SCOTTSDALE, AZ USA (UroToday.com) - Dr. Roger Dmochowski presented “Current status of urethral bulking for stress urinary incontinence." He specifically reviewed bulking agents for female stress urinary incontinence. The transurethral injection approach remains far more common than the periurethral approach. Collagen durability was reviewed. In one study dry rates at one year were 72%, but trended down to 45% at 3 years.
In discussing Coaptite® he stressed that Coaptite® is radiopaque as many calls from radiology for urethral stones or calcified urethral diverticulum occur after injections. Durasphere® has the limitation that the larger beads require a larger needle which can result in patient pain during injection, but there was no inferiority between agents for improvement in stress urinary incontinence. There is a paucity of data regarding the new Durasphere® formulation of smaller bead size to address this issue.
For all agents he recommended multiple smaller volume injections rather than single large volume injections to reduce the risk of urethral mucosa prolapse. He noted the increasing use of injectable agents after failed midurethral slings.
Lastly, he discussed autologous myocyte injections, which are harvested from the thigh and injected transurethrally. Clinical trials are underway to assess this new treatment modality.
In summary, he feels that injectable therapy can be considered as first line therapy in patients with multiple comorbidities excluding them from other procedures, rigid urethra, mixed urinary incontinence, and salvage after midurethral sling.
Presented by Roger R. Dmochowski, MD at the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) Winter Meeting - February 24 - 28, 2015 - JW Marriott Camelback Inn Resort & Spa - Scottsdale, AZ USA
Vanderbilt University Medical Center, Nashville, TN USA
Reported for UroToday by Drew Freilich, MD. Dr. Freilich is a graduate of the University of Massachusetts Medical School and completed his urology residency at New York Medical College/Westchester Medical Center. He is currently a fellow in Female Urology, Neurourology and Reconstructive Urology at Medical University of South Carolina. He has authored more than 40 peer-reviewed articles, monographs, abstracts, and book chapters and abstracts. Dr. Freilich is a member of the American Urological Association and the Society for Urodynamics and Female Urology.