title: Quality of life outcomes in peri-urethral calcium hydroxylapatite injection.
abstract: OBJECTIVE
  Peri-urethral calcium hydroxylapatite injection is an established treatment for patients with stress urinary incontinence. Information is limited regarding calcium hydroxylapatite treatment and quality of life (QOL) outcomes. We hypothesize that patients might improve QOL after peri-urethral calcium hydroxylapatite injection, which was reflected in validated questionnaires.
  
  
  METHODS
  The peri-urethral calcium hydroxylapatite injection billing code was used to identify patients who underwent injection from 2011-2013. Female patients who completed the American Urological Association Symptom Score (AUASS), the AUASS QOL and Michigan Incontinence Symptom Index (M-ISI), and the bother score (M-ISI bother), or pad count at baseline and follow-up were included. Change in questionnaire scores and pads were assessed using the paired t test.
  
  
  RESULTS
  Sixty patients underwent 1 (30), 2 (63) or 3 (7 %) peri-urethral calcium hydroxylapatite injections performed by a single surgeon. Thirty-seven patients provided questionnaires and 38 provided pad counts, all with a mean age of 75 years. The overall AUASS, AUASS QOL, and overall M-ISI scores improved in 67.6, 54.8, and 61.3 % respectively (4.5 ± 7.9, 1.3 ± 1.7 and 5.5 ± 8.6 respectively). The M-ISI bother score improved in 44.8 % with a mean improvement of 0.5 ± 2.9, but did not reach significance. There was a 1.7 ± 3.7 decrease in the mean number of pads used daily after the procedure (p = 0.006) and 19 % experienced transient urinary retention.
  
  
  CONCLUSIONS
  Peri-urethral calcium hydroxylapatite injections can improve urinary QOL scores in patients with initial and recurrent stress urinary incontinence. This short-term retrospective analysis suggests that larger long-term studies focusing on QOL outcomes are needed to evaluate the effect of peri-urethral calcium hydroxylapatite has on incontinence-specific QOL.
authors.affiliation: Urogynecology Division, Department of Obstetrics and Gynecology, Henry Ford Hospital, K-9 Urology, 2799 West Grand Blvd, Detroit, MI, 48202, USA. mgriffi3@hfhs.org.
authors.forename: Meghan A
authors.initials: MA
authors.lastname: Griffin
authors.affiliation: Henry Ford Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Kirsten J C
authors.initials: KJ
authors.lastname: Janosek-Albright
authors.affiliation: Henry Ford Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Mireya
authors.initials: M
authors.lastname: Diaz-Insua
authors.affiliation: Urogynecology Division, Department of Obstetrics and Gynecology, Henry Ford Hospital, K-9 Urology, 2799 West Grand Blvd, Detroit, MI, 48202, USA.
authors.forename: Solafa
authors.initials: S
authors.lastname: Elshatanoufy
authors.affiliation: Henry Ford Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Humphrey O
authors.initials: HO
authors.lastname: Atiemo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017886:Durapatite / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000628:therapy*
chemical_list: D017886:Durapatite
keywords: Calcium hydroxylapatite; Coaptite; Stress urinary incontinence; Urinary quality of life