Minimally invasive correction of stress urinary incontinence in women with pelvic floor dysfunction

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Abstract

BACKGROUND: Pelvic floor dysfunction is widespread among young women. Stress urinary incontinence is a common manifestation of the dysfunction and, even in mild forms, affects the quality of life of patients. Much attention is focused on finding and improving minimally invasive methods for treating stress urinary incontinence in women of reproductive and perimenopausal age to prevent disease progression and improve quality of life.

AIM: The aim of this study was to evaluate the immediate and long-term results of paraurethral injections of a high-density hyaluronic biopolymer for the correction of stress urinary incontinence in women of reproductive and perimenopausal age.

MATERIALS AND METHODS: We examined 37 patients aged 44.6 ± 4.7 years with mild to moderate stress urinary incontinence combined with grade I to II genital prolapse. After general clinical and special studies (urination diaries, King’s and Pelvic Organ Prolapse / Urinary Incontinence Sexual Questionnaire, cough test, complex urodynamic study, ultrasound examination of the urethrovesical junction and pelvic floor ultrasound with compression elastography), paraurethral injection of 4.0 ml of the high-density hyaluronic biopolymer crosslinked with 1,4-butanediol diglycidyl ether was performed. The effectiveness of therapy was evaluated 1, 6 and 12 months after the procedure.

RESULTS: A negative cough test was detected after one, six and 12 months of follow-up in 96.9, 73.1 and 43.8 % of women, respectively; the absence of stress urinary incontinence episodes according to urination diaries was in 85.7, 61.3 and 35.0 % of patients, respectively. Gradual resorption of the drug was monitored over 12 months of observation. An ultrasound examination showed a decrease in urethral mobility one month after the procedure. According to the results of elastography before treatment, the average value of the strain ratio of paraurethral tissues was 0.50 (0.30–0.69) (p < 0.001), after one and six months — 0.88 (0.76–1.03) and 0.79 (0.66–1.07) (p < 0.001 and p = 0.005 respectively). Thus, the stiffness of the paraurethral tissues of the proximal posterior wall of the urethra increased within six months after the procedure. When observing women after 12 months, the stiffness values of the studied tissues decreased and approached the values before treatment. During the entire observation period, the patients noted a decrease in the degree of discomfort due to problems with urination according to the questionnaires.

CONCLUSIONS: The introduction of the high-density hyaluronic biopolymer helps to increase the stiffness of paraurethral tissues and improve the structural support of the urethra in patients with stress urinary incontinence. After the procedure, a 12-month follow-up revealed a decrease or absence of stress urinary incontinence episodes according to urination diaries and the preservation of the positive effect of treatment according to the results of the cough test. A gradual decrease in the effect of therapy is associated with biodegradation of the drug. This method of treating mild forms of stress urinary incontinence is effective for women of reproductive and perimenopausal age who do not plan surgical treatment, are interested in achieving a quick result of therapy and are informed that the effect decreases over time after the procedure.

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About the authors

Elena I. Rusina

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Author for correspondence.
Email: pismo_rusina@mail.ru
ORCID iD: 0000-0002-8744-678X

MD, Dr. Sci. (Med.)

Russian Federation, Saint Petersburg

Maria M. Zhevlakova

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Email: gynecologist.spb@mail.ru
ORCID iD: 0009-0005-2084-3894

MD

Russian Federation, Saint Petersburg

Elizaveta V. Shelayeva

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Email: eshelaeva@yandex.ru
ORCID iD: 0000-0002-9608-467X

MD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Maria I. Yarmolinskaya

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Email: m.yarmolinskaya@gmail.com
ORCID iD: 0000-0002-6551-4147

MD, Dr. Sci. (Med.), Professor, Professor of the Russian Academy of Sciences

Russian Federation, Saint Petersburg

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Supplementary files

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2. Fig. 1. Compression elastography of the ureterovesical junction of a patient with stress urinary incontinence using transperineal access (Voluson E10 ultrasound system, RIC5-9-D multi-frequency transvaginal probe)

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3. Fig. 2. Scheme of location of the control area and area of interest for elastographic evaluation of supporting structures of the ureterovesical junction in patients with stress urinary incontinence

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4. Fig. 3. Points (3, 6, 9, and 12 hours of the conventional dial) for paraurethral injection of a bulking agent: а, conventional dial; b, vestibule of the vagina

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5. Fig. 4. Patient examination plan

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6. Fig. 5. Cough test results in women within 12 months after the procedure. p, level of significance of differences from the pretreatment indicator

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7. Fig. 6. Change in the number of stress urinary incontinence episodes based on seven-day urination diaries within 12 months after the procedure. p, level of significance of differences from the pretreatment indicator

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8. Fig. 7. 2D ultrasound examination of the urethrovesical junction using transperineal access in patient E., 48 years old, with stress urinary incontinence one (a) and six (b) months after paraurethral injection of the high-density hyaluronic biopolymer cross-linked with 1,4-butanediol diglycidyl ether (Voluson E6 ultrasound system, RIC5-9-D multi-frequency transvaginal probe). Arrow points to hyaluronic biopolymer

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9. Fig. 8. Strain ratio values in women within 12 months after the procedure. c. u., conventional units. p, level of significance of differences from the pre-treatment indicator

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10. Fig. 9. Compression elastography of the urethrovesical junction using transperineal access in patient E., 55 years old, with stress urinary incontinence before treatment (a) and 1 (b), 6 (c) and 12 (d) months after paraurethral injection of the high-density hyaluronic biopolymer cross-linked with 1,4-butanediol diglycidyl ether (Voluson E6 and Voluson E10 ultrasound systems, RIC5-9-D multi-frequency transvaginal probe)

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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
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