Urethral Bulking Agents in the Treatment of Stress Urinary Incontinence
Abstract: Aim. The article presents information on modern urethral bulking agents used in the treatment of female stress urinary incontinence (SUI).Materials and methods. The authors reviewed the current scientifi c literature on the topic (original articles, monographs, meta-analyses), whose relevance lies in the increasing interest of both clinicians and patients in the minimally invasive treatment of SUI.Results. On the basis of available information on the use of urethral bulking agents, regulatory bodies prohibited… Show more
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Minimally invasive correction of stress urinary incontinence in women with pelvic floor dysfunction
BACKGROUND: Pelvic floor dysfunction is widespread among young women. Stress urinary incontinence is a common manifestation of the dysfunction and, even in mild forms, affects the quality of life of patients. Much attention is focused on finding and improving minimally invasive methods for treating stress urinary incontinence in women of reproductive and perimenopausal age to prevent disease progression and improve quality of life. AIM: The aim of this study was to evaluate the immediate and long-term results of paraurethral injections of a high-density hyaluronic biopolymer for the correction of stress urinary incontinence in women of reproductive and perimenopausal age. MATERIALS AND METHODS: We examined 37 patients aged 44.6 ± 4.7 years with mild to moderate stress urinary incontinence combined with grade I to II genital prolapse. After general clinical and special studies (urination diaries, King’s and Pelvic Organ Prolapse / Urinary Incontinence Sexual Questionnaire, cough test, complex urodynamic study, ultrasound examination of the urethrovesical junction and pelvic floor ultrasound with compression elastography), paraurethral injection of 4.0 ml of the high-density hyaluronic biopolymer crosslinked with 1,4-butanediol diglycidyl ether was performed. The effectiveness of therapy was evaluated 1, 6 and 12 months after the procedure. RESULTS: A negative cough test was detected after one, six and 12 months of follow-up in 96.9, 73.1 and 43.8 % of women, respectively; the absence of stress urinary incontinence episodes according to urination diaries was in 85.7, 61.3 and 35.0 % of patients, respectively. Gradual resorption of the drug was monitored over 12 months of observation. An ultrasound examination showed a decrease in urethral mobility one month after the procedure. According to the results of elastography before treatment, the average value of the strain ratio of paraurethral tissues was 0.50 (0.30–0.69) (p 0.001), after one and six months — 0.88 (0.76–1.03) and 0.79 (0.66–1.07) (p 0.001 and p = 0.005 respectively). Thus, the stiffness of the paraurethral tissues of the proximal posterior wall of the urethra increased within six months after the procedure. When observing women after 12 months, the stiffness values of the studied tissues decreased and approached the values before treatment. During the entire observation period, the patients noted a decrease in the degree of discomfort due to problems with urination according to the questionnaires. CONCLUSIONS: The introduction of the high-density hyaluronic biopolymer helps to increase the stiffness of paraurethral tissues and improve the structural support of the urethra in patients with stress urinary incontinence. After the procedure, a 12-month follow-up revealed a decrease or absence of stress urinary incontinence episodes according to urination diaries and the preservation of the positive effect of treatment according to the results of the cough test. A gradual decrease in the effect of therapy is associated with biodegradation of the drug. This method of treating mild forms of stress urinary incontinence is effective for women of reproductive and perimenopausal age who do not plan surgical treatment, are interested in achieving a quick result of therapy and are informed that the effect decreases over time after the procedure.
Minimally invasive correction of stress urinary incontinence in women with pelvic floor dysfunction
BACKGROUND: Pelvic floor dysfunction is widespread among young women. Stress urinary incontinence is a common manifestation of the dysfunction and, even in mild forms, affects the quality of life of patients. Much attention is focused on finding and improving minimally invasive methods for treating stress urinary incontinence in women of reproductive and perimenopausal age to prevent disease progression and improve quality of life. AIM: The aim of this study was to evaluate the immediate and long-term results of paraurethral injections of a high-density hyaluronic biopolymer for the correction of stress urinary incontinence in women of reproductive and perimenopausal age. MATERIALS AND METHODS: We examined 37 patients aged 44.6 ± 4.7 years with mild to moderate stress urinary incontinence combined with grade I to II genital prolapse. After general clinical and special studies (urination diaries, King’s and Pelvic Organ Prolapse / Urinary Incontinence Sexual Questionnaire, cough test, complex urodynamic study, ultrasound examination of the urethrovesical junction and pelvic floor ultrasound with compression elastography), paraurethral injection of 4.0 ml of the high-density hyaluronic biopolymer crosslinked with 1,4-butanediol diglycidyl ether was performed. The effectiveness of therapy was evaluated 1, 6 and 12 months after the procedure. RESULTS: A negative cough test was detected after one, six and 12 months of follow-up in 96.9, 73.1 and 43.8 % of women, respectively; the absence of stress urinary incontinence episodes according to urination diaries was in 85.7, 61.3 and 35.0 % of patients, respectively. Gradual resorption of the drug was monitored over 12 months of observation. An ultrasound examination showed a decrease in urethral mobility one month after the procedure. According to the results of elastography before treatment, the average value of the strain ratio of paraurethral tissues was 0.50 (0.30–0.69) (p 0.001), after one and six months — 0.88 (0.76–1.03) and 0.79 (0.66–1.07) (p 0.001 and p = 0.005 respectively). Thus, the stiffness of the paraurethral tissues of the proximal posterior wall of the urethra increased within six months after the procedure. When observing women after 12 months, the stiffness values of the studied tissues decreased and approached the values before treatment. During the entire observation period, the patients noted a decrease in the degree of discomfort due to problems with urination according to the questionnaires. CONCLUSIONS: The introduction of the high-density hyaluronic biopolymer helps to increase the stiffness of paraurethral tissues and improve the structural support of the urethra in patients with stress urinary incontinence. After the procedure, a 12-month follow-up revealed a decrease or absence of stress urinary incontinence episodes according to urination diaries and the preservation of the positive effect of treatment according to the results of the cough test. A gradual decrease in the effect of therapy is associated with biodegradation of the drug. This method of treating mild forms of stress urinary incontinence is effective for women of reproductive and perimenopausal age who do not plan surgical treatment, are interested in achieving a quick result of therapy and are informed that the effect decreases over time after the procedure.
