title: Safety and efficacy of sling for persistent stress urinary incontinence after bulking injection.
abstract: OBJECTIVE
  To evaluate the impact of injectable agents on subsequent incontinence surgery outcomes to assess safety and efficacy of this treatment combination. Periurethral bulking agents are a minimally invasive treatment option for stress urinary incontinence (SUI), but often lack durability necessitating further surgical intervention.
  
  
  METHODS
  Retrospective review of 43 patients with SUI following bulking agent who underwent subsequent sling placement from November 2000 to September 2009 were evaluated for demographics, symptoms, urodynamics (UDS), bulking agent characteristics, concomitant procedures, pad requirements per day (PPD), subjective outcomes, and complications.
  
  
  RESULTS
  Mean patient age was 67 years, with mean follow-up of 37.3 months. All demonstrated SUI, and mixed urinary incontinence (MUI) was noted in 81.4%. Almost half (48.8%) had undergone a prior antiincontinence procedure. Mean number of injections was 3. After a bulking injection, 25 autologous fascia pubovaginal slings, 13 midurethral slings, and 5 biological pubovaginal slings were placed. Concomitant pelvic surgery was performed in 37.2%. Postoperatively, mean PPD decreased from 5.3 to 0.65, with a 60.5% subjective cure rate (no pads or leakage under any circumstances). No association was seen between number or type of injection, or type of sling with regards to patient outcomes. Results were significantly related to concomitant surgery (P = .007). SUI recurred in 8 patients (18.6%), which was not statistically associated with other parameters. Complications included urinary retention (8 patients) de novo urgency (1 patient), UTI (4 patients), abdominal wound infection (3 patients), and cystotomy (1 patient).
  
  
  CONCLUSIONS
  Prior treatment with bulking agents does not appear to negatively affect outcomes for future antiincontinence surgery in our patient population.
authors.affiliation: Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-0001, USA. mkoski82@hotmail.com
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Koski
authors.forename: Ekene A
authors.initials: EA
authors.lastname: Enemchukwu
authors.forename: Priya
authors.initials: P
authors.lastname: Padmanabhan
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Kaufman
authors.forename: Harriette M
authors.initials: HM
authors.lastname: Scarpero
authors.forename: Roger R
authors.initials: RR
authors.lastname: Dmochowski
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials / Q000008:administration & dosage; D003094:Collagen / Q000008:administration & dosage; D005260:Female; D005936:Glucans / Q000008:administration & dosage; D006801:Humans; D015552:Injections, Intralesional; D008875:Middle Aged; D012189:Retrospective Studies; D053825:Suburethral Slings / Q000009:adverse effects; D017211:Treatment Failure; D014550:Urinary Incontinence, Stress / Q000601:surgery* / Q000628:therapy; D015040:Zirconium / Q000008:administration & dosage
chemical_list: D001672:Biocompatible Materials; D005936:Glucans; C431745:durasphere; C048470:glutaraldehyde-cross-linked collagen; D003094:Collagen; D015040:Zirconium