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Treatment of postoperative male urinary incontinence using transurethral macroplastique injections
Timo Kylmälä1, Hanna Tainio, Mika Raitanen
1Division of Urology, Department of Surgery, Tampere University Hospital and Tampere University, Tampere, Finland.
Purpose:
To study the effect of Macroplastique injection on postoperative stress urinary incontinence (SUI) in male patients.
Patients And Methods:
Since 1997, 50 consecutive men with a mean age of 66.0 years (range 51-75 years) suffering from mild to moderate postoperative SUI were treated as outpatients with transurethral Macroplastique injections. Under local anesthesia, 2.5 to 5 mL of Macroplastique was injected adjacent to the external sphincter at 5 or 7 o'clock or both. Forty-six patients had undergone radical prostatectomy, three transurethral prostatic resection, and one cystoprostatectomy with bladder substitution. Patients suffering from detrusor instability were excluded. A standardized 1-hour pad test and the patient's grading of the severity of the incontinence from 0 to 3, where 0 meant leaking took place all the time and 3 that the patient was completely dry, were carried out prior to injection and again at 3 months after each injection. Macroplastique injection was repeated if the initial treatment was not curative.
Results:
The mean 1-hour pad test loss was 48.3 mL at baseline. After the first injection, 6 patients were completely dry and 28 improved; in the rest, no improvement was achieved. Forty patients underwent a second injection after which, 10 more patients became completely dry and 5 improved significantly. Twenty-three patients underwent a third injection, after which, 9 more patients were completely dry. Fourth injections were given to 8 patients, of whom 5 became dry, 1 improved, and 2 patients did not get any benefit. The total volume of Macroplastique injected ranged from 2.5 to 13.5 mL (mean 7.1 mL). A majority of the patients suffered some dysuria following the injection, but there were no significant side effects.
Conclusions:
The preliminary results of endoscopic treatment of mild to moderate postoperative SUI in males with outpatient Macroplastique injections are encouraging. To achieve satisfactory results, repeated injections are needed.