Early experience with small volume periurethral polytetrafluoroethylene for female stress urinary incontinence.
OBJECTIVE
Injectable polytetrafluoroethylene paste has been used to treat female stress urinary incontinence. Since the substance is antigenically nonreactive we postulated that the reported morbidity may be due in part to the relatively large volumes injected. Therefore, we assessed the outcome of injecting small volumes of polytetrafluoroethylene with attention to the durability of success and morbidity.


METHODS
A total of 46 women with a median age of 73.8 years (range 26 to 88) with stress urinary incontinence were treated. The procedure was done on an outpatient basis using topical urethral lidocaine and periurethral lidocaine as anesthesia. A 20Fr urethroscope was used to inject polytetrafluoroethylene through an 18 gauge needle periurethrally. Patients were reinjected 1 to 3 months after initial injection if not cured (no incontinence or no pads). Continence was assessed by questionnaire from an interviewer not known to the patient. Subsequent top-up injections were given if required. Morbidity was monitored with clinical examination and imaging as required.


RESULTS
Of the patients 14 (30.4%) were dry, 19 (41.3%) were improved and 13 (28.3%) had treatment failure at a mean of 17.9, 15. 9 and 9.1 months, respectively, after last injection. For cured and improved patients (71.7%) an average of 2 treatments were needed, for a total mean volume of 5.4 cc polytetrafluoroethylene. Using a Kaplan-Meier survival curve the probability of the 14 patients remaining dry without additional polytetrafluoroethylene was 90% at 1 and 60% at 2 years. Outcome was not affected by radiological type of incontinence (that is with or without hypermobility), age, pretreatment bladder instability or previous interventions.


CONCLUSIONS
Periurethral injection of small volumes of polytetrafluoroethylene is effective and safe for treatment of female stress urinary incontinence. Early analysis shows that success is durable with minimal morbidity.
Herschorn
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Division of Urology, Department of Surgery, University of Toronto, Sunnybrook and Women's Health Sciences Centre, Toronto, Ontario, Canada.
Glazer
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AA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008875:Middle Aged; D011138:Polytetrafluoroethylene / Q000627:therapeutic use*; D011446:Prospective Studies; D019736:Prostheses and Implants; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000503:physiopathology / Q000628:therapy*; D014563:Urodynamics
D011138:Polytetrafluoroethylene