Injection Of Urethral Bulking Agents Research Articles

Long-term complications of bulking agents in the treatment of stress urinary incontinence: Results of a national survey

Introduction and Objectives: Bulking agents have been used for decades as an alternative treatment for patients with stress urinary incontinence who are not appropriate for surgery. Despite this their long-term complications are poorly documented and can be misdiagnosed. This paper presents a literature review and the results of a national survey of members of the Section of Female, Neurological and Urodynamic Urology (FNUU) of the British Association of Urological Surgeons (BAUS) identifying the common long-term complications of widely used bulking agents in clinical practice. Methods: Following a comprehensive literature review an electronic survey was sent to members of the BAUS Section of FNUU. Data included hospital trust, use of urethral bulking agents (including type), the approximate number of procedures performed and whether any long-term complications had been observed and managed in their practice. Long-term complications were defined as those arising more than 12 months after treatment. Results: The literature review revealed multiple case reports of complications secondary to bulking agent injection but no high-level evidence regarding frequency or severity. The survey revealed complications including granulomas, erosions, abscesses and misdiagnoses of urethral diverticula and calculi formation. 88% of urologists who responded to the survey had performed a urethral bulking agent injection and 51% of urologists had observed or treated a long-term complication, some many decades after injection. Conclusion: Patients should be made aware of possible long-term complications of what appears to be a minimally invasive procedure in order for them to make an informed choice about treatment options. Level of evidence: Not applicable

Pathophysiology and Management of Long-term Complications After Transvaginal Urethral Diverticulectomy.

Female urethral diverticulum (UD) is a rare and benign condition that presents as an epithelium-lined outpouching of the urethra. It has various symptoms, of which incontinence in the form of postmicturition dribble is the most common. The gold standard for the diagnosis of UD is magnetic resonance imaging, and the treatment of choice is transvaginal diverticulectomy. Despite the high success rate of transvaginal diverticulectomy, postoperative complications such as de novo stress urinary incontinence (SUI), recurrence, urethrovaginal fistula, recurrent urinary tract infections, newly-onset urgency, and urethral stricture can occur. De novo SUI is thought to result from weakening of the anatomical support of the urethra and bladder neck or damage to the urethral sphincter mechanism during diverticulectomy. It can be managed conservatively or may require surgical treatment such as a pubovaginal sling, Burch colposuspension, or urethral bulking agent injection. Concomitant SUI can be managed by concurrent or staged anti-incontinence surgery. Recurrent UD may be a newly formed diverticulum or the result of a remnant diverticulum from the previous diverticulectomy. In cases of recurrent UD requiring surgical repair, placing a rectus fascia pubovaginal sling may be an effective method to improve the surgical outcome. Urethrovaginal fistula is a rare, but devastating complication after urethral diverticulectomy; applying a Martius flap during fistula repair may improve the likelihood of a successful result. Malignancies in UD are rarely reported, and anterior pelvic exenteration is the recommended management in such cases.

Use of bioactive extracellular matrix fragments as a urethral bulking agent to treat stress urinary incontinence

Injection of urethral bulking agents is a low-risk, minimally invasive surgical procedure to treat stress urinary incontinence (SUI). In this study, we developed a promising injectable bulking agent comprising extracellular matrix fragments of adipose-derived stem cell sheets (ADSC ECM) and investigated its effectiveness in urethral bulking therapy. The structural integrity and proteins of ADSC sheet ECM were well retained in decellularized ADSC ECM fragments. To locate transplanted ADSC ECM fragments, they were labeled with ultrasmall super-paramagnetic iron oxide nanoparticles, which enabled in vivo monitoring after implantation in a SUI rat model for up to 4 weeks. When ADSC ECM fragments were injected into the rat urethra, they became fully integrated with the surrounding tissue within 1 week. Four weeks after transplantation, host cells had regenerated within the ADSC ECM fragment injection area. Moreover, new smooth muscle tissue had formed around the ADSC ECM fragments, as confirmed by positive staining of myosin. These results indicate that injection of ECM fragments may be a promising minimally invasive approach for treating SUI.

Which procedure for stress urinary incontinence? Injectable.

Which procedure for stress urinary incontinence? Injectable.

