An ultra-miniinvasive treatment for stress urinary incontinence in complicated older patients

Objective: To evaluate use of bulking agents (polydimethylsiloxane) as an alternative treatment of female stress urinary incontinence (SUI) in older patients. Study design: Prospective cohort study. Main outcome measures: Women with age >75 years old, affected by stress urinary incontinence, presenting to our institution between January 2005 and January 2008 were considered for eligibility in this prospective study. All patients were submitted to transurethral implantation using Macroplastique Implantation System (MIS) (Uroplasty, Minneapolis, Minnesota). Cure of SUI was defined as the resolution of SUI symptoms. Objective cure rate was assessed by urogynecological physical examination and urodynamic assessment performed at 6 and 12 months after surgery respectively. Subjective cure rate was assessed during the interview of the 12th month with a visual analogue scale (VAS) for quantification of SUI severity and a standardized question about the repeatability of the procedure. Results: A total of 27 consecutive patients were enrolled in this study. After 12 months of surgery the objective cure rate was 44% (12 of 27 patients), the improvement rate was 33% (9 of 27) and the failure rate was 22% (6 of 27). The overall success rate was 77% (12 patients cured and 9 improved). 23 (85%) patients would like to repeat this surgical procedure if necessary. Conclusion: Transurethral implantation of bulking agents should be considered as alternative treatment of SUI in complicated older patients. (C) 2009 Elsevier Ireland Ltd. All rights reserved.