Neurogenic Stress Urinary Incontinence Research Articles

783 - Robot-assisted bladder neck artificial urinary sphincter implantation in male patients with neurogenic stress urinary incontinence: A multicenter study

783 - Robot-assisted bladder neck artificial urinary sphincter implantation in male patients with neurogenic stress urinary incontinence: A multicenter study

Neurogenic stress urinary incontinence: is there a place for Adjustable Continence Therapy (ACT™ and ProACT™, Uromedica, Plymouth, MN, USA)? A retrospective multicenter study.

Retrospective cohort study. To assess the effectiveness and complications of treatment for neurogenic stress urinary incontinence (nSUI) by Adjustable Continence Therapy (ACT™ and ProACT™). France. A retrospective multicentre study of consecutive patients with neurological pathologies treated for nSUI with ACT balloons. From January 2001 to January 2013, 102 patients were implanted. Mean (SD) age at implantation was 48.4 (16.5) years. Patients were followed-up for a mean 2.7 (2.3) years. After implantation, 5.9% of patients were totally continent, 51.2% had an improvement in symptoms of at least 50% (including 14.6% with improvements of at least 90%), and 48.8% had improvements of < 50%, including 7.3% of treatment failures. Complications occurred in 70 patients (120 balloons): 21 balloon infections, 34 migrations, 18 device failures, 28 urethral erosions and 28 cutaneous erosions. The procedure was ineffective for 35 patients. Twenty patients underwent permanent explantation. The rate of migrations was lower in patients with upper motor neuron lesion than in those with lower motor neuron lesion (p = 0.04). ACT is a minimally invasive treatment for SUI related to sphincter deficiency. This is one of the first reports in a sample of patients with neurological disorders implanted by multiple surgeons. ACT could be a less invasive, appropriate alternative to artificial urinary sphincters. However, it is associated with frequent local complications which are easy to manage but that should be reduced in this challenging population.

Management of male and female neurogenic stress urinary incontinence in spinal cord injured (SCI) patients using adjustable continence therapy.

Artificial urinary sphincter (AUS) is an option for the treatment of neurogenic stress urinary incontinence (nSUI), but complications and re-operation rates are high, and there is no clear indication from guidelines (1). The aim of our study is to evaluate the effectiveness of a less invasive continence device in neurogenic population: Adjustable Continence Therapy ProACT/ACT®. We retrospectively includedpatients with spinal cord injuries in this study, complaining of nSUI and treated at our Institution with Pro-ACT/ACT® implantation. Diagnosis of nSUI was achieved with clinical history data collection and video-urodynamic testing. We treated 13 males and 3 females by proACT/ACT device, mean age 47.5 years (range 27-71). Fifteen implantations were performed bilaterally under spinal anesthesia and under fluoroscopic control; in one male patient, only the right balloon was implanted. Mean refilling number was 2.8 (range 0-6), and mean final volume was 3.6 ml. No patient reported any perioperative complications according to Clavien-Dindo. Follow-up was 37 months (range 7-156). Five patients (31%) underwent device explantation for deflate in one case, erosion or migration in three cases (18%), and infection in one case. About 43.75% of patients were dry and 18.75% improved more than 50% their urine loss, 37.5% of patients improved less than 50%, and no one reported worsening of incontinence. Implantation of proACT/ACT® device is safe and a minimally invasive procedure also in neurological patients, with a relative low rate of intra and postoperative complications. Efficacy is good, although slightly lower than the results in non-neurological patients.

PD10-06 THE TENSION FREE VAGINAL TAPE VERSUS THE PUBOVAGINAL SLINGS FOR WOMEN WITH NEUROGENIC STRESS URINARY INCONTINENCE

