title: Three-dimensional endovaginal ultrasound examination following injection of Macroplastique for stress urinary incontinence: outcomes based on location and periurethral distribution of the bulking agent.
abstract: OBJECTIVE
  Our aim was to use three-dimensional enodovaginal ultrasound (3D EVUS) to identify sonographic parameters that are associated with successful outcomes following injection of Macroplastique.
  
  
  METHODS
  Three hundred and sixty degree 3D EVUS was performed in 100 treatment-naïve patients following Macroplastique injection. The location, volumes, periurethral distribution, and distance of the hyperechoic densities from the urethrovesical junction were assessed. The patients were divided into two groups: group A (n = 72): patients who had good clinical outcome and group B (n = 28): patients who were not improved or worsened. The two groups were compared with respect to the ultrasound parameters measured.
  
  
  RESULTS
  Group A had a greater proportion of women with Macroplastique located in the proximal urethra, while midurethral location was found to be significantly more frequent in group B (p = 0.036). The odds of a circumferential periurethral distribution in group A were 13.62 times the odds in group B (95% CI: 5.12-56.95). When the location of the injection and the type of periurethral distribution were considered together, it was found that when the site of injection was proximal, the odds of circumferential distribution in group A was significantly greater than those in group B (odds ratio [95% CI]: 22 [3.05-203.49]; p < 0.001).
  
  
  CONCLUSIONS
  Proximally located Macroplastique and circumferential periurethral distribution of Macroplastique are individually associated with successful outcomes following the injection. The combination of circumferentially distributed and proximally located Macroplastique is associated with the best short-term clinical outcomes.
authors.affiliation: Department of Gynecology, Urogynecology & Reconstructive Pelvic Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA.
authors.forename: Aparna
authors.initials: A
authors.lastname: Hegde
authors.forename: Aimee L
authors.initials: AL
authors.lastname: Smith
authors.forename: Vivian C
authors.initials: VC
authors.lastname: Aguilar
authors.forename: G Willy
authors.initials: GW
authors.lastname: Davila
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004129:Dimethylpolysiloxanes / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007267:Injections; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography; D014550:Urinary Incontinence, Stress / Q000000981:diagnostic imaging / Q000628:therapy*
chemical_list: D004129:Dimethylpolysiloxanes; C013830:baysilon