Can Urethral Bulking Agents Salvage Failed Slings?

ObjectiveTo evaluate the efficacy of urethral bulking agents for stress urinary incontinence (SUI) in the setting of prior failed sling. MethodsThis is a retrospective review of patients who underwent urethral bulking agent injections for a primary complaint of SUI following prior failed sling surgery. The outcomes assessed were patient reported improvement, need for further interventions for incontinence and validated questionnaires. Values for questionnaires were obtained from the patient's preprocedure visit, at the first visit following their last injection and at their most recent visit within our system. ResultsOver the study period, 73 patients underwent urethral bulking agent injection following failed sling. Thirty-eight patients received Macroplastique injections and 35 had collagen injections. On average, patients underwent 2.6 injections. Seventy-one percent of patient reported at least partial symptom resolution at first postinjection follow-up. Validated questionnaire responses also improved at short-term follow-up (mean difference in American Urological Association Symptom Index-3.8, Michigan Incontinence Symptom Index-5.1, P <.01). Forty patients had long-term follow-up data available (mean 39.6 months postinjection). Statistically significant improvement persisted on the stress incontinence and quality of life domains of the validated questionnaires. ConclusionIn our cohort of patients with persistent or recurrent SUI following urethral sling procedure, 71% experienced short-term improvement or resolution of symptoms following urethral bulking agent injections, with SUI-specific improvement persisting at an average of 35 months in patients with available data.

Face, Content, and Construct Validations of Endoscopic Needle Injection Simulator for Transurethral Bulking Agent in Treatment of Stress Urinary Incontinence

Endoscopic injection of urethral bulking agents is an office procedure that is used to treat stress urinary incontinence secondary to internal sphincteric deficiency. Validation studies important part of simulator evaluation and is considered important step to establish the effectiveness of simulation-based training. The endoscopic needle injection (ENI) simulator has not been formally validated, although it has been used widely at University of California, Irvine. We aimed to assess the face, content, and construct validity of the UC, Irvine ENI simulator. Dissected female porcine bladders were mounted in a modified Hysteroscopy Diagnostic Trainer. Using routine endoscopic equipment for this procedure with video monitoring, 6 urologists (experts group) and 6 urology trainee (novice group) completed urethral bulking agents injections on a total of 12 bladders using ENI simulator. Face and content validities were assessed by using structured quantitative survey which rating the realism. Construct validity was assessed by comparing the performance, time of the procedure, and the occlusive (anatomical and functional) evaluations between the experts and novices. Trainees also completed a postprocedure feedback survey. Effective injections were evaluated by measuring the retrograde urethral opening pressure, visual cystoscopic coaptation, and postprocedure gross anatomic examination. All 12 participants felt the simulator was a good training tool and should be used as essential part of urology training (face validity). ENI simulator showed good face and content validity with average score varies between the experts and the novices was 3.9/5 and 3.8/5, respectively. Content validity evaluation showed that most aspects of the simulator were adequately realistic (mean Likert scores 3.9-3.8/5). However, the bladder does not bleed, and sometimes thin. Experts significantly outperformed novices (p < 001) across all measure of performance therefore establishing construct validity. The ENI simulator shows face, content and construct validities, although few aspects of simulator were not very realistic (e.g., bleeding).This study provides a base for the future formal validation for this simulator and for continuing use of this simulator in endourology training.

Conservative Management of Male Stress Urinary Incontinence

Stress urinary incontinence is a demoralizing complication of common urologic procedures such as radical prostatectomy. Basic evaluation of postprostatectomy incontinence should include a careful history and physical examination with a focus on assessing the degree of incontinence and amount of bother and to rule out detrusor dysfunction. Evaluation can be supplemented by a voiding diary, pad test, urodynamics, and cystoscopy as indicated. Management options include behavioral modification, pelvic floor physical therapy, external drainage devices, and occlusive penile clamps. Randomized controlled trials have shown that pelvic floor physical therapy improves continence or enhances recovery of continence in the postoperative period but only when initiated before or immediately after catheter removal. Men who have intrinsic sphincter deficiency can be evaluated for injection of urethral bulking agents, including collagen, carbon-coated zirconium oxide beads, calcium hydroxylapatite particles, and heat-vulcanized polydimethylsiloxane. Injectable bulking agents have the advantage of being minimally invasive and are generally considered safe. However, multiple reinjections are often required due to deteriorating efficacy over time and thus should be considered only in patients with mild stress incontinence or in patients who are poor surgical candidates for slings or the artificial urinary sphincter. This review contains 3 figures and 54 references Key words: conservative management, injectable urethral bulking agents, pelvic floor physical therapy, postprostatectomy urinary incontinence, stress urinary incontinence