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Neurogenic Voiding Dysfunction II1 Apr 2015PD10-06 THE TENSION FREE VAGINAL TAPE VERSUS THE PUBOVAGINAL SLINGS FOR WOMEN WITH NEUROGENIC STRESS URINARY INCONTINENCE Ahmed El-Azab and Sherif El-Nashar Ahmed El-AzabAhmed El-Azab More articles by this author and Sherif El-NasharSherif El-Nashar More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.946AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES There are little data in the literature about the use of the minimally invasive midurethral slings (MUS) in women with neurogenic stress incontinence (nSUI) due to spinal pathologies at or below sacral micturition center. We designed this clinical trial to compare the efficacy and safety of TVT and rectus fascia Pubovaginal sling (PVS) in treating SUI in women with LMNL presenting with SUI. METHODS This is a pilot nonrandomized clinical trial including women with SUI associated with pathology at below S2 spinal segment. Women were non randomly assigned into TVT or PVS groups. Failure was defined as leakage of urine during cough test at 250 mL bladder volume. Primary outcome was time to treatment failure based on positive cough stress test. Other outcomes included UDI6 IIQ7 and Urodynamics. Regression models were utilized to adjust for confounders. Time to failure was the endpoint for that outcome and Kaplan Meier curves were used to calculate the cumulative failure rate in each group. RESULTS 40 women were included; 20 TVT and 20 PVS. For primary outcome, 7 out of 40 (17.5%) women had positive cough stress test and were considered treatment failures. 4 (20%) in the TVT group and 3 (15%) in PVS group. The time to treatment failure in TVT group was comparable to the PVS group with an unadjusted hazard ratio of 2.90 (95%CI, 0.61, 15.42, long-rank test P value=0.154). At 2 year, the cumulative objective failure rate was 5.9% in TVT group compared to 0% at the PVS group. At 4 years, cumulative failure rate was 41.8% in TVT group compared to 25.4% in the PVS group. In both groups, there were significant reductions in UDI-6 and the IIQ-7 total scores. IWhile all patients in PVS group had PVR >150 mL after surgery and required CIC, 8 patients (53%) in TVT group had PVR <150 mL and did not require CIC after surgery. Out of the remaining 12 patients in the TVT group, 5 patients were utilizing CIC before surgery. The remaining 7 had De novo increased PVR (PVR>150) and required CIC after surgery. The prevalence of De novo urge urinary incontinence was significantly higher after TVT (30% n=6 women) than after PVS (10%, n=2). Urodynamics 1 year after operation in those patients with De novo urge symptoms reveal low compliance in 2 patients and unstable bladder contractions in 6 patients (4 in TVT and 2 in PVS group). CONCLUSIONS Both PVS and TVT can be used effectively and safely to treat women with nSUI associated with spinal pathology. While postoperative CIC is needed in all patients after PVS, de novo postoperative CIC after TVT can be avoided in 50% of patients. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e202 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed El-Azab More articles by this author Sherif El-Nashar More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Surgical treatment of neurogenic stress urinary incontinence: A systematic review of quality assessment and surgical outcomes.

There are many opinions but little firm knowledge about the optimal treatment of neurogenic stress urinary incontinence (NSUI). To scrutinize the quality and surgical outcomes of the available treatment modalities in the published literature. A systematic review of the published literature from Pub Med and Web of Science was undertaken for studies describing surgical treatment of NSUI between 1990 and 2013. A checklist of criteria of methodological and reporting quality of interventions in urological publications was applied to assess quality of the retrieved publications. Surgical outcomes of success, failure, and reoperation were calculated. Statistical analyses included one-way ANOVA and post-hoc tests to determine significant differences between groups. Thirty studies were identified with Level 3 evidence. The quality of reporting was 43-81%, with significantly higher quality noted in studies published after 2002 (64% vs. 45%, P < 0.0001). None of the studies followed a randomized controlled trial (RCT) design. Three primary surgical procedures were used in 29 of 30 studies: artificial urinary sphincter (AUS), urethral slings, and urethral bulking agents. One study used a ProACT device. AUS was considered more successful than urethral bulking agents (77 ± 15% vs. 27 ± 20%, P = 0.002). Urethral bulking agents reported higher failures than urethral sling procedures (49 ± 16% vs. 21 ± 19%, P = 0.016) and AUS (21 ± 19% vs. 10 ± 11%, P < 0.002). The quality of evidence obtained from non-RCTs is modest. Surgeries for NSUI have relatively high success rates but also high complication rates in this highly heterogeneous population. More studies using modern techniques are required to update our knowledge.

