BERKELEY, CA (UroToday.com) - The effective use of urethral bulking agents (UBA) to treat female stress urinary incontinence (SUI) due to intrinsic sphincter disorder (ISD) has been well documented in the clinical literature for over 25 years.
Within our community based urology practice, we have incorporated Macroplastique® (Uroplasty, Inc., Minnetonka, MN) into our SUI algorithm of care. Performing the procedure within our normal clinic hours rather than at a hospital or at an ambulatory surgery center gives our practice control over scheduling, provides convenient access for our patients and allows us to monitor patient progress more easily.
Patient selection is important to ensure that realistic expectations for improvement are communicated and met. This includes women who want a less-invasive therapy over surgery, older women who may be an anesthetic risk, frail or have had a failed sling procedure in the past having a diagnosis of intrinsic sphincter deficiency. Also needing to be considered are younger women of childbearing age who may desire more children or those who have multiple co-morbidities.
We use local anesthesia, sometimes along with mild oral sedation to keep the patient comfortable while also decreasing recovery time. Nursing staff ensure that the patient is educated in advance on what to expect from post-procedure care. They are taught how to perform intermittent self-catheterization in case of transient urinary retention. The procedure is performed by using a tunneling technique to inject a Macroplastique bolus into 2 or 3 sites to obtain good urethral coaptation. Using a unique administration device the injections can be carefully controlled for depth and volume. See the attached illustrations for further details.
Macroplastique Injection Tunneling Technique:
The patient returns one month after the UBA procedure for evaluation of her SUI symptoms. A second UBA injection may be necessary in some patients, although we wait for at least 3 months after the first procedure to allow for complete healing and for the body’s own collagen in-growth.
Macroplastique can be offered as a minimally invasive, in-office procedure with good lasting clinical results.
by Mary Ramsden, LPN., Elizabeth Williams, MD., and Steve Siegel, MD. as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.