Conservative Management of Male Stress Urinary Incontinence

Stress urinary incontinence is a demoralizing complication of common urologic procedures such as radical prostatectomy. Basic evaluation of postprostatectomy incontinence should include a careful history and physical examination with a focus on assessing the degree of incontinence and amount of bother and to rule out detrusor dysfunction. Evaluation can be supplemented by a voiding diary, pad test, urodynamics, and cystoscopy as indicated. Management options include behavioral modification, pelvic floor physical therapy, external drainage devices, and occlusive penile clamps. Randomized controlled trials have shown that pelvic floor physical therapy improves continence or enhances recovery of continence in the postoperative period but only when initiated before or immediately after catheter removal. Men who have intrinsic sphincter deficiency can be evaluated for injection of urethral bulking agents, including collagen, carbon-coated zirconium oxide beads, calcium hydroxylapatite particles, and heat-vulcanized polydimethylsiloxane. Injectable bulking agents have the advantage of being minimally invasive and are generally considered safe. However, multiple reinjections are often required due to deteriorating efficacy over time and thus should be considered only in patients with mild stress incontinence or in patients who are poor surgical candidates for slings or the artificial urinary sphincter. This review contains 3 figures and 54 references Key words: conservative management, injectable urethral bulking agents, pelvic floor physical therapy, postprostatectomy urinary incontinence, stress urinary incontinence

MP01-15 FACE, CONTENT, AND CONSTRUCT VALIDATION OF ENDOSCOPIC NEEDLE INJECTION (ENI) SIMULATOR FOR TRANSURETHRAL BULKING AGENT IN TREATMENT OF STRESS URINARY INCONTINENCE

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment I1 Apr 2018MP01-15 FACE, CONTENT, AND CONSTRUCT VALIDATION OF ENDOSCOPIC NEEDLE INJECTION (ENI) SIMULATOR FOR TRANSURETHRAL BULKING AGENT IN TREATMENT OF STRESS URINARY INCONTINENCE Bilal Farhan, Gamal Ghoniem, and Rebecca Do Bilal FarhanBilal Farhan More articles by this author , Gamal GhoniemGamal Ghoniem More articles by this author , and Rebecca DoRebecca Do More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.121AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Endoscopic injection of urethral bulking agents is an office procedure that is used to treat stress urinary incontinence secondary to internal sphincteric deficiency. Validation studies are important in simulator evaluation. The ENI simulator has not been formally validated, although it has been used widely at University of California, Irvine. We aimed to demonstrate the descriptive analysis as a first step for the face, content, and construct validities of this simulator in the future. METHODS Dissected female porcine bladders were mounted in a modified Hysteroscopy Diagnostic Trainer (Figure 1). Using routine endoscopic equipment for this procedure with video monitoring, 6 urologists (experts group) and 6 urology trainee (novice group) completed urethral bulking agent injections on a total of 12 bladders using ENI simulator. Face and content validities were assessed by using structured quantitative survey which rating the realism. Construct validity was assessed, by comparing the performance of experts and novices, using Objective Structured Assessment of Technical Skills. Trainees also completed a post-procedure feedback survey. Effective injections were evaluated by measuring the retrograde urethral opening pressure, visual cystoscopic coaptation, and post-procedure gross anatomic examination. RESULTS All 12 participants felt the simulator was a good training tool and should be used as essential part of urology training (face validity). ENI simulator showed good face and content validity with average score varies between the experts and the novices was 3.9/5 and 3.8/5 respectively. Content validity evaluation showed that most aspects of the simulator were adequately realist (mean Likert scores 3.9-3.8/5). However, the bladder does not bleed, and sometimes thin. Experts significantly outperformed novices (P<001) across all measure of performance therefore establishing construct validity. CONCLUSIONS The ENI simulator shows face, content and construct validities, although few aspects of simulator were not very realist (e.g., bleeding). This study provides a base for the future formal validation for this simulator and for continuing use of this simulator in endourology training. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e8 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Bilal Farhan More articles by this author Gamal Ghoniem More articles by this author Rebecca Do More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP40-10 CAN URETHRAL BULKING AGENTS SALVAGE FAILED SLINGS?

