Periurethral injection of autologous fat for the treatment of sphincteric incontinence.
A total of 15 women with stress incontinence and 6 men with post-prostatectomy sphincteric incontinence underwent periurethral injection of autologous fat while under local anesthesia. The fat was harvested from the abdominal wall by liposuction. Preoperative evaluation consisted of a micturition diary, questionnaire, semiquantitative pad test, cystoscopy and urodynamics. Sequential injections were performed at 1 to 3-month intervals. Results were assessed by subjective patient scores, pad tests and clinical evaluation performed at intervals. Followup was 12 to 30 months (mean 18). Only 1 man and none of the women with urethral hypermobility had lasting improvement. Of the 15 women 12 had intrinsic sphincteric deficiency (type 3 stress incontinence) and they were our most successful group. Of the 12 women 10 (83%) were improved (mean score of 8.8-7 before injection compared to 1.87 after injection) at 1 month following the initial injection. Of the 9 patients who continued with the treatment 7 (78%) noticed lasting improvement objectively and subjectively after 1 to 4 injections (mean 2.4). We believe that this technique shows sufficient promise as an alternative therapy for sphincteric incontinence to warrant continued clinical investigation.
Santarosa
R P
RP
Squire Urologic Clinic, Columbia-Presbyterian Medical Center, New York, New York.
Blaivas
J G
JG
D000273:Adipose Tissue; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007267:Injections; D008297:Male; D017060:Patient Satisfaction; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects; D012074:Remission Induction; D014521:Urethra; D014549:Urinary Incontinence / Q000209:etiology / Q000628:therapy*