Macroplastique for women with stress urinary incontinence secondary to intrinsic sphincter deficiency.

OBJECTIVE: To evaluate the subjective and objective outcomes of MacroplastiqueR (MPQ) in women with stress urinary incontinence (SUI) secondary to intrinsic sphincter deficiency (ISD). MATERIALS AND METHODS: Following Institutional Review Board (IRB) approval, charts of non-neurogenic women with SUI secondary to ISD who underwent MPQ injection and had 6 months minimum follow-up were reviewed from a prospectively maintained database. Patients were divided into 3 groups: Naive (Group I), Prior Anti-Incontinence Surgery (Group II), and combined Prior Bulking Agent and Anti-Incontinence Surgery (Group III). Data collected included SUI self-report, Urogenital Distress Inventory (UDI-6) Question 3, and VAS Quality of Life (QoL) Questionnaire scores at baseline and in follow-up. Three-dimensional ultrasound (3DUS) evaluated volume/confi guration of MPQ. Success was defi ned after the last MPQ injection as a UDI-6 Question 3 score of 0 (dry) or 1, and no reoperation for SUI. RESULTS: From 2011-2017, 106 of 142 women met study criteria. At a median follow-up of 20 months (mean=26 months; range: 6-71), success rate was 41% for Group I, 40% for Group II, and 65% for Group III (p = 0.22). QoL scores were signifi cantly improved over baseline in all groups. There was no signifi cant difference in clinical outcome between the asymmetrical and symmetrical group on 3DUS. The completely dry rate was highest in Group III at 29%, compared to 4% for Group I and 15% for Group II (p = 0.05). CONCLUSION: MacroplastiqueR improved subjective and objective outcome measures for SUI secondary to ISD as both a primary and secondary treatment option in women.

Endopelvic free anchor minisling technique for stress urinary incontinence treatment: 10 years of experience.

INTRODUCTION AND HYPOTHESIS: We present our 10-year experience in treating stress urinary incontinence (SUI) using a new minisling technique based on a tension-free vaginal tape band designed by our group. The major advantage of this tape is the use of minibelt polypropylene inserted through a single retropubic incision without the use of needles-the Endopelvic Free Anchor (EFA)-based on its location at the midurethra with a U shape. For insertion, each branch is placed using a simple Pean clamp from the vagina with perforation of the endopelvic fascia to achieve a retropubic insertion. METHODS: From May 2001 to May 2011, we surgically treated 166 women with primary first- or second-degree SUI due to urethral hypermobility without genital prolapse. All were evaluated according to our study protocol, which included clinical and urodynamic evaluation before and 12 months after surgery. RESULTS: With a median follow-up of 5 (1-11) years, 152 patients (91.6 %) were fully cured both from urodynamic and subjective points of view. Six patients (3.6 %) had significant improvement, and eight (4.8 %) were identified as technique failure. Complications included one bladder perforation (0.6 %), two cases of postoperative urinary retention (1.24 %), two of retropubic hematoma (1.24 %), and one of de novo urgency (0.6 %). No reinterventions were necessary, and there were no major bleeding complications, no chronic pain or de novo dyspareunia, and no voiding difficulty. CONCLUSIONS: EFA is a viable, safe, and effective technique for treating UI due to urethral hypermobility.

Use of autologous platelet rich fibrin in urethracutaneous fistula repair: preliminary report.

Urethrocutaneous fistula (UCF) is one of the most common complications occurring after hypospadias repair. Despite the surgical advancement in hypospadias, multiple failed fistula closures are commonly referred to paediatric urologists. Although several techniques have been described to interpose a waterproof layer between urethral and skin closures, occurrence of urethrocutaneous fistula cannot be eliminated completely. In addition to several local tissue grafts, autologous and homologous fibrin sealants are used to prevent UCF. Platelet rich fibrin (PRF) is known as an autologous source of growth factors obtained from the sera of the patient. PRF supports collagen synthesis and tissue repair and accelerates wound healing. We aimed to present our initial experience about the use of autologous PRF in a 3-year-old boy with a UCF after hypospadias repair.

Pubovaginal sling using polypropylene mesh and Vesica bone anchors.

OBJECTIVES: To report preliminary results from a modified pubovaginal sling procedure using polypropylene mesh as the sling suspended by nonabsorbable sutures anchored to the pubic tubercle with Vesica bone anchors. METHODS: Thirty-five women with type III stress urinary incontinence (SUI) (with or without associated urethral hypermobility) or type II SUI with additional risk factors such as obesity, chronic obstructive pulmonary disease, or failed prior incontinence-correcting procedures underwent this modified pubovaginal sling procedure. Postoperative voiding status was evaluated during office follow-up visits and telephone surveys. RESULTS: With a mean follow-up of 8.4 months (range 2 to 18), 32 women (91.4%) were dry, 1 improved, and 2 remained incontinent. The pubovaginal sling procedure was the only operation performed in 46% of patients, with a mean operative time of 72 minutes, a mean estimated blood loss of 137 mL, and a mean hospital period of 2.3 days. Patients on whom concomitant gynecologic procedures were performed had a mean duration of surgery of 122 minutes, a mean estimated blood loss of 202 mL, and a mean hospitalization period of 2.9 days. Thirteen women had preoperative urgency that persisted in 31% of patients. De novo urgency developed in 3 patients. Seven women required prolonged suprapubic tube drainage but no patient remained in permanent retention. There has been no infection or erosion. CONCLUSIONS: Our experience with this modified pubovaginal sling procedure using polypropylene mesh and Vesica bone anchors showed excellent results with greater technical ease, minimal morbidity, and decreased hospitalization period when compared to a traditional pubovaginal sling performed in our hands. Additional follow-up will be needed to assess long-term efficacy.

