Volume-forming substances for treatment of stress urinary incontinence in women

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.