Résultats initiaux de l’utilisation des ballons périurétraux ajustables (ACT™ et pro ACT™) dans le traitement de l’incontinence urinaire d’effort par insuffisance sphinctérienne de l’adulte

To report efficacy and morbidity of periurethral adjustable balloons (PUAB) in the treatment of stress urinary incontinence (SUI) with intrinsic sphincter deficiency (ISD). Retrospective descriptive and analytic patients cohort study was performed from July 2010 to June 2012. We reviewed data from 43 patients (19 women and 24 men). The patients were categorized into 3 groups: i) women, ii) men after prostatectomy, iii) men with neurogenic SUI (prostate in position). Sandvick score and the average of 3 days 24 h Pad test evaluated the efficacy of the device. The patients impression of improvement was assessed in three degrees: completely improved, partially improved, not improved. After a median follow-up of 67 weeks (min. 40, max. 91) a significant improvement of the score of Sandvik was observed (8 to 4, P<0.005). The proportion of dry patients or with one security protection in the three groups was 57.9%, 64.3% and 50% respectively for women, men after prostatectomy, and men with neurological SUI. About 27.9% (12/43) of the patients had post-operative complications. These complications required an explantation of the PUAB in 11/12 patients among whom 7/11 (63.6%) had a delayed re-implantation of the device. In this series, the overall efficacy observed was 67.4% with a post-operative complication rate of 27.9%. The device adjustment was done in consultation as well as the complications management and the explantation when necessary. 4.

Adjustable balloons in the treatment of neurogenic stress urinary incontinence: A French retrospective multicentric study

Adjustable balloons in the treatment of neurogenic stress urinary incontinence: A French retrospective multicentric study

Evaluation and Management of Neurogenic Stress Urinary Incontinence

Neurogenic bladder is a broad term that encompasses many different types of neurologic diseases and a wide spectrum of dysfunction of the lower urinary tract. Patient with neurogenic stress urinary incontinence (SUI) have poor urine store storage due to outlet dysfunction. Office examination, cystoscopy, video urodynamics (UDS), and renal imaging all play an important role in evaluating these patients (Wyndaele et al. Neurourol Urodyn. 2009;29:662-669 [27]). Based on patients’ overall function, bladder capacity and compliance, and ability to void or perform clean intermittent catheterizations, outlet procedures such as slings and artificial urinary sphincters may be offered safely (Arun Sahai et al. Curr Urol Rep. 2011;12:404-412 [28••]). Other options for partial or complete urinary diversion exist for patients with limited residual function or low capacity bladders. Improving continence in this population can positively impact quality of life and help with issues such as skin break down and chronic infection from incontinence (Ku. BJU Int. 2006;98:739-745 [26]).

Robot‐assisted laparoscopic artificial urinary sphincter insertion in men with neurogenic stress urinary incontinence

To describe for the first time the technique of robot-assisted artificial urinary sphincter (R-AUS) insertion in male patients with neurogenic incontinence. From January 2011 to the present date, six patients with spinal cord injury have undergone R-AUS insertion at our academic institution and we have prospectively collected data on pre-, peri- and early postoperative outcomes. A transperitoneal five-port approach was used using a three-arm standard da Vinci® robot (Intuitive Surgical, Sunnyvale, CA, USA) in a 30° reverse Trendelenburg position. The artificial urinary sphincter (AUS) cuff was placed circumferentially around the bladder neck, the reservoir was left intra-abdominally in a lateral vesicular space and the pump was placed in a classic scrotal position. All six patients had successful robotic implantation of the AUS. The median patient age was 51.5 years, the median (range) operating time was 195 (175-250) min with no significant blood loss or intra-operative complications. The median (range) length of hospital stay was 4 (4-6) days. At a median (interquartile range) follow-up of 13 (6-21) months, all six patients had a functioning device with complete continence. To date, we have observed no incidence of early erosion, device infection or device malfunction. Allowing for the preliminary nature of our data, R-AUS insertion appears safe and technically feasible. Larger studies with long-term follow-up and comparison with open AUS insertion are necessary before definitive statements can be made for R-AUS in respect of complications and functional outcomes.

