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Urinary Incontinence
was found that 90.6% of women had an objective cure and 9.4% were injected at the level of the bladder neck using either a urethral or peri-
improved with a minimum follow-up of one year. There were no intra- urethral approach. Overall success rates tend to be lower with injectable
operative complications, one case of complete retention – which resolved agents than with other procedures. A prospective multicentre trial of
after four weeks – and five cases of voiding difficulties. There were two cases Macroplastique has reported success rates of 75% at three months,
43
of de novo detrusor overactivity. There were no cases of tape erosion. A although other trials have reported cure and improvement rates of
larger comparative study with TVT has now also been reported.
42
Sixty-one 60%.
44
Results are similar for collagen, although again there is a fall in
women with urodynamic stress urinary incontinence were randomly efficacy with time: 90% at one month, 75% at three months and 48%
allocated to either TVT or TOT. At one year, success rates (83.9 and 90%, at two years.
45
Injectable agents, although having lower efficacy than
respectively), improvement rates (9.7 and 3.3%, respectively) and failure other procedures, represent an alternative minimally invasive approach
rates (6.5 and 6.7%, respectively) were no different between the two and may be particularly suited to those who have recurrent urodynamic
groups. There was no difference in frequency of voiding difficulties although stress incontinence following previous surgery.
there were more bladder injuries in the TVT group (0 versus 9.7%). While
the data from these papers are reassuring, they have relatively few patients Conclusion
with only short-term follow-up. More trials need to be performed with Stress incontinence is a common distressing condition that significantly
larger numbers and longer follow-up before we can really compare the role impairs the QoL of affected women. The initial line of treatment should
of a retropubic approach with that of a transobturator approach. be conservative, with lifestyle advice and pelvic floor muscle training.
Medical management is a relatively new approach in the treatment of
Injectables stress incontinence and should be considered where there are no
A number of injectables have been used for the treatment of stress contraindications to the use of duloxetine. Surgery, however, remains the
incontinence in women, including collagen, Macroplastique (Uroplasty), mainstay of treatment in women with severe stress incontinence or in
Zuidex (Q-Med), autologous fat and Teflon. These bulking agents are those who fail to improve with conservative measures. ■
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76 EUROPEAN GENITO-URINARY DISEASE 2007
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