Bulking Agent Injections Effective for Incontinence Salvage Therapy

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GLASGOW—Periurethral injections of polyacrylamid hydrogel (PAHG), a new bulking agent, are a safe and effective option as a salvage therapy for women with severe stress urinary incontinence (SUI) after failed previous surgical management, data show.

Based on a prospective study of 50 such women who had a low maximum urethral closure pressure and a fixed urethra, researchers reported a 66% overall success rate with the PAHG treatment.

To test the therapy, an experienced surgeon injected 1 mL of PAHG into the urethral submucusa 1 cm distal to the vesicourethral junction at 3, 6, and 9 o'clock. Patients received the treatment under local anesthesia on an outpatient basis. The operating time was 10 minutes, with minimal blood loss. A second procedure was performed on patients not satisfied with the result at the first evaluation at one month. Seventeen patients (34%) had two procedures. Subjects had a median post-operative follow-up of 19 months.

At the last follow-up, 17 patients (34%) were cured, 16 patients (32%) had improved, and 17 (34%) did not improve, Jean-Nicolas Cornu, MD, and colleagues at Tenon Hospital in Paris, reported at the International Continence Society annual meeting.

Patients were considered cured if they required no pads, had no stress-related leakage, and had a Patient Global Impression of Improvement score of 1 or 2. They were considered improved if their pad usage and reported leakage episodes were decreased by more than 50%.

All patients presenting with OAB symptoms prior to treatment were still experiencing urgency during follow-up; this was managed with anticholinergics. Four patients developed urinary tract infections, which were treated with antibiotics.

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