Biomedical subjects
Publications and source records attributed to Deborah J Lightner.
Durasphere is a urethral bulking agent used to treat stress urinary incontinence secondary to intrinsic sphincter deficiency. Although rare, chronic outlet obstruction and urinary retention are possible complications of this "permanent" bulking agent. We describe the endoscopic evacuation of Durasphere causing bladder outlet obstruction 1 year after being injected.
Stress urinary incontinence (SUI) is primarily managed by conservative strategies. When these methods fail, minimally invasive treatments, if effective, safe, and durable, can result in a considerable reduction in current medical costs for this common condition. Injection of currently available bulking agents is a safe, minimally invasive procedure and offers a degree of efficacy. The long-term durability of several of these agents is yet to be determined. The use of bulking agents for the treatment of anatomic SUI has been demonstrated to produce success rates similar to those observed when these materials are used in patients with intrinsic sphincter deficiency, opening up new therapeutic options for women with SUI. We review the current basic science and clinical research into the development of newer agents for soft-tissue bulking.
PURPOSE OF REVIEW: Newer tissue bulking agents used to treat stress urinary incontinence and vesicoureteral reflux provide for similar rates of success as older agents, but with greater safety and hopefully with greater durability. We review the new studies on the development and on the current trials of bulking agents. RECENT FINDINGS: Recent reports suggest that periurethral bulking agents are as effective for genuine stress urinary continence as for intrinsic sphincter deficiency, expanding the indications for injectable agents to include patients desiring less invasive procedures due to personal preference or as a result of medical necessity. Newer bulking agents, Durasphere and Macroplastique, appear safe and as efficacious as older agents in early trials. Durability remains a question for these agents. Injectable tissue matrices and autologous cells may prove useful in the future. SUMMARY: If durable and safe, these minimally invasive bulking agents may prove useful for all types of stress urinary incontinence. The price of minimal invasiveness may be lower efficacy, but their use does not compromise further therapy, should it be needed.
Female sexual dysfunction (FSD) was recently recognized as arising from multiple organic etiologies; it is not primarily a psychological symptom as believed previously. A symptom-related complex resulting in physiologic changes, FSD can respond to either treatment of the underlying condition or supportive measures. A new diagnostic classification allows physicians to perform a clinical evaluation of women with FSD, and recently validated FSD question naires allow monitoring of treatment efficacy. This article details the clinical evaluation and physical examination of women with FSD and outlines the fledgling research and treatment options.
PURPOSE: Gynecare tension-free vaginal tape (Ethicon, Inc., New Brunswick, New Jersey) is a propylene mesh tape recently introduced in the United States as minimally invasive treatment for stress urinary incontinence. We report the combined experience at 3 tertiary care institutions with graft erosion and bladder outlet obstruction after procedures performed elsewhere. MATERIALS AND METHODS: We reviewed the records of 5 patients with complications who presented to 1 of 3 institutions after polypropylene mesh tape placement. All pertinent information was obtained from the medical records and the operating surgeon at the referring institution. RESULTS: Treatment was required in 2 patients with urethral erosion, 1 with vaginal and bladder erosion, and 2 with bladder outlet obstruction. Common presenting symptoms included urge, urge incontinence and gross hematuria. Cystoscopy showed polypropylene graft erosion at the urethra or through the bladder wall. Each patient required explantation of the polypropylene mesh tape and further surgery to restore continence. The graft was divided transvaginally in the 2 patients presenting with outlet obstruction. Urge incontinence resolved and they returned to complete spontaneous voiding. CONCLUSIONS: High clinical suspicion is necessary when evaluating patients presenting with urinary symptoms after polypropylene mesh tape placement. Bladder outlet obstruction and possible graft erosion should be considered.