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy I1 Apr 2017MP40-10 CAN URETHRAL BULKING AGENTS SALVAGE FAILED SLINGS? Elizabeth Dray, Anne Cameron, Marybeth Hall, J. Quentin Clemens, and John Stoffel Elizabeth DrayElizabeth Dray More articles by this author , Anne CameronAnne Cameron More articles by this author , Marybeth HallMarybeth Hall More articles by this author , J. Quentin ClemensJ. Quentin Clemens More articles by this author , and John StoffelJohn Stoffel More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1257AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While pubovaginal and midurethral slings are highly effective interventions for stress urinary incontinence (SUI), persistent or recurrent incontinence is not uncommon and can significantly impact patients' quality of life. Multiple studies have shown the relative success of repeat sling procedures in this population, however, not all patients desire further operative interventions. The goal of this study is to evaluate the efficacy of urethral bulking agents for SUI in the setting of failed prior sling which has only been studied in very small populations in the past. METHODS This is a retrospective review of patients who underwent urethral bulking agent injections for a primary complaint of stress urinary incontinence following failed sling. The outcomes assessed were patient reported improvement, need for further interventions for incontinence and the Michigan Incontinence Symptom Index (M-ISI), which is a validated questionnaire that has a range of 0-32 for symptom score and 0-8 for bother score with higher scores indicating worse incontinence. Values for questionnaires were obtained from the patient's pre-procedure visit and following their last injection. Demographic data, type of prior sling procedure, and type of bulking agent utilized were also reported. RESULTS From May of 2009 to March of 2016, 73 patient underwent injection of urethral bulking agents following failed sling. Of these patients, 49 had prior mesh midurethral slings, 20 had prior fascial pubovaginal slings, and 4 had undergone both procedures. Average time from sling placement was 40.5 months. Following injection, 67.1% of patients reported at least moderate improvement in incontinence, while 24.7% reported total resolution of incontinence and 32.9% endorsed minimal or no improvement. The majority of patients (75.3%) required further injections to maintain or augment their results. Only 19.2% of patients went on to undergo more invasive operative interventions for incontinence. Pre-procedure average M-ISI symptom score was 23.1 with a bother score of 5.2. Post-procedure, these values were 18.9 and 4.2 respectively. No difference was found in symptom resolution based on prior sling type or bulking agent used. CONCLUSIONS Urethral bulking agents are a viable option for improving SUI following failed sling procedures. The majority of patients have at least moderate improvement in symptoms and do not opt for more invasive interventions. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e526-e527 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Elizabeth Dray More articles by this author Anne Cameron More articles by this author Marybeth Hall More articles by this author J. Quentin Clemens More articles by this author John Stoffel More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Postoperative Imaging after Surgical Repair for Pelvic Floor Dysfunction.

Pelvic floor dysfunction encompasses an extremely common set of conditions, with various surgical and nonsurgical treatment options. Surgical options include injection of urethral bulking agents, native tissue repair with or without bioabsorbable or synthetic graft material, placement of synthetic midurethral slings or use of vaginal mesh kits, and mesh sacrocolpopexy procedures. Numerous different synthetic products with varied imaging appearances exist, and some of these products may be difficult to identify at imaging. Patients often present with recurrent or new symptoms after surgery; and depending on the presenting complaint and the nature of the initial intervention, imaging with ultrasonography (US), magnetic resonance (MR) imaging, voiding cystourethrography, or computed tomography (CT) may be indicated. US and MR imaging can both be used to image urethral bulking agents; US is often used to follow potential changes in bulking agent volume with time. Compared with MR imaging, US depicts midurethral slings better in the urethrovaginal space, and MR imaging is better than US for depiction of the arms in the retropubic space and obturator foramen. Mesh along the vaginal wall may be depicted with both US and MR imaging; however, the distal arms of the mesh traversing the sacrospinous ligaments or within the ischiorectal fossae (ischioanal fossae) are better depicted with MR imaging. Scarring can mimic slings and mesh at both US and MR imaging. MR imaging is superior to US for depiction of sacrocolpopexy mesh and associated complications. Voiding cystourethrography and CT are used less commonly because they rarely allow direct depiction of implanted material. Online supplemental material is available for this article. (©)RSNA, 2016.

