Stress Urinary Incontinence: Treatment With Platelet-Rich-Plasma Injection and Placement of Polydioxanone Threads—A Pilot Study

2021 ◽  
pp. 074880682199810
Author(s):  
Ariel Luksenburg ◽  
Juan J. Barcia ◽  
Roberto Sergio ◽  
Santiago Fernandez ◽  
Marco A. Pelosi ◽  
...  
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Minimally Invasive ◽  
Platelet Rich Plasma ◽  
Short Form ◽  
Vaginal Wall ◽  
Anterior Vaginal Wall ◽  
Invasive Technique ◽  
Urethral Pressure ◽  
Urodynamic Studies

Stress urinary incontinence is an important clinical problem that affects millions of women worldwide. The aim of this article was the evaluation of a minimally invasive procedure as an alternative treatment for mild urinary stress incontinence in women, using platelet-rich-plasma (PRP) injections and polydioxanone (PDO) threads. A total of 23 patients with mild urinary incontinence, mean age 46, were evaluated with detailed history, examination, urinary diary, complete laboratory tests, ultrasonography, urodynamic studies, and completion of International Consultation on Incontinence Questionaire–Urinary Incontinence Short Form (ICIQ-UI SF). Under local anesthesia, PRP was injected through the anterior vaginal wall, PDO threads placed in paraurethral, suburethral, and lateral urethrovaginal spaces, using instruments developed for safe and effective performance. Patients were analyzed at 1, 2, 4, 8 weeks and 6 months posttreatment. A total of 10 patients were biopsed preoperatively and 60 days after treatment. Symptoms and ICIQ-UI SF score were significantly improved. Postoperative urodynamic studies were normal in all cases. Biopsies after treatment showed a dense connective tissue tridimensional mesh. No complications or adverse effects were observed. All patients declared satisfaction with results, will have the procedure again, and will recommend it. The minimally invasive technique presented here results in strengthening of the paraurethral, suburethral, and lateral urethrovaginal spaces and the mucosa of the anterior vaginal wall. The combination of PRP injections and the placement of PDO threads creates a fibrotic and absorbable mesh-like structure, aimed to increase the urethral resistance, so that under effort the intravesical pressure does not overcome the urethral pressure. These results suggest that the procedure is safe and a cost-effective alternative in patients with mild urinary incontinence, reducing the need for invasive surgical procedures. Larger studies are needed to confirm the results of this study.

scholarly journals Outcome of Treatment of Anterior Vaginal Wall Prolapse and Stress Urinary Incontinence with Transobturator Tension-Free Vaginal Mesh (Prolift) and Concomitant Tension-Free Vaginal Tape-Obturator

2009 ◽  
Vol 2009 ◽  
pp. 1-6 ◽  
Author(s):  
Ashraf Abou-Elela ◽  
Essam Salah ◽  
Haitham Torky ◽  
Sameh Azazy
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Vaginal Wall ◽  
Anterior Vaginal Wall ◽  
Vaginal Mesh ◽  
Anterior Vaginal Wall Prolapse ◽  
Tension Free ◽  
Tension Free Vaginal Tape ◽  
Urodynamic Assessment ◽  
Vaginal Tape Obturator

Objective. It is to assess the feasibility, effectiveness, and safety of transobturator tension-free vaginal mesh (Prolift) and concomitant tension-free vaginal tape-obturator (TVT-O) system as a treatment of female anterior vaginal wall prolapse associated with stress urinary incontinence (SUI).Patients and Methods. Between December 2006 and July 2007, 20 patients with anterior genital prolapse and voiding dysfunction were treated with the transobturator tension-free vaginal mesh (Prolift) and concomitant tension-free vaginal tape-obturator (TVT-O). Sixteen patients had stress urinary incontinence and 4 patients were considered at risk for development of de novo stress incontinence after the prolapse is repaired. All patients underwent a complete urodynamic assessment. All the patients underwent pelvic examination 4–6 weeks after the operation, and anatomical and functional outcomes were recorded.Results. Twenty cystocoeles were repaired: 6 grade II, 12 grade III, and 2 grade IV. There were no vessel or bladder injuries. Eighteen patients had optimal anatomic results and 2 patients had persistent asymptomatic stage I prolapse.Conclusion. These preliminary results suggest that Prolift system offers a safe and effective treatment for female anterior vaginal wall prolapse. However, a long-term followup is necessary in order to support the good result maintenance.

scholarly journals Ambulatory Pessary Trial Unmasks Occult Stress Urinary Incontinence

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Bilal Chughtai ◽  
Sara Spettel ◽  
Jonathan Kurman ◽  
Elise De
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Stress Incontinence ◽  
Real Life ◽  
Vaginal Wall ◽  
Anterior Vaginal Wall ◽  
Sling Procedure ◽  
Occult Stress Urinary Incontinence ◽  
Anatomic Results

Objective. We evaluated the use of a one-week ambulatory pessary trial in predicting patients' postoperative outcomes for occult stress incontinence.Methods. Patients with anterior vaginal wall prolapse were offered a pessary trial to predict response to reconstruction. We performed a retrospective review of 4 years of cases. All patients underwent a detailed evaluation including videourodynamics with and without pessary reduction.Results. Twenty-six patients completed the 1-week pessary trial. Ten (38%) women showing no evidence of stress urinary incontinence (SUI) underwent surgical repair of prolapse without anti-incontinence procedure. None of these patients had SUI postoperatively. Sixteen women (61%) had occult stress urinary incontinence on evaluation and underwent concurrent sling procedure. Three (19%) of these patients were identified by the pessary trial alone. Twenty-five of the 26 patients were without clinical stress incontinence at a mean follow up of 12 months (range 4–37 months). The pessary trial correctly predicted persistent urgency in six patients and persistent frequency in five. No patients with SUI or persistent voiding difficult were missed in a pessary trial.Conclusion. An ambulatory pessary trial is an effective, easy, and inexpensive method to approximate anatomic results achieved by surgery under real-life conditions. In our series, 20% of patients with occult SUI were identified by pessary trial alone.

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