Clinical effectiveness of bulking agent hyaluronic acid/dextranomer (Urodex)

Aims of study. The treatment of stress urinary incontinence (UI) traditionally include conservative and surgical methods. Conservative methods are relatively long and often uncomfortable for patients. At present a sling urethropexy is more preferable surgical method. Surgical treatment is successful but not in all cases UI. This method is limited by some factors: some synthetic material, a transient urinary, a bleeding, formation of hematomas, a bladder perforation risk, wound infection and high cost.

The bulking agent hyaluronic acid/dextranomer (NASHA/dx) is used for periurethral injection It consists of positively charged particles of a polysaccharide and 100% cleared hyaluronic acid. NASHA/dx promotes synthesis of own collagenic fibres in place of introduction. Improvement of methods of treatment of stress UI at women periurethral injection of bulking agent NASHA/dx.

Methods. In prospective research have been included 49 women with low- and medium-grade stress UI. Age of patients was 33–75 (54.3±2.9) years. All patients have been surveyed: diaries of urinations, the general analysis of urine, pelvic examination, tussive-, Valsalva's-, Pad- tests, the King's questionnaire about health, questionnaires PGI-S and PGI-I, three-dimensional ultrasound of urinoexcretory ways and measurement of volume of residual urine. Patients have been divided into 2 groups depending on UI type: 34 (69%) women with stress UI and 15 (31%) with the mixed UI with prevalence of the stress component. At the mixed UI group woman received M-holinoblockers for correction of an urgent component. Patients used a cream Estriol locally 2 weeks prior to introduction NASHA/dx

Introduction NASHA/dx was aseptic in small operational using local or intravenous anestesia. A bladder was empted with a catheter and length of an urethra was measured. The Ljuer's applikator used as a conductor for introduction of needles in the submucous layer of a middle third of urethra. It was performed in 4 positions.

Results: General efficiency depending on numbers of episodes of UI after 1 month in both groups remained high enough: in 1 group –91.2%, in 2 group –90.3%, after 3 month efficiency has drop by 10%, and after 12 month drop by 30% in both groups. Indicators of the cushioning test after treatment in both groups of patients showed the reduction of urine loss: in 1 group (from 6.83 to 3.63) and in 2 group (from 7.6 to 3.8) (p<0.05).

Statistically significant decrease in numbers of episodes of urine loss from 2.3±1.85 to 0.45±0.02 in 1 group (p=0.05) and from 1.93±0.52 to 1.14±0.23 in 2 group (p=0.05) is revealed.

After 1 month in paraurethral area the NASHA/dx volume was 2.5±0.7 sm3, after 3 months 1.9±0.5 sm3 and after 12 months 1.3±0.7 sm3. At first there was 4ml. It is caused by feature NASHA/dx. It breaks up to water and carbonic acid. There were not complications.

Conclusion. The research has shown that patients with the stress and mixed UI after periurethral injection of bulking agent (NASHA/dx) have similar treatment results. This method of treatment stress UI with low- and medium-grade is highly effective, the most simple and convenient in performance. Besides, its performance in out-patient conditions under local anesthesia is possible. Results of this research show that the careful differentiated selection of patients is necessary for achievement of the maximum effect from administered therapy.