PD28-04 MANAGEMENT OF COMPLICATIONS IN USE OF URETHRAL BULKING AGENTS IN WOMEN FOR STRESS URINARY INCONTINENCE – A META-ANALYSIS

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Incontinence - Therapy II1 Apr 2015PD28-04 MANAGEMENT OF COMPLICATIONS IN USE OF URETHRAL BULKING AGENTS IN WOMEN FOR STRESS URINARY INCONTINENCE – A META-ANALYSIS Majdee Islam, Harpreet Wadhwa, Ryan Dobbs, and Ervin Kocjancic Majdee IslamMajdee Islam More articles by this author , Harpreet WadhwaHarpreet Wadhwa More articles by this author , Ryan DobbsRyan Dobbs More articles by this author , and Ervin KocjancicErvin Kocjancic More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1901AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Stress urinary incontinence (SUI) is a common condition that adversely impacts the quality of life in effected women. Periurethral injection of urethral bulking agents (UBA) is considered a simple and cost effective treatment of SUI for these women. This meta-analysis critically assesses the safety of the seven most commonly used UBA, along with the management of reported complications. METHODS Using PubMed, Scopus and Ovid Medline, a meta-analysis of the scientific literature from 1996 to July 2014 was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements to quantitatively summarize the complications and reported treatments of urethral bulking agents. Initially, 1022 studies were identified and evaluated for relevancy and redundancy (Figure 1). Abstracts were excluded. A total of 4,326 patients from eligible 78 study samples were analyzed. Complication incidence was recorded, along with treatment and efficacy. Statistical analysis of complication incidence and type between UBAs was performed. RESULTS 1,999 complications were reported in the 78 studies that were analyzed. Of the reported complications, 3.8% were considered major (Clavien III); of which 70.6% required incision and drainage (I&D) and 29.3% required more invasive procedures. The incidence of major UBA complications for Durasphere was 9.4%, Coaptite was 7.4%, Ziudex was 17.8%, Bulkamid was 0.8%, Contigen was 1.8%, and Tegress was 5.9%. Macroplastique had no serious complications reported. Odds ratio (OR) of any UBA complication compared to control (Contigen) was 4.8 with p<0.0001, and OR of major complication was 58.4 with p=0.0042. CONCLUSIONS Although all urethral bulking agents are associated with complications, some are more prone to major complications than others. Most urethral bulking agent complications are transient and/or do not require treatment. Of the major complications, almost 71% were treated by I&D. For major complications, Macroplastique is the only UBA with a superior safety profile as compared to Contigen. Bulking Agent Odds Ratio Confidence Interval (95%) p-value Durasphere 75.66 4.36-1314.29 0.003 Coaptite 114.23 6.28-3076.95 0.0014 Ziudex 307.48 18.95-4988.08 0.0001 Bulkamid 5.95 0.24-146.29 0.2749 Tegress 82.57 3.32-2051.65 0.0071 Macroplastique∗ N/A N/A N/A Odds Ratios of major complications for each UBA compared to Contigen (control). ∗ Macroplastique did not have any major complications reported. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e645 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Majdee Islam More articles by this author Harpreet Wadhwa More articles by this author Ryan Dobbs More articles by this author Ervin Kocjancic More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Current Trends in the Management of Post-Prostatectomy Incontinence

