Treatment of stress urinary incontinence using polyacrylamide hydrogel in women after radiotherapy: 1-year follow-up.
OBJECTIVE
Information on urethral bulking therapy in women after previous pelvic radiotherapy is lacking. This study compared the safety and efficacy of polyacrylamide intraurethral injections in patients with and without previous radiotherapy.


METHODS
A total of 46 patients with severe stress urinary incontinence (SUI) were enrolled in this multicenter prospective trial. Group A consisted of 24 patients with previous radiotherapy to the pelvis for the treatment of a gynaecological malignancy. Group B consisted of 22 patients without previous radiotherapy. All patients were treated with a transurethral injection of a bulking solution (Bulkamid). The average follow-up was 12.4 months. The paired Wilcoxon test was used to compare the results before and after the procedure within the groups, and the two-sample Wilcoxon test was used for comparisons between groups.


RESULTS
Complete continence was achieved in 25 % of patients in group A and in 36.4 % of patients in group B. Significantly reduced urine leakage was observed in both groups (p = 0.0164 in group A and p = 0.0002 in group B). The total scores in the International Consultation on Incontinence Questionnaire decreased by 5.2 in group A (p = 0.0000) and 6.36 in group B (p = 0.0001). The scores for the Total Patient Perception of Bladder Condition decreased by 1.54 in group A (p = 0.0001) and 2.59 in group B (p = 0.0000), with a significant difference between groups (p = 0.0224). No clinically significant changes in urodynamic parameters were observed. No severe adverse events were noted.


CONCLUSIONS
Based on our results, we conclude that urethral bulking therapy is a valuable treatment option in patients with severe SUI who have undergone pelvic radiotherapy for the treatment of gynaecological malignancy.
Department of Urology, University Hospital, 17. listopadu 1790, Poruba, 708 52, Ostrava, Czech Republic. jan.krhut@fno.cz.
Jan
J
Krhut
Department of Obstetrics and Gynecology, 1st Medical Faculty, Charles University and General Faculty Hospital, Prague, Czech Republic.
Alois
A
Martan
Department of Obstetrics and Gynecology, University Hospital, Ostrava, Czech Republic.
Michaela
M
Jurakova
Department of Urology, University Hospital, 17. listopadu 1790, Poruba, 708 52, Ostrava, Czech Republic.
David
D
Nemec
Department of Obstetrics and Gynecology, 1st Medical Faculty, Charles University and General Faculty Hospital, Prague, Czech Republic.
Jaromir
J
Masata
Department of Surgical Studies, Ostrava University, Ostrava, Czech Republic.
Peter
P
Zvara
D000180:Acrylic Resins / Q000008:administration & dosage* / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005833:Genital Neoplasms, Female / Q000150:complications / Q000532:radiotherapy*; D006801:Humans; D020100:Hydrogels / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D000099166:Polyacrylamides
D000180:Acrylic Resins; D001672:Biocompatible Materials; D020100:Hydrogels; D000099166:Polyacrylamides; C528271:Bulkamid
Pelvic radiotherapy; Polyacrylamide hydrogel; Stress urinary incontinence; Urethral bulking