Ramirez-Caban Laura, Malekzadeh Maral, Ossin David A, Hurtado Eric A
Department of Gynecology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, 33331, USA.
Department of Urology, University of Texas Health Science San Antonio, 7703 Floyd Curl Drive, Mail Code 7845, San Antonio, TX, 78229-3900, USA.
Int Urogynecol J. 2022 Mar;33(3):681-687. doi: 10.1007/s00192-021-04910-y. Epub 2021 Jul 2.
Manufacturers of Macroplastique® for urethral bulking have not previously reported exposures as potential complications. This study was aimed at identifying presenting symptoms, management, and outcomes in patients experiencing urethral or bladder exposures.
A retrospective case series from 2010 to 2019 was performed in an academic affiliated hospital system. Participants were 18-89 years old and received Macroplastique® urethral bulking for treatment of stress urinary incontinence. Charts were identified through diagnosis and procedure codes relating to injections of urethral bulking agents and foreign bodies in the bladder or urethra. Factors evaluated were patient history and presenting symptoms, diagnostic evaluation, treatment, and outcomes using frequency tables for categorical values and statistical distribution with median and interquartile ranges (IQR) for continuous variables.
After review of 1,269 charts, 580 cases met the inclusion criteria and 14 Macroplastique® urethral exposures were identified. The median age at first presentation was 73.5 years (IQR57.5-79.7 years) with 48 months (IQR 22-78 months) as the median time to first presentation after last Macroplastique® injection. The median number of injection sessions was 2 (IQR 1-2.75 sessions) with a medium volume of 4.5 ml (IQR 2.75-9.0 ml). Presenting symptoms included urge incontinence (64.3%), stress urinary incontinence (57.1%), recurrent urinary tract infection (42.9%), urinary urgency (28.9%), urinary frequency (28.9%), urinary retention (14.3%), and interrupted flow (7.1%). Macroplastique® urethral exposures were extracted in 10 patients using blunt, sharp, or electrocautery excision. No complications after excision were identified and improvement in urinary symptoms was observed.
Urethral bulking with Macroplastique® can lead to symptomatic urethral exposures.
用于尿道填充的Macroplastique®制造商此前未将暴露作为潜在并发症进行报告。本研究旨在确定发生尿道或膀胱暴露的患者的症状表现、治疗方法及治疗结果。
在一家学术附属医院系统中进行了一项2010年至2019年的回顾性病例系列研究。参与者年龄在18至89岁之间，接受Macroplastique®尿道填充治疗压力性尿失禁。通过与尿道填充剂注射以及膀胱或尿道异物相关的诊断和手术编码来识别病历。评估的因素包括患者病史和症状表现、诊断评估、治疗方法以及治疗结果，分类变量使用频率表进行分析，连续变量使用中位数和四分位间距（IQR）进行统计分布分析。
在审查了1269份病历后，580例符合纳入标准，其中发现14例Macroplastique®尿道暴露。首次就诊的中位年龄为73.5岁（IQR 57.5 - 79.7岁），自最后一次注射Macroplastique®至首次就诊的中位时间为48个月（IQR 22 - 78个月）。注射疗程的中位数为2次（IQR 1 - 2.75次），注射量中位数为4.5毫升（IQR 2.75 - 9.0毫升）。症状表现包括急迫性尿失禁（64.3%）、压力性尿失禁（57.1%）、复发性尿路感染（42.9%）、尿急（28.9%）、尿频（28.9%）、尿潴留（14.3%）和尿流中断（7.1%）。10例患者通过钝性、锐性或电灼切除取出Macroplastique®尿道填充物。切除后未发现并发症，且观察到尿路症状有所改善。
使用Macroplastique®进行尿道填充可导致有症状的尿道暴露。