One of the annoying complications of radical prostatectomy is urinary incontinence. Post-prostatectomy incontinence (PPI) causes a significant impact on the patient's health-related quality of life. Although PPI is stress urinary incontinence caused by intrinsic sphincter deficiency in most cases, bladder dysfunction and vesicourethral anastomotic stenosis can induce urine leakage also. Exact clinical assessments, such as a voiding diary, incontinence questionnaire, pad test, urodynamic study, and urethrocystoscopy, are necessary to determine adequate treatment. The initial management of PPI is conservative treatment including lifestyle interventions, pelvic floor muscle training with or without biofeedback, and bladder training. An early start of conservative treatment is recommended during the first year. If the conservative treatment fails, surgical treatment is recommended. Surgical treatment of stress urinary incontinence after radical prostatectomy can be divided into minimally invasive and invasive treatments. Minimally invasive treatment includes injection of urethral bulking agents, male suburethral sling, and adjustable continence balloons. Invasive treatment includes artificial urinary sphincter implantation, which is still the gold standard and the most effective treatment of PPI. However, the demand for minimally invasive treatment is increasing, and many urologists consider male suburethral slings to be an acceptable treatment for PPI. The male sling is usually recommended for patients with persistent mild or moderate incontinence. It is necessary to improve our understanding of the pathophysiologic mechanisms of PPI and to compare different procedures for the development of new and potentially better treatment options.

Durability of Urethral Bulking Agent Injection for Female Stress Urinary Incontinence: 2-Year Multicenter Study Results

We evaluated the durability of the urethral bulking agent Macroplastique for stress urinary incontinence in a 24-month study in women with a previously documented successful outcome 12 months after the last injection. In a multicenter study females diagnosed with stress urinary incontinence primarily due to intrinsic sphincter deficiency successfully treated with Macroplastique, defined as 1 or greater Stamey grade improvement 12 months from baseline, were followed for 24 months to assess the sustained therapeutic response. Outcome measures were Stamey grade, Patient Global Impression of Improvement, Physician Assessment of Improvement, 1-hour pad weight, Incontinence Quality of Life scores and safety assessment. At 24 months 56 of 67 patients (84%) had sustained success since 12 months, of whom 45 of 67 (67%) were dry (Stamey grade 0). Of the dry patients at 12 months 33 of 38 (87%) maintained cure at 24 months. Also, 12 of 29 patients (41%) considered improved at 12 months were dry at 24 months. Overall Incontinence Quality of Life scores and all subscales showed statistically significant improvement from baseline (p <0.001). Mean pad weight was 24 gm at baseline, and 4 gm at 12 and 24 months. Patient and physician assessments rated 85% of patients dry or markedly improved 24 months after the last treatment. Substantial, durable results were sustained during 2 years with 84% of patients maintaining significant Stamey grade improvement from the 12-month assessment. Two-thirds of patients were dry at 24 months. The durability of Macroplastique shows its effectiveness as a viable long-term therapy for female stress urinary incontinence primarily due to intrinsic sphincter deficiency.

TRANSURETHRAL INJECTION OF BULKING AGENTS FOR STRESS URINARY INCONTINENCE FOLLOWING ORTHOTOPIC NEOBLADDER RECONSTRUCTION IN WOMEN

The clinical efficacy of transurethral bulking agents for the treatment of new onset urinary incontinence following radical cystectomy and orthotopic lower urinary tract reconstruction in women was evaluated. Between 1990 and 2002, 101 female patients with primary transitional cell carcinoma of the bladder were treated with radical cystectomy and orthotopic ileal neobladder reconstruction. Of the 101 patients 12 (12%) underwent treatment for new onset urinary incontinence following exenterative surgery with transurethral injection of bulking agents, including collagen in 11 and nonabsorbable pyrolytic carbon coated beads in 1. A total of 25 injections were administered to 12 female patients with a mean age of 75.4 years following orthotopic neobladder reconstruction. Mean followup was 22.5 months (range 2 to 51). Two of the 12 patients (16.7%) reported complete continence and were considered cured, although subjective complaints of urinary frequency persisted. Four patients (33%) had decreased objective average daily pad use (6.75 to 2.25) and 6 (50%) showed no subjective or objective improvement in symptomatology. Although injection of urethral bulking agents is a minimally invasive treatment for stress urinary incontinence following orthotopic neobladder reconstruction, long-term results in patients with severe disease show a less than optimal durable response.