NEW TREATMENT FOR STRESS URINARY INCONTINENCE

Abstract

Objective: The aim of this study is to evaluate the safety and efficacy of the Zuidex implacement for the treatment of type III incontinence. Methods: We evaluated 36 women (median age 51) with type III ( MUCP<20 cm H2O and VLPP<60 cm H2O), with fixed urethra demonstrated (Delta Value<30 at Q-tip test). 21 (58.3%) had undergone previous continence surgery .They were recluted by a complete urogynaecological work-up( Vaginal profile, Q- tip test, Endoscopy and Urodynamic study, one hour Pad test, Ultrasonography). We defined as cured patients that were dry after the implant was performed, and as improved those who decreased in number of pads and symptoms.We underwent all patients an intraurethral injection of Zuidex, in four different points at the bladder neck level under local anesthesia. Subjective and urodynamic assessments were made at 6 months after injection to evaluate success and short term effects. No catheter was placed after procedure and each patient was invited to void spontaneously after four hours before discharge. We introduced the Implacer (with the tube covering the needles) so that the top of the tube is located approximately at the mid-urethra level. It is important that the tube does not move backwards during the insertion into the urethra. To avoid this apply pressure on the rear end of the tube while inserting. Pull back the tube to release the needles within the urethra. The position of the needle eyes is then approximately at the mid-urethra. With a firm grip on the hand piece, retract one syringe 5–10 mm and then push it forward to its bottom position Symptom Pre-op (no.) 24 mth post-op (no.) Urge 52 12 UI 40 7 Constipation 21 2 Dyspareunia 20 6 Voiding difficulty 32 1 S28 in order to penetrate the mucosa. Inject the contents of the syringe. Leave the emptied syringe in place. Going clockwise, repeat this manoeuvre with the remaining 3 syringes. Remove the syringes with the needles one by one and thereafter the implacer.The syringes, needles and the Implacer must be discarded after the treatment session. Results: Objective success rates at six months were 53%(19 pts), significantly improvement 25%(9pts), failures 22%(8 pts). At the follow-up there was no change in mean bladder capacity, urinary flow rate, bladder compliance and stability; UPP showed a statistically significant increase in functional urethral length and MPCU. Conclusions: Our clinical studies on use of Zuidex in the endoscopic correction of type III incontinence show that up to 78% of patients can be cured or significantly improved. It is easy to use and safe and does not complicate or preclude open surgery at a later date.