Clearwater Whitney L, Panushka Katherine, Najor Anna, Laudano Melissa, Fleischmann Nicole
Urology, Albert Einstein College of Medicine, Montefiore Hospital.
Department of Urology, White Plains Hospital, White Plains, NY.
Urogynecology (Phila). 2024 Mar 1;30(3):293-299. doi: 10.1097/SPV.0000000000001470. Epub 2024 Mar 6.
Urethral bulking is an alternative to synthetic midurethral sling for the treatment of stress urinary incontinence (SUI) in women. Urethral bulking agents, which are injected in the submucosal tissues of the proximal urethra/bladder neck, have demonstrated less adverse effects with similar satisfaction rates but lower subjective and objective cure rates when compared with midurethral sling. Cystoscopic Reconstruction of External Sphincter Technique (CREST) is a novel technique, which reinforces the natural closure mechanism of the external urinary sphincter (EUS).
The aim of the study was to provide safety and efficacy data for injecting polyacrylamide hydrogel (PAHG) in the components of the female EUS.
This was a retrospective chart review of patients using CREST with PAHG as initial treatment for SUI by a single surgeon from January 2022 to October 2022. Exclusion criteria are as follows: younger than 18 years, prior SUI surgery, concomitant pelvic organ prolapse or reconstructive procedure, neurological conditions, or history of radiation. Subjective and objective cure rates were measured by patient-reported symptoms and cough stress test. Urinary retention, postoperative urinary infection, and de novo urinary urgency were assessed.
One hundred and thirteen consecutive patients met inclusion criteria with median follow-up of 3 months. Eighty-five percent of participants reported subjective improvement, 69% reported subjective cure, and 69% demonstrated objective cure. Nine patients reported transient postoperative retention, 8 reported postoperative urinary tract infections, and 5 reported de novo urgency. There were no serious adverse events.
CREST is a novel technique for injection of PAHG, into the EUS to treat SUI. Our data suggest that this technique could improve urethral injection outcomes with minimal complications.
尿道填充术是治疗女性压力性尿失禁（SUI）的一种替代合成尿道中段吊带的方法。尿道填充剂注射于近端尿道/膀胱颈的黏膜下组织，与尿道中段吊带相比，其不良反应较少，满意度相似，但主观和客观治愈率较低。膀胱镜下外括约肌重建技术（CREST）是一种新技术，可加强尿道外括约肌（EUS）的自然闭合机制。
本研究旨在提供在女性EUS各组成部分注射聚丙烯酰胺水凝胶（PAHG）的安全性和有效性数据。
这是一项回顾性图表审查，纳入了2022年1月至2022年10月由单一外科医生采用CREST联合PAHG作为SUI初始治疗方法的患者。排除标准如下：年龄小于18岁、既往有SUI手术史、合并盆腔器官脱垂或重建手术、神经系统疾病或放疗史。通过患者报告的症状和咳嗽压力试验来测量主观和客观治愈率。评估尿潴留、术后尿路感染和新发尿急情况。
113例连续患者符合纳入标准，中位随访时间为3个月。85%的参与者报告主观症状改善，69%报告主观治愈，69%显示客观治愈。9例患者报告术后短暂性尿潴留，8例报告术后尿路感染，5例报告新发尿急。未发生严重不良事件。
CREST是一种将PAHG注射到EUS中治疗SUI的新技术。我们的数据表明，该技术可改善尿道注射效果，并发症最少。
