Introduction: Advances in the Treatment of Stress Urinary Incontinence: Bulking Therapy

INTRODUCTION Advances in the Treatment of Stress Urinary Incontinence: Bulking Therapy Roger R. Dmochowski, MD, FACS Department of Urology, Vanderbilt University Medical Center, Nashville, TN [Rev Urol. 2005;7(suppl 1):S1-S2] © 2005 MedReviews, LLC tress urinary incontinence (SUI) is the most common form of urinary incontinence and is estimated to affect more than 13 million communitydwelling adult women in the United States.1,2 Although staggering, this figure is thought to substantially underestimate the true prevalence of SUI because up to 70% of women with incontinence do not report the condition to their physician because of embarrassment or lack of knowledge about treatment options and their efficacy, or because they are under the misconception that incontinence is transitory and/or an inevitable consequence of aging or childbirth, or both. Thus, many women treat their symptoms in private, withdrawing from society, restricting activities, experiencing a decreased quality of life along with an increase in depression and anxiety, years before seeking medical help.3-8 As the population continues to age and increasing numbers of patients and clinicians become more familiar with and more comfortable reporting and discussing SUI, it is anticipated that efforts to educate the public about the condition will grow and treatment options will continue to evolve, becoming more available, less invasive, and more efficacious. The following is the second installment of a 2-part series that resulted from a roundtable discussion of advances in the treatment of SUI held in Dallas, Texas in January 2004. Experts in the field met at this summit and the proceedings of their discussions are summarized in this and an earlier supplement to Reviews in Urology.9 Lindsey Kerr, MD, leads the supplement with a discussion of a variety of bulking agents, which are among the newer albeit established technologies for treating SUI. The efficacy and safety profile of these agents is detailed, as are the patient characteristics to be considered when determining the agent of choice and S VOL. 7 SUPPL. 1 2005 REVIEWS IN UROLOGY S1 Introduction continued the positive history of federal and private reimbursement for the therapy. Sender Herschorn, MD, follows with a detailed description of the techniques used to administer various injectable agents to treat SUI patients with intrinsic sphincter deficiency, the properties of these agents, results of studies using the injectable materials, as well as the complications and controversies surrounding their use. Dr. Herschorn stresses that safety, durability, and cost-effectiveness remain issues of concern and are in need of additional research. I conclude the supplement with a review of the development of new urethral bulking agents that are expected to be available in the near future with particular attention paid to the clinical results and characteristics of Tegress™ Urethral Implant, a bulking material with unique phase-change properties upon S2 VOL. 7 SUPPL. 1 2005 exposure to the temperature of body fluids. As experience with and knowledge of urethral bulking agents continue to evolve, improvements in materials science and understanding of host response have resulted in new bulking agents with reproducible tissue effects when implanted. Although progress has been made in our understanding and treatment of women with SUI, questions and areas of study remain to be explored. I trust that this supplement answers a number of questions facing clinicians treating women with SUI and look forward to additional improvements in such treatment as the result of research efforts currently under investigation. References 1. REVIEWS IN UROLOGY Fultz NH, Burgio K, Diokno AC, et al. Burden of stress urinary incontinence for community- 2. 3. 4. 5. 6. 7. 8. 9. dwelling women. Am J Obstet Gynecol. 2003; 189:1275-1282. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology of lower urinary tract function: report from the Standardisation Subcommittee of the International Continence Society. Neurourol Urodyn. 2002;21:167-178. Bogner HR, Gallo JJ, Sammel MD, et al. Urinary incontinence and psychological distress in community-dwelling older adults. J Am Geriatr Soc. 2002;50:489-495. Shaw C. A review of the psychosocial predictors of help-seeking behaviour and impact on quality of life in people with urinary incontinence. J Clin Nurs. 2001;10:15-24. Naughton MJ, Wyman JF. Quality of life in geriatric patients with lower urinary tract dysfunction. Am J Med Sci. 1997;314:219-227. Mitteness LS, Barker JC. Stigmatizing a “normal” condition: urinary incontinence in late life. Med Anthropol Q. 1995;9:188-210. Minassian VA, Drutz HP, Al-Badr A. Urinary incontinence as a worldwide problem. Int J Gynecol Obstet. 2003;82:327-338. Kinchen KS, Burgio K, Diokno AC, et al. Factors associated with women’s decision to seek treatment for urinary incontinence. J Womens Health (Larchmt). 2003;12:687-698. Dmochowski RR. Advances in the treatment of stress urinary incontinence. Rev Urol. 2004; 6(suppl 5):1-46.