Introduction and hypothesis Stress urinary incontinence (SUI) is common, impacts women's quality of life, and generates high costs. Physiotherapy is the first-line therapy, and if it fails, suburethral slings are the gold standard in SUI surgery. Bulking agents injected periurethrally might be a beneficial alternative, but there is a paucity of data on bulking therapy. The aim of this study was to prospectively analyze the efficacy and safety of bulking agents in the setting of a tertiary referral center. Methods In the last 13 years, 514 elderly women with SUI were treated by injection therapy with either collagen (Contigen®), hyaluronic acid (Zuidex®), ethylene vinyl alcohol (Tegress®), or polyacrylamide hydrogel (Bulkamid®). Subjective and objective outcome was recorded at the 12-month postoperative appointment using the King's Health Questionnaire, visual analogue scale (VAS) describing their incontinence severity, standardized pad test, and urethral pressure profile.Results Demographic data were equally distributed in all four groups of agents used. Sixty-one patients were lost to follow-up (10.6 %). Statistically significant changes were found for maximum urethral closure pressure (MUCP), pad weight, and VAS before and after bulking for the four agents used. Pad test was negative in 73.2 % of patients after bulking therapy. Subjective assessment showed improvements in general health and role limitations. The overall complication rate was low for all agents. Conclusions This study shows improvement in incontinence after bulking therapy according to subjective and objective outcomes in an elderly population. In contrast to earlier reports, side effects due to injections were few and mild. We can advocate bulking therapy for treating SUI, as it is simple, safe, and shows both objective and subjective improvement and relief.
Three hundred randomly selected nurses employed at the university hospital of Berne were asked by means of a questionnaire as to the application of complementary methods (CM) in patients of this hospital. 75% of the questionnaires were completed. 95% of the nursing staff indicated that they had recommended or applied CM's. The most frequently used methods being compresses, aroma therapy and homoeopathy. The members of the nursing staff, who use CM are ecology-minded, have had higher education and are nutrition conscious. CM training was found in 21%. The application of CM is usually suggested by members of the nursing staff, less frequently by the patients and rarely by physicians. One quarter of the nursing staff consults a physician before applying CM. Motivations for the application of CM are often based on the experiences of others and experiences from one's own childhood. Homoeopathy is the most prevalent method. CM is regarded to be integral, supplementary and conducive for the integration of orthodox medicine and psyche. In arrangement with the nursing staff direction we do not critically discuss our observations in this paper.
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