Efficacy and safety of a novel system (NASHA/Dx copolymer using the Implacer device) for treatment of stress urinary incontinence.
OBJECTIVE
To investigate the efficacy and safety of non-animal-stabilized hyaluronic acid/dextranomer (NASHA/Dx) copolymer for transurethral injection using a new guiding instrument (the Implacer) for stress urinary incontinence.


METHODS
In an open, prospective, multicenter study, 42 invasive therapy-naive female patients with stress urinary incontinence were given 4 x 1.0 mL or 4 x 0.7 mL of NASHA/Dx copolymer using the Implacer. The efficacy parameters, measured at baseline and 1, 3, 6, and 12 months after treatment, included cough-induced leak point pressure, urine leakage by provocation test, number of incontinence episodes in 24 hours, and patient perception of bladder condition, rated on a 6-point scale.


RESULTS
The collected cough-induced leak point pressure data were not judged to be valid and reliable. Statistically significant reductions in median urine leakage were observed (P <0.0001), from 36 g (range 0.0-300) after 20 "jumping jacks" or vigorous coughs at baseline to 5.5 g (range 0.0-98) at 3 months and sustained at 12 months (7.0 g, range 0.0-98). Of the 42 patients, 32 (76%) demonstrated a degree of improvement in urine leakage at 3 and 12 months. The median number of incontinence episodes in 24 hours decreased significantly from 1.9 (range 0.0-24) at baseline to 0.4 (range 0.0-24) at 12 months (P <0.0001). At both 3 and 12 months, 29 patients (69%) had improved by at least one category on the 6-point patient perception scale. Treatment was well tolerated, and no complications were reported with use of the Implacer.


CONCLUSIONS
The results of this study indicate that a novel system (NASHA/Dx copolymer insertion using the Implacer) is an effective and well-tolerated treatment for invasive therapy-naive patients with stress urinary incontinence, with improvement sustained for at least 12 months. These encouraging results warrant additional study.
van Kerrebroeck
Philip
P
Department of Urology, University Hospital Maastricht, Maastricht, The Netherlands.
ter Meulen
Flip
F
Larsson
Gregor
G
Farrelly
Elisabeth
E
Edwall
Lena
L
Fianu-Jonasson
Aino
A
D001672:Biocompatible Materials / Q000008:administration & dosage / Q000627:therapeutic use*; D003371:Cough; D003911:Dextrans / Q000008:administration & dosage / Q000627:therapeutic use*; D004337:Drug Carriers; D005260:Female; D005782:Gels; D049669:History, 16th Century; D049670:History, 17th Century; D049671:History, 18th Century; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D007267:Injections / Q000295:instrumentation*; D008863:Microspheres; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D016896:Treatment Outcome; D014521:Urethra; D014550:Urinary Incontinence, Stress / Q000628:therapy*; D014636:Valsalva Maneuver
D001672:Biocompatible Materials; D003911:Dextrans; D004337:Drug Carriers; D005782:Gels; C496587:NASHA-Dx copolymer; D006820:Hyaluronic Acid