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用作女性压力性尿失禁尿道旁注射剂的乙烯基二甲基聚二甲基硅氧烷的影像学表现。

Imaging findings of vinyl dimethyl polydimethylsiloxane used as a paraurethral injectable for female stress urinary incontinence.

作者信息

de Vries Allert M, Casteleijn Fenne M, Roovers Jan-Paul W R, Heesakkers John P F A, Fütterer Jurgen J

机构信息

Department of Urology - Experimental Urology (Route 267), Radboud University Medical Centre, Geert Grooteplein 10, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.

Department of Obstetrics and Gynaecology, Amsterdam UMC, Amsterdam, The Netherlands.

出版信息

Ther Adv Urol. 2021 Dec 5;13:17562872211060909. doi: 10.1177/17562872211060909. eCollection 2021 Jan-Dec.

Abstract

OBJECTIVES

Vinyl dimethyl polydimethylsiloxane (VDPDMS) is a urethral bulking agent used for female stress urinary incontinence (SUI), that is clearly visible on computed tomography (CT). Clinical effects are promising, but it remains difficult to identify factors predicting clinical success. Clinical outcome might depend on the shape and position of the implants after injection. Objective of this study is to analyze the appearance and position of bulk material on CT scans and to see whether it is delivered the intended circumferential and mid-urethral position.

METHODS

A single-center retrospective study was performed in 20 women, treated with VDPDMS for SUI. A senior radiologist analyzed all CTs, using an assessment scheme. This scheme describes whether the bulk is scattered, mid-urethral, and/or circumferentially distributed. The imaging findings were subsequently correlated to the patient global impression of improvement (PGI-I) and the percentage of subjective improvement experienced 6 weeks post-operatively.

RESULTS

The patient's mean age was 61 years, and they underwent median 2.0 previous surgical treatments for SUI. Three patients reported no improvement, 9 patients had 20-90% improvement and 8 reported >90% improvement of their SUI. In 17/74 (24%) positions, the implant was scattered rather than spherical. In 9/20 (45%), the implants were not located in the intended mid-urethral position. In 8/20 patients (40%), the material was distributed circumferentially.

CONCLUSION

This is the first study describing the position and shape of VDPDMS in patients after treatment. The appearance and position of the implants appears to be variable, but optimal positioning or shape seems to be no absolute requisite for success.

摘要

目的

乙烯基二甲基聚二甲基硅氧烷(VDPDMS)是一种用于女性压力性尿失禁(SUI)的尿道填充剂,在计算机断层扫描(CT)上清晰可见。临床效果令人期待,但仍难以确定预测临床成功的因素。临床结果可能取决于注射后植入物的形状和位置。本研究的目的是分析CT扫描上填充材料的外观和位置,看看其是否被放置在预期的尿道周围和尿道中段位置。

方法

对20例接受VDPDMS治疗SUI的女性进行了一项单中心回顾性研究。一位资深放射科医生使用评估方案分析了所有CT图像。该方案描述了填充剂是分散的、位于尿道中段还是呈周向分布。随后将影像学结果与患者的总体改善印象(PGI-I)以及术后6周主观改善的百分比进行关联。

结果

患者的平均年龄为61岁,她们之前因SUI接受的手术治疗中位数为2.0次。3例患者报告无改善,9例患者有20%-90%的改善,8例患者报告SUI改善>90%。在17/74(24%)个位置,植入物是分散的而非球形。在9/20(45%)的情况下,植入物未位于预期的尿道中段位置。在8/20例患者(40%)中,材料呈周向分布。

结论

这是第一项描述治疗后患者体内VDPDMS位置和形状的研究。植入物的外观和位置似乎存在差异,但最佳定位或形状似乎并非成功的绝对必要条件。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b3ac/8842146/af7378c17d47/10.1177_17562872211060909-fig1.jpg

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