1036 PRIMARY ARTIFICIAL URINARY SPHINCTER IMPLANTATION FOR MALE NON-NEUROGENIC STRESS URINARY INCONTINENCE: EARLY AND MIDTERM RESULTS OF A MULTICENTER CONTEMPORARY SERIES

1036 PRIMARY ARTIFICIAL URINARY SPHINCTER IMPLANTATION FOR MALE NON-NEUROGENIC STRESS URINARY INCONTINENCE: EARLY AND MIDTERM RESULTS OF A MULTICENTER CONTEMPORARY SERIES

Treatment of Neurogenic Stress Urinary Incontinence Using an Adjustable Continence Device: 4-Year Followup

We evaluated the long-term safety and efficacy of an adjustable continence device (ACT® or ProACT™) in male and female patients with neurogenic stress urinary incontinence. Data on patients consecutively treated with implantation of an adjustable continence device due to neurogenic stress urinary incontinence were reviewed from the start of our experience to the current 4-year followup. We reviewed data on 13 male and 24 female patients with neurogenic stress urinary incontinence due to different forms of pelvic nerve or spinal cord lesions. Mean ± SD age at implantation was 46.2 ± 17.4 years. Of the patients 92% performed clean intermittent self-catheterization. The device was implanted bilaterally using general and local anesthesia in 16.2% and 83.8% of cases, respectively. From before implantation to 48-month followup the mean number of urinary incontinence episodes decreased from 6.1 ± 2.4 to 2.8 ± 3.1 and the mean number of pads used per 24 hours decreased from 4.2 ± 2.7 to 2.2 ± 2.2. Of the patients 54.5% indicated more than 50% improvement of stress urinary incontinence symptoms after 48 months, of whom 38.9% indicated complete continence. Adverse events included erosion/migration, device infection or failure, implantation site pain, bladder stone formation and difficult clean intermittent self-catheterization. Implantation of the ProACT/ACT device in patients with neurogenic stress urinary incontinence is minimally invasive and safe. It can significantly improve neurogenic stress urinary incontinence in the long term. Thus, it might be a reasonable option for patients who are not willing, not suitable or not yet ready for more invasive surgery, such as artificial urinary sphincter or fascial suspension sling placement.

2160 A PROSPECTIVE ANALYSIS OF VIDEO-URODYNAMIC DATA TO MEASURE URETHRAL MOBILITY IN MEN WITH POST-PROSTATECTOMY INCONTINENCE

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Urodynamic Testing1 Apr 20112160 A PROSPECTIVE ANALYSIS OF VIDEO-URODYNAMIC DATA TO MEASURE URETHRAL MOBILITY IN MEN WITH POST-PROSTATECTOMY INCONTINENCE Craig Comiter, Christopher Payne, and Richard Vecchiotti Craig ComiterCraig Comiter Stanford, CA More articles by this author , Christopher PayneChristopher Payne Stanford, CA More articles by this author , and Richard VecchiottiRichard Vecchiotti Stanford, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2397AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Innovations in male sling surgery have contributed to an increased interest in their use for the treatment of stress urinary incontinence (SUI). There is controversy, however, regarding their mechanism of action for improving continence. Bone-anchored slings appear to compress the bulbous urethra, as evidenced by increased retrograde leak point pressure (RLPP). Retroluminal (transobturator) slings, on the other hand, are purported to function by repositioning a ‘mobile' urethra and external sphincter back into the pelvis, thereby increasing functional membranous urethral length. As the prevalence of male urethral mobility is not well-defined, we describe a novel video-urodynamic technique designed to measure urethral mobility in men with SUI. METHODS 22 men with SUI were evaluated with video urodynamics. Fluoroscopy (3.75 frames/s) was performed at rest and during strain. Magnification differences in captured images were normalized by a 1/4” steel sphere (scaling factor) within the field of view. The ‘rest' and ‘maximal straining-induced displacement' frames were imported into a Computer Aided Design program.Reference geometries were constructed and measured about the structures of interest. A fixed tissue reference (FTR) line was created tangent to and coincident with the inferior boundary of the pubic ramus. A second line was created parallel to the FTR line coincident with the lowest point of functional continence (LPFC) – the point at which the contrast agent boundary was closest to the FTR line. Normalized measurements were made between the FTR and the LPFC in ‘rest' and the 'maximal straining-induced displacement' frames. Urethral mobility was calculated as the difference between the FTR and LPFC in each frame. RESULTS 9 men were status-post prostatectomy, 9 had external beam radiation (XRT), and 4 had neurogenic SUI. The mean maximal displacement (mobility) was 0.167 ± 0.059 inches in men with post-prostatectomy SUI, compared to 0.0841 ± 0.0261 inches in SUI men after XRT and 0.275 ± 0.161 inches in men with neurogenic SUI. CONCLUSIONS We have created a novel method to measure urethral mobility in men. We will expand this study to determine the relationship among urethral mobility, leak point pressure, degree of incontinence, and ultimately to response to various sling surgeries. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e864-e865 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Craig Comiter Stanford, CA More articles by this author Christopher Payne Stanford, CA More articles by this author Richard Vecchiotti Stanford, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Long-Term Results of Bulking Agent Injection for Persistent Incontinence in Cases of Neurogenic Bladder Dysfunction

