Urethral injection therapy: What is the mechanism of action?

Klarskov, Niels; Lose, Gunnar

doi:10.1002/nau.20602

Cited by 70 publications

(35 citation statements)

References 20 publications

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“…Injection therapy into the urethral submucosa creates cushions and is therefore meant to improve coaptation [10]. Additionally, bulking agents are suggested to act as a central filler volume, which lengthens the muscle fibers and thus increases urethral sphincter strength [26]. However, urodynamic data are limited, and according to the Cochrane review, urodynamic measures should be included Fig.…”

Section: Discussionmentioning

confidence: 99%

Bulking agents: an analysis of 500 cases and review of the literature

et al. 2012

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Introduction and hypothesis Stress urinary incontinence (SUI) is common, impacts women's quality of life, and generates high costs. Physiotherapy is the first-line therapy, and if it fails, suburethral slings are the gold standard in SUI surgery. Bulking agents injected periurethrally might be a beneficial alternative, but there is a paucity of data on bulking therapy. The aim of this study was to prospectively analyze the efficacy and safety of bulking agents in the setting of a tertiary referral center. Methods In the last 13 years, 514 elderly women with SUI were treated by injection therapy with either collagen (Contigen®), hyaluronic acid (Zuidex®), ethylene vinyl alcohol (Tegress®), or polyacrylamide hydrogel (Bulkamid®). Subjective and objective outcome was recorded at the 12-month postoperative appointment using the King's Health Questionnaire, visual analogue scale (VAS) describing their incontinence severity, standardized pad test, and urethral pressure profile.Results Demographic data were equally distributed in all four groups of agents used. Sixty-one patients were lost to follow-up (10.6 %). Statistically significant changes were found for maximum urethral closure pressure (MUCP), pad weight, and VAS before and after bulking for the four agents used. Pad test was negative in 73.2 % of patients after bulking therapy. Subjective assessment showed improvements in general health and role limitations. The overall complication rate was low for all agents. Conclusions This study shows improvement in incontinence after bulking therapy according to subjective and objective outcomes in an elderly population. In contrast to earlier reports, side effects due to injections were few and mild. We can advocate bulking therapy for treating SUI, as it is simple, safe, and shows both objective and subjective improvement and relief.

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Section: Discussionmentioning

confidence: 99%

Bulking agents: an analysis of 500 cases and review of the literature

et al. 2012

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“…Klarskov and Lose [2] measured pressure and cross-sectional area in the urethra of women with SUI and mixed incontinence before and after urethral injection therapy, using a pressure profi le refl ectometer. This novel technique detected a more signifi cant increase in squeezing opening pressures in patients who had subjectively noticed an effect.…”

Section: Mechanism Of Actionmentioning

confidence: 99%

Urethral bulking agents: Techniques and outcomes

Kotb¹,

Campeau²,

Corcos

2009

Curr Urol Rep

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Stress urinary incontinence is a common health problem affecting women and interfering with their quality of life. The use of bulking agents for urethral augmentation seems to be a beneficial way of restoring continence in these patients while avoiding the risk of surgical intervention. Many agents are available for injection, but the ideal choice should be durable, nonmigratory, and hypoallergenic, while evoking healing with minimal scarring. We reviewed the literature to provide an update on the best techniques of bulking agent injection, to describe the different available injectable agents, and to give their outcome and possible complications.

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“…The other theory states that the mass in the urethra supports the contractility of the rhabdosphincter, thereby increasing the stretch of the muscle fibres. All these result in an increase of urethral closure pressure that restores continence [6].…”

Section: Introductionmentioning

confidence: 99%

“…Some of them were abandoned due to safety concerns, secondary to migration of the product, hypersensitivity and adverse effects such as abscess formation [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%