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Treatment options for intrinsic sphincter deficiency

Nature Reviews Urology volume 9, pages 638–651 (2012)Cite this article

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Abstract

Type III stress urinary incontinence (SUI) is generally defined as a condition that involves intrinsic sphincter deficiency (ISD). Although the clinical parameters for ISD are loosely defined as a Valsalva leak-point pressure <60 cmH2O or a maximal urethral closure pressure <20 cmH2O, consensus is lacking. As a result, studies evaluating the success of any treatment for ISD are difficult to interpret. Regardless, several studies over the past 20 years have evaluated a number of surgical and nonsurgical treatments specifically for SUI caused by ISD. Surgical options include retropubic suspension, needle suspensions, various types of suburethral slings and the artificial urinary sphincter, whereas nonsurgical options include urethral bulking agents. Assessing urethral function (specifically, leak-point pressure or maximal urethral closure pressure) and urethral hypermobility will enable treating physicians to determine the ideal solution for individual patients, especially as no standardized treatment for ISD exists.

Key Points

  • Intrinsic sphincter deficiency (ISD) has classically been treated with pubovaginal slings

  • However, the optimal treatment of ISD is not universally agreed upon

  • Urethral bulking agents were developed for refractory stress urinary incontinence (SUI) caused by ISD

  • Midurethral slings are widely used to treat SUI, including that caused by ISD

  • The evolution of the midurethral sling (by the retropubic or transobturator methods) has further confused decision making for the treatment of ISD

  • An assessment of urethral function (leak-point pressure or maximal urethral closure pressure) and of urethral hypermobility will help determine the ideal treatment

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References

  1. Luber, K. M. The definition, prevalence, and risk factors for stress urinary incontinence. Rev. Urol. 6 (Suppl. 3), S3–S9 (2004).

    PubMed  PubMed Central  Google Scholar 

  2. Green, T. H. Development of a plan for the diagnosis and treatment of urinary stress incontinence. Am. J. Obstet. Gynecol. 83, 632–640 (1962).

    Article  PubMed  Google Scholar 

  3. Crystle, C. D., Charme, L. S. & Copland, W. E. Q-tip test in stress urinary incontinence. Obstet. Gynecol. 38, 313–315 (1971).

    CAS  PubMed  Google Scholar 

  4. McGuire, E. J., Lytton, B., Kohorn, E. I. & Pepe, V. The value of urodynamic testing in stress urinary incontinence. J. Urol. 124, 256–258 (1980).

    Article  CAS  PubMed  Google Scholar 

  5. Petros, P. E. & Ulmsten, U. I. An integral theory of female urinary incontinence. experimental and clinical considerations. Acta Obstet. Gynecol. Scand. Suppl. 153, 7–31 (1990).

    Article  CAS  PubMed  Google Scholar 

  6. Delancey, J. O. Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am. J. Obstet. Gynecol. 170, 1713–1720 (1994).

    Article  CAS  PubMed  Google Scholar 

  7. Burch, J. C. Urethrovaginal fixation to cooper's ligament for correction of stress urinary incontinence, cystocele, and prolapse. Am. J. Obstet. Gynecol. 81, 281–286 (1961).

    Article  CAS  PubMed  Google Scholar 

  8. Marshall, V. F., Marchetti, A. A. & Krantz, K. E. The correction of stress incontinence by simple vesicourethral suspension. Surg. Gynecol. Obstet. 88, 590–596 (1949).

    Google Scholar 

  9. Sand, P. K., Bowen, L. W., Panganiban, R. & Ostergard, D. R. The low pressure urethra as a factor in failed retropubic urethropexy. Obstet. Gynecol. 69, 399–402 (1987).

    CAS  PubMed  Google Scholar 

  10. Koonings, P. P., Bergman, A., Ballard, C. A. Low urethral pressure and stress urinary incontinence in women: risk factor for failed retropubic surgical procedure. Urology 36, 245–248 (1990).

    Article  CAS  PubMed  Google Scholar 

  11. McGuire, E. J. Urodynamic findings in patients after failure of stress incontinence operations. Prog. Clin. Biol. Res. 78, 351–354 (1981).

    CAS  PubMed  Google Scholar 

  12. McGuire, E. J. et al. Clinical assessment of urethral sphincter function. J. Urol. 150, 1452–1454 (1993).

    Article  CAS  PubMed  Google Scholar 

  13. Ridley, J. H. in Te Linde's Operative Gynecology (eds Mattingly, R. F. & Thompson, J. D.) 623–636 (J. B. Lippincott & Co., Philadelphia, 1985).

    Google Scholar 

  14. Goebell, R. Zur operativen Beseitigung der angeborenen Incontinentia Vesicae [German]. Dtschr. Gynakol. Urol. 2, 187–191 (1910).

    Google Scholar 

  15. Aldridge, A. A. Transplantation of fascia for relief of urinary stress incontinence. Am. J. Obstet. Gynecol. 44, 398–411 (1942).

    Article  Google Scholar 

  16. McGuire, E. J. & Lytton, B. The pubovaginal sling stress urinary incontinence. J. Urol. 119, 82 (1978).

    Article  CAS  PubMed  Google Scholar 

  17. McGuire, E. J., Bennett, C. J., Konnak, J. A., Sonda, L. P. & Savastano, J. A. Experience with pubovaginal slings for urinary incontinence at the University of Michigan. J. Urol. 138, 525–526 (1987).

    Article  CAS  PubMed  Google Scholar 

  18. Cespedes, R. D., Cross, C. A. & McGuire, E. J. Pubovaginal fascial slings. Tech. Urol. 3, 195–201 (1997).

    CAS  PubMed  Google Scholar 

  19. Boyd, S. D. & Raz, S. Needle bladder neck suspension for female stress incontinence. Urol. Clin. North Am. 11, 357–366 (1984).

