Urethral injection therapy for urinary incontinence in women

Abstract

The available evidence base remains insufficient to guide practice. In addition, the finding that placebo saline injection was followed by a similar symptomatic improvement to bulking agent injection raises questions about the mechanism of any beneficial effects. One small trial comparing silicone particles with pelvic floor muscle training was suggestive of benefit at three months but it is not known if this was sustained, and the treatment was associated with high levels of postoperative retention and dysuria. Greater symptomatic improvement was observed with surgical treatments, though the advantages need to be set against likely higher risks. No clear-cut conclusions could be drawn from trials comparing alternative agents, although dextranomer hyaluronic acid was associated with more local side effects and is no longer commercially available for this indication. There is insufficient evidence to show superiority of mid-urethral or bladder neck injection. The single trial of autologous fat provides a reminder that periurethral injections can occasionally cause serious side effects.

Periurethral bulking agents for female stress urinary incontinence in Canada

“…An updated Cochrane review in 2012 found insufficient data to allow for meta-analysis or support clinical decisionmaking. 8 Bulking agents have been demonstrated to be more effective than pelvic floor muscle therapy, but less effective than surgical management for SUI. Gluteraldehyde crosslinked bovine collagen (Contigen™) has often been used as an established comparison agent in clinical trials of novel bulking agents, but was removed from the market in 2010.…”

“…Gluteraldehyde crosslinked bovine collagen (Contigen™) has often been used as an established comparison agent in clinical trials of novel bulking agents, but was removed from the market in 2010. 8 The efficacy of collagen for SUI has been reported at 48% at 12 months, with a decline to 32% at 34-47 months.…”

Surgical Approaches To Treatment Of Non-Complicated Stress Urinary Incontinence

“…Kullanılan başlıca ajanlar; Politetrafloroetilen, Glutaraldehid çapraz bağlı sığır kollajeni, otolog yağ, slikon, karbon mikroimplant, kalsiyum hidroksilapatit, Etilen vinil . Bu ajanlar ile yapılan müdahalelerin 3 ay gibi kısa sürelerde fayda sağladığı ilerleyen zamanlarda başarılarının azaldığı belirtilmiş-tir 49 . Buna ek olarak ajanların da birbirlerine karşı üstünlüğü olduğu gösterilememiştir 49 .…”

“…Bu ajanlar ile yapılan müdahalelerin 3 ay gibi kısa sürelerde fayda sağladığı ilerleyen zamanlarda başarılarının azaldığı belirtilmiş-tir 49 . Buna ek olarak ajanların da birbirlerine karşı üstünlüğü olduğu gösterilememiştir 49 .…”

Recent Developments in the Surgical Management of Urinary Stress Incontinence

“…Side effects were rare. A recent Cochrane review by Kirchin et al [74] extensively analyzed what materials would be optimal for bulking injection and how efficacious the bulking agents are. In their review with 14 randomized or quasi-randomized, controlled trials, including 2,004 women, 8 trials compared different agents with collagen among silicone particles, calcium hydroxylapatite, ethylene vinyl alcohol, carbon spheres, and dextranomer hyaluronic acid.…”