[The injectables in urogynecology]. / L'utilizzo di iniezioni periuretrali in uroginecologia.

The purpose of this review is to summarize the results of reports of injectable agents for the treatment of female urinary stress incontinence. The real indication for injectables is intrinsic shincter deficiency (ISD) but urethral hypermobility is not a controindication. Six agents were reviewed: Teflon, autologous fat, collagen, silicone microparticles, silicone microballoons and pyrolytic carbon. Collagen was the most frequently reported agent and yielded 1 year cure/ improvement rate of 60-80%, but results de-creased significantly with longer term follow-up. Teflon has been used longer for the treatment of stress incontinence but both low long and short-term success rate and the reported complications such as particles migration have resulted in its lack of widespread acceptance. Autologous fat has been suggested as the natural injectable but yielded disappointing success rate. Injection of silicone microparticles was associated with a long-term success rate of about 70% in patients with ISD. Moreover, it is now injected without urethroscopy and this makes the procedure easier. Silicone microballoons and pyrolytic carbon have been recently introduced into clinical practice with a short-term success rate of about 70%. However, longer follow-up is needed. In conclusion, long-term durability, cost effectiveness and some safety issues still have to be addressed by further clinical trials.

Injection therapy for the treatment of stress urinary incontinence in women.

The purpose of this review is to summarize the results of reports on injectable agents in the treatment of female stress urinary incontinence. Six agents were reviewed: Teflon; autologous fat; collagen; silicone microparticles; silicone microballoons, and pyrolytic carbon. Collagen was the most frequently reported agent and yielded a 1-year cure/improvement rate of 60-80%, but results worsened significantly with longer follow-up. Teflon has been used longer in the treatment of stress incontinence, but low long- and short-term success rates and reported complications such as particle migration have prevented its widespread acceptance. Autologous fat has been suggested as a natural injectable but its success rate has been disappointing. The injection of silicone microparticles is associated with a long-term success rate of about 70% in patients with intrinsic sphincter deficiency, and it can now be injected more easily without the need of urethroscopy. Silicone microballoons and pyrolytic carbon has recently been introduced into clinical practice with a short-term success rate of about 70%, but longer follow- up is needed. In conclusion, the long-term durability, cost-effectiveness, and some safety issues still have to be addressed by further clinical trials.

[Multicenter study on the effectiveness of Tension Vaginal Tape (TVT) in the treatment of stress urinary incontinence]. / Studio multicentrico sull'efficacia del Tension Free Vaginal Tape (TVT) nella terapia della incontinenza urinaria da sforzo.

BACKGROUND: The aim of the study was to evaluate the efficacy of Tension Free Vaginal Tape (TVT) for the surgical treatment of stress urinary incontinence. METHODS: The design was an open multicenter study including six Italian hospitals. Between January 1998 and November 1999, 429 stress incontinent women were enrolled in the study. Before surgery subjects had been studied through their history, urine culture, physical examination, cotton swab test, cough provocation test and urodynamic evaluation including: uroflowmetry, water cystometry and urethral profilometry. Incontinence inconvenience has been quantified through a 10-grade visual analogue scale (VAS). Postoperatively patients were assessed after 6, 12 and 24 months. RESULTS: The mean age of the patients considered was 57 years (range 31-83) and 78 of them had undergone a previous operation for the treatment of stress urinary incontinence or genital prolapse. Out of the 429 patients, 371 were followed for a minimum of 6 months, 11 were lost to follow-up and 47 had been operated recently. After surgery 355 subjects (96%) were subjectively cured and no leakage of urine was observed in 97% of the patients during the postoperative cough provocation test. CONCLUSIONS: This study carried out on a great number of patients demonstrates that TVT is a safe and effective procedure for the treatment of stress urinary incontinence.