Macroplastique outcome in women with stress urinary incontinence secondary to intrinsic sphincteric deficiency

Abstract

ObjectivesTo evaluate short-term outcomes of Macroplastique (MPQ) in women with stress urinary incontinence (SUI) using patient reported outcome and three-dimensional vaginal ultrasound (3DUS). Materials and methodsAfter obtaining institutional review board approval, a chart review of non-neurogenic women that received MPQ for intrinsic sphincter deficiency (ISD) was extracted from a prospective database. Patients were divided into three groups: naïve (Group I), prior incontinence surgery (Group II), and both prior incontinence surgery and bulking agent (Group III). Women with urethral hypermobility were excluded. Baseline evaluation included a history, physical examination to confirm SUI, and questionnaires [Urinary Distress Inventory-6 (UDI-6), 1 quality of life (QOL) global score based on visual analog scale], and in select patients urodynamic studies and/or standing voiding cystogram. Patient follow up included repeat questionnaires scores and 3DUS to objectively assess MPQ volume. Success was defined as sufficient improvement after one injection so that a subsequent reinjection/different SUI operation was not requested at the last follow-up visit. It was hypothesized that Group I would fare best. ResultsFifty-nine women met the inclusion criteria. Success rate was 83% for Group I, 70% for Group II, and 69% for Group III (p = 0.54) at 9 months mean follow up. Fifteen patients underwent a second 3DUS during follow up with a stable volume, compared to the first study (4.5 ± 1.5 vs. 4.4 ± 1.5, p = 0.70), which confirmed stable volumes over time. Among the failures (N = 15), nine patients proceeded with reinjection; four patients had fascial slings, and two patients had artificial sphincters. ConclusionAs confirmed by 3DUS, Macroplastique appears efficacious as a primary treatment and as a salvage treatment for SUI due to ISD in the short-term.