAHG injection includes women both of an older age (over 60 years old) and/or with MUI, including some longer-term outcomes. A recent retrospective review reported outcomes of 216 consecutive patients treated with either PAHG or Macroplastique (polydimethylsiloxane macroparticles suspended within polyvinylpyrrolidone hydrogel) with a mean age of 66 years old and included 36% with MUI (including preoperative DO in 25%) [94]. At 12-month follow up, 70% of patients declared themselves "improved" or "very improved", and 33% were completely dry.…”

Section: Surgical Management Of Stress Urinary Incontinencementioning

confidence: 99%

Mixed Urinary Incontinence: Diagnosis and Management

Sebesta,

Dmochowski

2023

OBM Geriatr

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The evaluation and treatment of mixed urinary incontinence receives relatively little attention as compared to other forms of incontinence. Mixed incontinence, however, defined as the combination of stress and urgency incontinence, accounts for the largest proportion of incontinence, with an increased incidence in older women. The condition can be very challenging to manage due to the coexistence of multiple pathologies. Treating either component can worsen the other, which means careful discussion of the risks and benefits, in addition to considerations of multimodal treatment approaches are required. In the older adult population, where this condition confers a significant impact on quality of life, there are many special considerations when evaluating and treating patients. Evaluation requires a careful assessment of the impact on QOL and goals of care and may need to involve caregivers and/or family members in the discussion, in addition to considerations of more advance evaluation on an individual basis prior to invasive treatments. Conservative treatments including behavioral and lifestyle modifications and pelvic floor physical therapy should be the mainstay of first-line treatment for older women with MUI, while taking into careful consideration how cognitive and/or physical limitations may impact treatment. Pharmacologic therapy should include a consideration of vaginal estrogen replacement, however oral medications for urgency and overactive bladder have increased risks in older women, which means more advanced treatments may want to be introduced sooner. There is really limited data on the use of third-line overactive bladder treatments in older women with mixed incontinence, however there may be some demonstrated benefits. Finally, when considering surgical interventions in this population, although the data demonstrate some benefit in mixed incontinence, providers may want to utilize a formalized assessment of frailty due to the increased morbidity associated with frailty in surgeries for incontinence.

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Urethral Bulking in the Treatment of Stress and Mixed Female Urinary Incontinence: Results from a Multicenter Cohort and Predictors of Clinical Outcomes

Cited by 7 publications

References 18 publications

Management of mixed urinary incontinence: IUGA committee opinion

Management of mixed urinary incontinence: IUGA committee opinion

Current Treatment of Stress Urinary Incontinence by Bulking Agents and Laser Therapy—An Update

Mixed Urinary Incontinence: Diagnosis and Management

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