New Insights in the Treatment of Urinary Incontinence: The Luksenburg System

Abstract

Introduction: Urinary incontinence (UI) is an important clinical problem which affects millions of women worldwide. We describe the Luksenburg system, a minimally invasive procedure for the treatment of UI in women, using platelet-rich plasma (PRP) injections and polycaprolactone (PCL) threads. Material & Methods: A total of 302 patients with UI, mean age 52, were evaluated with detailed history, examination, urinary diary, complete laboratory tests, ultrasonography, urodynamic studies, and completion of International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF). Under local anesthesia, PRP was injected through the anterior vaginal wall, and PCL threads were placed in paraurethral, suburethral, and lateral urethrovaginal spaces, using instruments developed for safe and effective performance. Patients were analyzed at 1, 2, 4, 8 weeks and 6 months posttreatment. Twenty patients were biopsied preoperatively and 60 days after treatment. Results: Symptoms, ICIQ-UI SF score, and postoperative urodynamic studies were significantly improved in 95% of patients with UI grade I, 92% of patients with UI grade II, and in 30% of UI grade III. Biopsies after treatment showed a dense connective tissue 3-dimensional mesh. No complications or adverse effects were observed. All patients declared satisfaction with results, will have the procedure again, and will recommend it. Discussion: The Luksenburg system results in strengthening of the paraurethral, suburethral, and lateral urethrovaginal spaces and the mucosa of the anterior vaginal wall. The combination of PRP injections and the placement of PCL threads create a fibrotic and absorbable mesh-like structure, aimed to increase the urethral resistance, so that under effort the intravesical pressure does not overcome the urethral pressure. Conclusions: These results support that the Luksenburg system is safe and a cost-effective alternative in patients with all grades of UI, reducing the need for invasive surgical procedures.