Macroplastique for women with stress urinary incontinence secondary to intrinsic sphincter deficiency

ABSTRACT Objective To evaluate the subjective and objective outcomes of Macroplastique® (MPQ) in women with stress urinary incontinence (SUI) secondary to intrinsic sphincter deficiency (ISD). Materials and Methods Following Institutional Review Board (IRB) approval, charts of non-neurogenic women with SUI secondary to ISD who underwent MPQ injection and had 6 months minimum follow-up were reviewed from a prospectively maintained database. Patients were divided into 3 groups: Naïve (Group I), Prior Anti-Incontinence Surgery (Group II), and combined Prior Bulking Agent and Anti-Incontinence Surgery (Group III). Data collected included SUI self-report, Urogenital Distress Inventory (UDI-6) Question 3, and VAS Quality of Life (QoL) Questionnaire scores at baseline and in follow-up. Three-dimensional ultrasound (3DUS) evaluated volume/configuration of MPQ. Success was defined after the last MPQ injection as a UDI-6 Question 3 score of 0 (dry) or 1, and no reoperation for SUI. Results From 2011-2017, 106 of 142 women met study criteria. At a median follow-up of 20 months (mean=26 months; range: 6-71), success rate was 41% for Group I, 40% for Group II, and 65% for Group III (p = 0.22). QoL scores were significantly improved over baseline in all groups. There was no significant difference in clinical outcome between the asymmetrical and symmetrical group on 3DUS. The completely dry rate was highest in Group III at 29%, compared to 4% for Group I and 15% for Group II (p = 0.05). Conclusion Macroplastique® improved subjective and objective outcome measures for SUI secondary to ISD as both a primary and secondary treatment option in women.

Transurethral implantation of macroplastique for the treatment of female stress urinary incontinence secondary to urethral sphincter deficiency.

OBJECTIVE: To assess the results of transurethral implantation of Macroplastique in women with stress incontinence secondary to urethral sphincter deficiency using subjective and objective outcome measures. METHODS: A total of 60 women with genuine stress incontinence secondary to intrinsic urethral sphincter deficiency were treated with transurethral implantation of Macroplastique. The patients had undergone a mean of 1.9 (range 0-7) previous episodes of continence surgery. Up to three treatment episodes were used, if necessary. The outcome was assessed by telephone interview (56 patients, mean follow-up period 19 months) and videocystometry (41 patients, mean follow-up period 16 months). Transurethral ultrasound scanning was performed in a further 9 patients. RESULTS: Symptomatically, 19.6% of the women interviewed by telephone considered themselves cured of their incontinence or were no longer using pads. A further 41.1% said their symptoms had significantly improved. Pad usage was reduced from a median of five to three pads per day (p < 0.001). Videocystometry in 41 women (mean follow-up period 16 months) was normal in 16 patients (39%) and showed genuine stress incontinence in 18 (43.9%) and detrusor instability in 12 patients (29.3%). Overall, 71.4% stated that they would undergo the procedure again under the same circumstances, and 80.4% would recommend this form of treatment to a friend with the same condition. Transurethral ultrasound scanning was performed in 9 patients (5 subjectively improved or cured, 1 patient with persistent symptoms but normal cystometry, and 3 patients with persistent genuine stress incontinence). Hyperechoic foci were seen surrounding the proximal urethra, consistent with implanted Macroplastique boluses. When completely encircling the urethra, the outcome was generally good. A total of 10 patients have undergone or are awaiting open surgery, and 3 are awaiting repeat implantation. CONCLUSION: Sustained improvement or cure of genuine stress incontinence has been achieved using Macroplastique in a large proportion of women with intrinsic sphincter deficiency, often following previous unsuccessful continence surgery. Transurethral ultrasound may prove to be a clinically useful imaging technique for the assessment and subsequent management of treatment failure following Macroplastique implantation.

Endoscopic silicone injection for female stress urinary incontinence due to intrinsic sphincter deficiency: impact of coexisting urethral mobility on treatment outcome.

OBJECTIVES: To evaluate periurethral silicone injection in the treatment of female stress urinary incontinence due to intrinsic sphincter deficiency (ISD) and assess whether coexisting urethral hypermobility has an impact on treatment outcome. METHODS: A total of 29 female patients with stress urinary incontinence underwent endoscopic periurethral silicone injection. Using abdominal leak point pressure measurement, ISD was shown preoperatively in all cases. In addition, urethral hypermobility was demonstrated in 14 cases by cotton-swab testing. Treatment outcome was assessed at 3 and 24 months by questionnaire and classified as cure, improvement, or failure. RESULTS: The morbidity of the procedure was minimal. The median follow-up was 29 months (range 24 to 36). For the entire group, the cure rate was 55% and 45% at 3 and 24 months, respectively. Depending on the existence of urethral hypermobility, the treatment outcome differed significantly. At 3 months, cure was achieved in 73% of the patients with pure ISD and in 36% with urethral hypermobility (P = 0.04). At 24 months, 67% with pure ISD remained continent, but only 21% with urethral hypermobility (P = 0.02). CONCLUSIONS: In our experience, periurethral silicone injection was a safe treatment for female stress urinary incontinence and provided a moderately successful and durable therapeutic effect in those with sphincter deficiency and good anatomic support. Unsatisfactory results in those with both anatomic incontinence and sphincter deficiency highlight the need for careful preoperative assessment of urethral mobility to exclude such patients from injection therapy.