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• W4246576078 abstract "Stress urinary incontinence (SUI) is a major clinical problem affecting a high proportion of women (1). The treatment options for mild cases are physiotherapy, drug therapy and minimally invasive devices, whereas in more severe cases surgery is often considered as the only treatment choice (2). Urethral injection is a minimally invasive procedure that offers improved efficacy over noninvasive therapy but may be preferable to open surgery as it carries a lower risk of complications (3). Recent advances have simplified the procedure by allowing urethral injection to be performed without surgical facilities. Before urethral injection may be considered for early treatment of SUI, the feasibility of subsequent surgical procedures must be established. We report three cases of SUI who were treated initially with transurethral injection and later underwent placement of tension-free vaginal tape (TVT). The vast majority of patients are improved by Zuidex™ (Q-med AB, Uppsala, Sweden) but for those who are not, going on to TVT could be an alternative. All three presented with SUI and no sign of detrusor instability. Cough provocation and jumping tests were used to measure urine leakage at presentation and these were 103, 50 and 20 g (including 8 g pad weight) for patients 1, 2 and 3, respectively. For urethral injection, dextranomer/hyaluronic acid (Dx/HA) copolymer (Q-med) was administered without endoscopy, using the Implacer® device. This device, consisting of a hand piece and tube assembled together with four prefilled syringes of Dx/HA copolymer and 50-mm 21G needles, allows sequential injections to be made into the midpoint of the urethra, in the 12, 3, 6 and 9 o'clock positions (4 × 1.0 mL). After treatment, patients returned for controlled provocation tests − all three patients demonstrated an initial improvement in leakage, but not cessation. A second procedure was offered and patient 1 accepted. TVT placement was performed 3 months (patients 1 and 2) or 4 months (patient 3) after the last urethral injection, with preoperative leakage measurements of 62, 44 and 113 g (including 8 g pad weight) for patients 1, 2 and 3, respectively. In all three cases the surgical procedure was performed as normal, without any complications. All three patients recovered from the procedure as expected, and were cured of their incontinence. These three case reports indicate that surgery is possible following urethral injection and no procedural difficulties are caused by implanted Dx/HA copolymer. This is a significant finding as it implies that urethral injection could be considered as an early treatment for SUI regardless of whether subsequent surgery may be required. Until recently, the available materials for implantation have limited the use of urethral injection. Polytetrafluoroethylene (PTFE) paste and silicone have been used but there are potential safety concerns with both these bulking agents, whereas the long-term efficacy of bovine collagen and autologous fat is uncertain (4). Dx/HA copolymer is a biocompatible, biodegradable and nonallergenic material, with proven safety and long-term efficacy as a bulking agent in the treatment of vesico-ureteral reflux (VUR) (5). There is also evidence that this material does not cause any damage to the surrounding tissue (6), an important aspect when subsequent surgery may be required. The availability of the Implacer® device has further simplified urethral injection using Dx/HA copolymer. All three of the present patients were participants in a study using this device, preliminary data from which indicate that the large majority of patients responded successfully. In our opinion, this therapy could now be investigated for early use in patients with SUI failing to respond to conservative therapy." @default.
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• W4246576078 date "2003-01-01" @default.
• W4246576078 modified "2023-09-26" @default.
• W4246576078 title "Stress urinary incontinence: feasibility of surgery after urethral injection" @default.
• W4246576078 doi "https://doi.org/10.1080/j.1600-0412.2003.00257.x" @default.
• W4246576078 hasPublicationYear "2003" @default.
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