We evaluated the effectiveness of bladder neck injection as a supplementary treatment for persistent low pressure incontinence after unsatisfactory fascial sling procedures in patients with neurogenic lower urinary tract dysfunction. A total of 89 patients with neurogenic lower urinary tract dysfunction underwent fascial sling procedures between 1992 and 2005. Because of unsatisfactory results, 27 patients received endoscopic injection of a bulking agent. All patients included in the study underwent urodynamic examination after the sling procedure, which revealed persistent low pressure transurethral leakage of urine. We retrospectively analyzed the endoscopic approach used to administer the bladder neck injection, method of postoperative catheterization and number of injections given. Efficacy of bladder neck injection was graded by the patient and the urologist. After a median followup of 8 years (range 2.5 to 14) only 2 patients (7%) were continent after having received a single injection of bulking agent. A total of 12 patients (44%) were given a second injection and 8 (30%) were given a third injection but these subsequent injections did not result in continence. Of the patients 16 (59%) eventually underwent bladder neck surgery, 2 (7%) were dry and 8 (30%) accepted the inconvenience. Two patients underwent ileocystoplasty and 1 patient underwent botulinum A toxin (Botox(R)) injection due to decreased bladder capacity and poor bladder compliance. Neither the endoscopic approach nor the method of postoperative catheterization affected the success rate. Bladder neck injection after failure of primary sling procedures has limited value in patients with neurogenic lower urinary tract dysfunction. Repeat bladder neck injection yields no additional benefits.

Comparing Outcomes of Slings With Versus Without Enterocystoplasty for Neurogenic Urinary Incontinence

We compared 2 cohorts of children with neurogenic urinary incontinence undergoing bladder neck sling with and without augmentation to determine relative continence outcomes, catheterization intervals, anticholinergic requirements and health related quality of life improvement as perceived by the patients and their parents. Consecutive patients followed through our spina bifida program underwent a structured postoperative interview by a research nurse to assess continence, interval between catheterizations and anticholinergic use. In addition, the child and parent together answered a health related quality of life satisfaction survey to determine the impact of surgery from their perspectives. There were 18 patients undergoing sling with augmentation and 23 with sling alone. Overall improved continence rate was 83%, with no difference between outcomes in patients with vs without augmentation. However, the interval between catheterizations was longer and the use of anticholinergics was less following augmentation. Nevertheless, health related quality of life responses differed significantly in only 1 area, independent care, with both cohorts reporting similarly improved overall health, and increased ability to participate in social and leisure activities. We directly compared results in patients undergoing slings with and without augmentation. Both procedures were similarly successful in achieving improved continence, with patients undergoing augmentation having a longer interval between catheterization and requiring fewer anticholinergics. However, health related quality of life responses revealed that both cohorts were similarly satisfied with the outcomes.

Implantation of an Adjustable Continence Therapy System Using Local Anesthesia in Patients With Post-Radical Prostatectomy Stress Urinary Incontinence: A Pilot Study

We evaluated whether transrectal ultrasound guided ProACT system implantation in patients under local anesthesia and with stress urinary incontinence after radical prostatectomy is feasible in a day hospital setting, and is safe and well tolerated. The procedure was used in 11 consecutive patients (mean age 69.9 years) with stress urinary incontinence after undergoing radical prostatectomy between November 2006 and July 2007. The ProACT system was implanted with a transrectal ultrasound guided procedure after administration of local anesthesia (40 ml ropivacaine 7.5 mg/ml) in perineal skin, subcutaneous tissue, pelvic diaphragm and laterally to the anastomosis. During surgery any reason for discomfort was collected. Pain was evaluated with the visual analogue scale, Numeric Pain Intensity Scale and Simple Descriptive Pain Intensity Scale. Transrectal ultrasound was performed 7 days after surgery to exclude device migrations due to early patient mobilization. The ProACT systems were successfully implanted in all patients under local anesthesia without any need for general anesthesia, and without perioperative surgical or anesthesia related complications. Subjective discomfort was minimal. Mean visual analogue scale was 13 mm (range 0 to 28). Mean Numeric Pain Intensity Scale was 1.4 points (range 0 to 4). On the Simple Descriptive Pain Intensity Scale 4 patients (36.3%) reported no pain, 5 (45.5%) reported mild pain and 2 (18.2%) reported moderate pain. Discharge from the hospital was possible for all patients after 6 hours. All transrectal ultrasound performed after 7 days excluded balloon migrations. Transrectal ultrasound guided ProACT system implantation with the patient under local anesthesia only is feasible, safe, well tolerated and may be performed as a day surgery procedure.