Differentiated approach to the choice of therapy for stress urinary incontinence in women with pelvic floor dysfunction
BACKGROUND: Among the symptoms of pelvic floor dysfunction, urinary incontinence is common in young patients. Stress urinary incontinence disrupts psychological health, sexual and social life. The effectiveness of modern conservative treatments for mild stress urinary incontinence in women of reproductive and perimenopausal age is being studied to prevent disease progression and improve the quality of life. AIM: The aim of this study was a comparative assessment of the effectiveness of pelvic floor muscle training using the Tyulpan laser vaginal simulator and paraurethral injections of a high-density hyaluronic biopolymer for the correction of stress urinary incontinence in women of reproductive and perimenopausal age with pelvic floor dysfunction. MATERIALS AND METHODS: We examined 82 patients aged 43.35 ± 6.25 years with mild to moderate stress urinary incontinence combined with grade I to II genital prolapse. After general clinical and special studies, including voiding diaries, Urgency Bother Visual Analogue Scale, cough test, ultrasound of the urethrovesical junction and pelvic floor, 41 women were prescribed a course of remote pelvic floor muscle training under medical supervision using the Tyulpan laser vaginal simulator (group I). 41 patients underwent paraurethral injection of 4.0 ml of high-density hyaluronic biopolymer crosslinked with 1,4-butanediol diglycidyl ether (group II). The effectiveness of therapy was evaluated one, six and 12 months after the start of treatment. RESULTS: After one month, the absence of stress urinary incontinence episodes based on voiding diaries was found in 29.4% of patients in group I and in 85.4% of patients in group II (2.9 times more often) (p 0.001); after 12 months, in 73.1% of patients in group I and in 36.4% of patients in group II (half as often) (p = 0.011). After one month, a negative cough test was detected in 65.0% of women in group I and in 92.1% of women in group II (1.4 times more often) (p = 0.023). After six months, the results of treatment for stress urinary incontinence based on the cough test were not different and amounted to 80.0% in group I and 71.9% in group II (p = 0.725). When assessing the pelvic floor muscle strength using the Oxford Scale and perineometry, an increase in strength after one and six months was detected in 100% of patients in group I (p 0.001). Both techniques equally reduced urethral mobility as measured by ultrasound over the one-month follow-up. Pelvic floor muscle training more significantly improved the quality of life of women 12 months after the start of therapy (p 0.05). CONCLUSIONS: The introduction of high-density hyaluronic biopolymer leads to a rapid and pronounced positive result in the treatment of stress urinary incontinence and an improvement in the quality of life in the short term; it is recommended for patients interested in quickly achieving results, informed about the limited duration of the effect. Regular training of the pelvic floor muscles in biofeedback mode under the remote control of a doctor contributes to better results in the long term. This method is recommended for women who are able to contract the pelvic floor muscles and are ready for regular exercise.
The use of hyaluronic acid based bulking agent for stress urinary incontinence in women: A prospective controlled study
Background. Paraurethral injection of bulking agents in women is one of the minimally invasive technologies for the treatment of stress urinary incontinence (SUI). The effectiveness and safety of this method depend on the properties of injected substance. Aim. To evaluate the results of paraurethral injections of 1,4-butanediol diglycidyl ether crosslinked high-density hyaluronic acid (EsteFILL® intim) in the treatment of SUI in women of reproductive and perimenopausal age. Materials and methods. We examined 18 patients aged 45.8±5.0 years with mild SUI in combination with grade I–II genital prolapse. After general clinical and special studies (urination diaries, King and PISQ-12 questionnaires, cough test, complex urodynamic study, urethrovesical segment and pelvic floor ultrasound with compression elastography) paraurethral injection of 4.0 ml EsteFILL® intim drug was performed. The results of therapy were studied 1 and 6 months after the procedure. Results. It was found that the injection of the drug contributed to an increase in the stiffness of paraurethral tissues by 1.5 times within 6 months after injection. According to the results of elastography before treatment, the average value of the strain ratio of paraurethral tissues of the proximal posterior wall of the urethra was 0.66±0.46 (0.42–0.91), after 1 and 6 months – 0.99±0.45 (0.76–1.23) and 1.00±0.36 (0.78–1.22) respectively; p=0.009 and 0.018. The effectiveness of EsteFILL® intim drug in the treatment of mild SUI in women after 1 and 6 months according to the results of a cough test was 88.2 and 71.4%, according to urination diaries – 88.9 and 66.7% respectively. During the entire observation period the patients noted a decrease in the degree of discomfort due to SUI and an improvement in the quality of life. Conclusion. Paraurethral injection of EsteFILL® intim drug helps to increase the stiffness of the urethra supporting structures in patients with SUI. This method of treating SUI is effective for women of reproductive and perimenopausal age with mild severity disease, who do not plan surgical treatment, are interested in achieving a quick result of therapy and are informed that the effect decreases over time after the procedure.
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