Urethral injection therapy for urinary incontinence in women

摘要: Background Urinary incontinence imposes a significant health and economic burden to society. Periurethral or transurethral injection of bulking agents is minimally invasive surgical procedure used as one the treatments stress urinary (SUI) in adult women. Objectives To assess effects periurethral therapy on cure improvement women. Search methods We searched Cochrane Incontinence Group Specialised Trials Register (searched 8 November 2010) reference lists relevant articles. Selection criteria All randomised quasi-randomised controlled trials treatment for which at least management arm involved therapy. Data collection analysis Two review authors independently assessed methodological quality each study using explicit criteria. Data extraction was undertaken clarification concerning possible unreported data sought directly from investigators. Main results Excluding duplicate reports, we identified 14 (excluding that subsequently withdrawn publication not included this analysis) including 2004 women met inclusion The limited available were suitable meta-analysis because they all came separate trials. small generally moderate quality. One trial 45 compared with conservative showed early benefit injectable respect continence grade (risk ratio (RR) 0.70, 95% confidence interval (CI) 0.52 0.94) life (mean difference (MD) 0.54, CI 0.16 0.92). Another trial, comparing Injection autologous fat placebo, terminated safety concerns. Two found significantly better objective group (RR 4.77, 1.96 11.64; RR 1.69, 1.02 2.79), although latter did reach statistical significance if an intention-to-treat analysis used. Eight different results had wide intervals. Silicone particles, calcium hydroxylapatite, ethylene vinyl alcohol, carbon spheres dextranomer hyaluronic acid combination gave improvements shown be more less efficacious than collagen. Dextranomer compound treated patients appeared have higher rates site complications (16% versus none collagen; 37.78, 2.34 610.12) product has now been market. A comparison methods similar outcomes but (though statistically significant) rate group. One 30 weak (but clinically advantage patient satisfaction (data RevMan) after mid-urethral bladder neck no demonstrable levels. Authors' conclusions The evidence base remains insufficient guide practice. In addition, finding placebo saline followed by symptomatic agent raises questions about mechanism any beneficial effects. silicone particles pelvic floor muscle training suggestive three months it known sustained, associated high levels postoperative retention dysuria. Greater observed treatments, though advantages need set against likely risks. No clear-cut conclusions could drawn alternative agents, local side longer commercially indication. There show superiority injection. single provides reminder injections can occasionally cause serious Also, Brief Economic Commentary (BEC) studies suggesting urethral might cost-effective retropubic slings, transobturator traditional sling when initial without hypermobility follow-up surgery failure provided kept minimal. However, SUI up period (15 post-surgery).