Nonabsorbable urethral bulking agent - clinical effectiveness and late complications rates in the treatment of recurrent stress urinary incontinence after 2 years of follow-up.
OBJECTIVE
Those patients who failed to achieve continence after a procedure aimed to correct it, require a special attitude and precise management due to the sophisticated anatomical and functional field of interest. The purpose of the present study was to assess long-term clinical efficacy and evaluate the frequency and severity of any complications related to recurrent stress urinary incontinence treatment with a non-absorbable bulking agent periurethral injections.


METHODS
Between February 2012-September 2013, 66 patients with recurrent stress urinary incontinence were treated with Urolastic in the tertiary referral gynecologic department. The efficacy of the procedure was assessed objectively at each follow-up visit, scheduled at two, six weeks and 3, 6, 12 and 24 months after primary procedure. Material was injected under local anesthesia according to the manufacturer's instructions, at 10, 2, 4 and 8 o'clock positions with 0.5-1.25ccm per spot. Statistical analyses were performed with Statistica package version 8.0 (StatSoft Inc., Tulsa, OK, USA). A p value <0.05 was considered statistically significant.


RESULTS
Objective success rate at 24 months was found in 32.7% of patients, including 22.4% patients who were completely dry. The efficacy of Urolastic, when considering the intention to treat, is 24.2% and 16.7%, respectively. In 4.5% patients an oval shaped material was found inside the bladder. Overall, complications were observed in 17 (25.8%) patients.


CONCLUSIONS
Although only 30% of patients will benefit from Urolastic injection on the long-term basis it seems to be a safe procedure in the treatment of recurrent stress urinary incontinence.
2nd Department of Gynecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland. Electronic address: futymakonrad@mp.pl.
Konrad
K
Futyma
2nd Department of Gynecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland.
Łukasz
Ł
Nowakowski
2nd Department of Gynecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland.
Krzysztof
K
Gałczyński
2nd Department of Gynecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland.
Paweł
P
Miotła
2nd Department of Gynecology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland.
Tomasz
T
Rechberger
D000368:Aged; D003131:Combined Modality Therapy / Q000009:adverse effects; D004129:Dimethylpolysiloxanes / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004343:Drug Implants; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057194:Intention to Treat Analysis; D059012:Lost to Follow-Up; D008875:Middle Aged; D009775:Obstetrics and Gynecology Department, Hospital; D010298:Parity; D011044:Poland / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D012306:Risk; D055502:Secondary Prevention; D012720:Severity of Illness Index; D053825:Suburethral Slings / Q000009:adverse effects; D062606:Tertiary Care Centers; D014025:Titanium / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D014521:Urethra / Q000187:drug effects* / Q000503:physiopathology; D014550:Urinary Incontinence, Stress / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery; D064804:Urological Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
D004129:Dimethylpolysiloxanes; D004343:Drug Implants; D064804:Urological Agents; C000620953:urolastic; D014025:Titanium
Bulking agent; Midurethral sling; Minimally invasive procedure; Periurethral injections; Stress urinary incontinence