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Bulking agents for stress urinary incontinence: short-term results and complications in a randomized comparison of periurethral and transurethral injections

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Abstract

The purpose of our study was to compare the two standard routes of urethral bulking injection in a prospective randomized trial. Forty women with genuine stress incontinence (n=36), or mixed incontinence with a minor and controlled urge component (n=4), participated in a urethral bulking agent trial. All patients had a standardized preoperative evaluation which included history, physical examination, assignment of incontinence status on a Stamey grading scale, postvoid residual (PVR) determination, Valsalva leak-point pressure, maximal urethral closure pressure, functional urethral length, Q-tip excursion angle, quantitative pad test, and completion of a quality of life questionnaire. On the day of injection they were randomly assigned to a periurethral or transurethral route of injection based on a computer-generated block randomization scheme. An ultrasound-determined PVR was obtained on all patients after injection. If self-catheterization was necessary, and the PVR was >200 ml, urinary retention was diagnosed. Postoperative assessment included a patient interview, subjective assessment of improvement, PVR, voiding diary, and assignment of incontinence grade. At the screening visit there were no significant differences between the groups for any variables except type of stress incontinence. With short-term follow-up both transurethral and periurethral routes of injection seem to be equally efficacious. In the periurethral injection group there was a higher rate of postoperative retention; this group had a significantly higher volume of injectable agent used. There was no significant difference in risk of urinary tract infections between the two groups. We conclude that both periurethral and transurethral methods of bulking agent injection for stress urinary incontinence are equally efficacious, with minimal morbidity.

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Abbreviations

FUL:

Functional urethral length

ISD:

Intrinsic sphincter deficiency

MUCP:

Maximum urethral closure pressure

PVR:

Postvoid residual

SUI:

Stress urinary incontinence

VLPP:

Valsalva leak-point pressure

References

  1. Monga AK, Robinson D, Stanton SL (1995) Periurethral collagen injections for genuine stress incontinence: a 2-year follow-up. Br J Urol 76:156–160

    CAS  PubMed  Google Scholar 

  2. Duckett JRA (1998) The use of periurethral injectables in the treatment of genuine stress incontinence. Br J Obstet Gynecol 105:390–396

    CAS  Google Scholar 

  3. Faerber GJ (1996) Endoscopic collagen injection therapy in elderly women with type I stress urinary incontinence. J Urol 155:512–514

    Article  CAS  PubMed  Google Scholar 

  4. Stamey TA (1986) Urinary incontinence in the female.In: Campbell’s Urology, 5th edn.Vol. 3, pp 2680–2711

  5. Raz S, Erickson DR (1992) SEAPI QMM Incontinence classification system. Neurourol Urodyn 11:187–199

    Google Scholar 

  6. Brown M, Wickham JEA (1969) The urethral pressure profile. Br J Urol 41:211–217

    CAS  PubMed  Google Scholar 

  7. Abrams P, Blaivas JG, Stanton SL, Andersen JT (1988) Standardization of terminology of lower urinary tract function. The International Continence Society Committee on Standardization of Terminology. Neurourol Urodyn 7:403–427

    Google Scholar 

  8. Bump RC, Coates KW, Cundiff GW, Harris RL, Weidner AC (1997) Diagnosing intrinsic sphincteric deficiency: comparing urethral closure pressure, urethral axis, and valsalva leak point pressures. Am J Obstet Gynecol 177:303–310

    CAS  PubMed  Google Scholar 

  9. Steele AC, Kohli N, Karram MM (2000) Periurethral collagen injection for stress incontinence with and without hypermobility. Obstet Gynecol 95:327–331

    Article  CAS  PubMed  Google Scholar 

  10. Gorton E, Stanton SL, Monga A, Wiskind AK, Lentz GM, Bland DR (1999) Periurethral collagen injection: a long-term follow-up study. BJU Int 84:966–971

    Article  CAS  PubMed  Google Scholar 

  11. Faerber GJ, Belville WD, Ohl DA, Plata A (1998) Comparison of transurethral versus periurethral collagen injection in women with intrinsic sphincter deficiency. Tech Urol 4:124–127

    CAS  PubMed  Google Scholar 

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Correspondence to Jane A. Schulz.

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Editorial Comment: This pilot study is the first randomized controlled trial comparing the short-term efficacy of periurethral and transurethral injections. The poor 1-year success rates found in this study are disappointing if compared to other studies (showing up to a 70% success rate). In addition, owing to the small sample size and lack of power to find a statistical difference in efficacy rates, larger studies with longer follow-up periods are required.

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Schulz, J.A., Nager, C.W., Stanton, S.L. et al. Bulking agents for stress urinary incontinence: short-term results and complications in a randomized comparison of periurethral and transurethral injections. Int Urogynecol J 15, 261–265 (2004). https://doi.org/10.1007/s00192-004-1148-6

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  • DOI: https://doi.org/10.1007/s00192-004-1148-6

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