Stress incontinence injection therapy: what is best for our patients?
OBJECTIVE
Urethral injection (periurethral/intraurethral bulking) is an established, minimally invasive therapy for stress urinary incontinence (SUI). This review aims to determine which women should potentially benefit from, and be considered as candidates for, injection therapy and to elucidate what we are trying to achieve.


METHODS
Based on MEDLINE database searches, all aspects of urethral injection were examined, including patient selection, safety, injection technique, efficacy, quality of life, goals and cost.


RESULTS
Such therapy has a low complication rate, improves or cures about 3 out of 4 women, as shown in mainly short-term studies, and improves patients' quality of life. It can be used in the majority of patients with uncomplicated SUI. Therefore, injection therapy may be considered as a first-line treatment option for patients who have failed conservative therapy such as pelvic floor exercises and who decline or have a contraindication for pharmacological treatment. However, the decision of whether to use this type of treatment must be based on an informed discussion between the physician and patient--this dialogue should incorporate questions about patients' own treatment goals. Injection therapy appears to have the profile required to meet patients' goals, based on the findings that a procedure with an improvement in incontinence, minimal short-term risk, no long-term risk, and performed in a clinic, would be acceptable.


CONCLUSIONS
Investigating and trying to achieve patients' own treatment goals will ultimately enable us to do what is best for our patients, but current evidence suggests that injection therapy is a valid option worth discussing with many patients.
Chapple
Christopher R
CR
Department of Urology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Glossop Road, Sheffield, South Yorkshire S10 2JF, UK. c.r.chapple@sheffield.ac.uk
Wein
Alan J
AJ
Brubaker
Linda
L
Dmochowski
Roger
R
Pons
Montserrat Espuña
ME
Haab
François
F
Hill
Simon
S
D001672:Biocompatible Materials / Q000008:administration & dosage*; D001673:Biodegradation, Environmental; D003094:Collagen / Q000008:administration & dosage; D003911:Dextrans / Q000008:administration & dosage; D017886:Durapatite / Q000008:administration & dosage; D004869:Equipment Safety; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D007267:Injections / Q000295:instrumentation* / Q000379:methods; D018579:Patient Selection; D011788:Quality of Life; D012828:Silicones / Q000008:administration & dosage; D016896:Treatment Outcome; D014521:Urethra; D014550:Urinary Incontinence, Stress / Q000191:economics / Q000628:therapy*; D015040:Zirconium / Q000008:administration & dosage
D001672:Biocompatible Materials; D003911:Dextrans; C496587:NASHA-Dx copolymer; D012828:Silicones; D006820:Hyaluronic Acid; D003094:Collagen; D017886:Durapatite; D015040:Zirconium