Artificial Urinary Sphincter in Adult Male with Neurogenic Stress Urinary Incontinence: A Rare Indication

Introduction: The artificial urinary sphincter (AUS) is a rare indication for stress urinary incontinence secondary to spinal cord injury. Clinical Picture: A 48-year-old male sustained spinal cord injury, resulting in detrusor acontractility and urinary stress incontinence. Treatment and Outcome: An AUS was implanted and the patient achieved complete urinary continence. Conclusion: The AUS is an appropriate and durable device for management of patients with neurogenic stress incontinence.

EROSION OF A MALE POLYPROPYLENE SLING

No AccessJournal of UrologyAdult Urology: Voiding Dysfunction1 Nov 2004EROSION OF A MALE POLYPROPYLENE SLING J. HAKIM and M. GIGNAC J. HAKIMJ. HAKIM More articles by this author and M. GIGNACM. GIGNAC More articles by this author View All Author Informationhttps://doi.org/10.1097/01.ju.0000142106.38139.e2AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "EROSION OF A MALE POLYPROPYLENE SLING." The Journal of Urology, 172(5), p. 1925 References 1 : Management of vaginal erosion of polypropylene mesh slings. J Urol2003; 169: 2242. Link, Google Scholar 2 : Polypropylene sling of the bulbar urethra for post-radical prostatectomy incontinence. Eur Urol2003; 43: 152. Google Scholar 3 : The male sling for stress urinary incontinence: a prospective study. J Urol2002; 167: 597. Link, Google Scholar From the Triangle Urology Group, Pittsburgh, Pennsylvania© 2004 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 172Issue 5November 2004Page: 1925 Advertisement Copyright & Permissions© 2004 by American Urological Association, Inc.Keywordssurgical meshurinary incontinence, stresspolypropylenesMetricsAuthor Information J. HAKIM More articles by this author M. GIGNAC More articles by this author Expand All Advertisement PDF downloadLoading ...

PARTICLE MIGRATION AFTER TRANSURETHRAL INJECTION OF CARBON COATED BEADS FOR STRESS URINARY INCONTINENCE

Despite 20 years of experience with injectable bulking agents for stress urinary incontinence results are rather disappointing. The satisfying initial results of collagen injection are rapidly decreasing with time, whereas synthetic bulking agents have shown problems with migration and biocompatibility. The ideal bulking agent would be permanent with a good clinical long-term success rate. We report our experience with Durasphere (Carbon Medical Technologies, Inc., St. Paul, Minnesota), a new injectable bulking agent containing carbon coated beads. Seven men and 13 women with a mean age of 62.5 years underwent transurethral submucosal injection. The 13 female patients had been diagnosed with type III stress urinary incontinence and each had undergone at least 1 unsuccessful previous operation for urinary incontinence. There were iatrogenic and traumatic sphincter lesions in 6 and 1 of the male patients, respectively. Mean volume injected per treatment was 6.0 cc. Mean followup was 10 months. After 6 months 76.9% of the female patients were improved but after 12 months the success rate decreased to 33%. In the male patients after 6 months the success rate was 66%, which decreased to 33% after 12 months. At the 6-month followup we observed significant migration of the carbon coated beads into the local and distant lymph nodes as well as into the urethral mucosa. Due to limited success and proved particle migration, carbon coated beads do not show any improvement over existing bulking materials. The clinical effect of bead migration must be determined before extended use of this substance.

THE LONG-TERM OUTCOME OF ARTIFICIAL URINARY SPHINCTERS

THE LONG-TERM OUTCOME OF ARTIFICIAL URINARY SPHINCTERS