    CAS  PubMed  Google Scholar 

  20. Mundy, A. R. A trial comparing the Stamey bladder neck suspension procedure with colposuspension for the treatment of stress urinary incontinence. Br. J. Urol. 55, 687–690 (1983).

    Article  CAS  PubMed  Google Scholar 

  21. Peattie, A. B. & Stanton, S. L. The Stamey operation for the correction of genuine stress incontinence in the elderly woman. Br. J. Obstet. Gynaecol. 96, 983–986 (1989).

    Article  CAS  PubMed  Google Scholar 

  22. Ulmsten, U. I., Henriksson, L., Johnson, P. & Varhos, G. An ambulatory surgical procedure under local anesthesia for treatment of female urinary incontinence. Int. Urogynecol. J. Pelvic Floor Dysfunct. 7, 81–86 (1996).

    Article  CAS  PubMed  Google Scholar 

  23. Delorme, E., Droupy S., de Tayrac, R. & Delmas, V. Transobturator tape (UraTape): a new minimally invasive procedure to treat female stress urinary incontinence. Eur. Urol. 45, 203–207 (2004).

    Article  PubMed  Google Scholar 

  24. Dmochowski, R. R. et al. Update of AUA guideline on the surgical management of female stress urinary incontinence. J. Urol. 183, 1906–1914 (2010).

    Article  PubMed  Google Scholar 

  25. Bai, S. W., Park, J. H., Kim, S. K. & Park, K. H. Analysis of the success rates of burch colposuspension in relation to valsalva leak-point pressure. J. Reprod. Med. 50, 189–192 (2005).

    PubMed  Google Scholar 

  26. Hsieh, G. C., Klutke, J. J. & Kobak, W. H. Low valsalva leak-point pressure and success of retropubic urethropexy. Int. Urogynecol. J. Pelvic Floor Dysfunct. 12, 46–50 (2001).

    Article  CAS  PubMed  Google Scholar 

  27. McGuire, E. J. & O'Connell, H. E. Surgical treatment of intrinsic urethral dysfunction. Slings. Urol. Clin. N. Am. 22, 657–664 (1995).

    CAS  Google Scholar 

  28. Zaragoza, M. R. Expanded indications for the pubovaginal sling: treatment of type 2 or 3 stress incontinence. J. Urol. 156, 1620–1622 (1996).

    Article  CAS  PubMed  Google Scholar 

  29. Carr, L. K., Walsh, P. J., Abraham, V. E. & Webster, D. Favorable outcome of pubovaginal slings for geriatric women with stress incontinence. J. Urol. 157, 125–128 (1997).

    Article  CAS  PubMed  Google Scholar 

  30. Wright, E. J., Iselin, C. E., Carr, L. K. & Webster, G. D. Pubovaginal sling using cadaveric allograft fascia for the treatment of intrinsic sphincter deficiency. J. Urol. 160, 759–762 (1998).

    Article  CAS  PubMed  Google Scholar 

  31. Chaikin, D. C., Rosenthal, J. & Blaivas, J. G. Pubovaginal fascial sling for all typles of stress urinary incontinence: long-term analysis. J. Urol. 160, 1312–1316 (1998).

    Article  CAS  PubMed  Google Scholar 

  32. Cross, C. A., Cespedes, R. D. & McGuire, E. J. Our experience with pubovaginal slings in patients with stress urinary incontinence. J. Urol. 159, 1195–1198 (1998).

    Article  CAS  PubMed  Google Scholar 

  33. Hassouna, M. E. & Ghoniem, G. M. Long-term outcome and quality of life after modified pubovaginal sling for intrinsic sphincteric deficiency. Urology 53, 287–290 (1999).

    Article  CAS  PubMed  Google Scholar 

  34. Albo, M. E. et al. Burch colposuspension versus fascial sling to reduce urinary stress incontinence. N. Engl. J. Med. 356, 2143–2155 (2007).

    Article  CAS  PubMed  Google Scholar 

  35. Nilsson, C. G., Palva, K., Rezapour, M. & Falconer, C. Eleven years prospective follow-up of the tension-free vaginal tape procedure for treatment of stress urinary incontinence. Int. Urogynecol. J. 19, 1043–1047 (2008).

    Article  CAS  Google Scholar 

  36. Rezapour, M. & Ulmsten, U. Tension-free vaginal tape (TVT) in women with recurrent stress urinary incontinence—a long-term follow up. Int. Urogynecol. J. 12 (Suppl. 2), S9–11 (2001).

    Article  Google Scholar 

  37. Rechberger, T., Futyma, K., Jankiewicz, K., Adamiak, A. & Skorupski, P. The clinical effectiveness of retropubic (IVS-02) and transobturator (IVS-04) midurethral slings: randomized trial. Eur. Urol. 56, 24–30 (2009).

    Article  CAS  PubMed  Google Scholar 

  38. Schierlitz, L. et al. Effectiveness of tension-free vaginal tape compared with transobturator tape in women with stress urinary incontinence and intrinsic sphincter deficiency: a randomized controlled trial. Obstet. Gynecol. 112, 1253–1261 (2008).

    Article  PubMed  Google Scholar 

  39. Mutone, N., Mastropietro, M., Brizendine, E. & Hale, D. Effect of tension-free vaginal tape procedure on urodynamic continence indices. Obstet. Gynecol. 98, 638–645 (2001).

    CAS  PubMed  Google Scholar 

  40. Oliveira, R. et al. Single-incision sling system as primary treatment of female stress urinary incontinence: prospective 12 months data from a single institution. BJU Int. 108, 1616–1621 (2011).

    Article  PubMed  Google Scholar 

  41. Haliloglu, B., Karateke, A., Coksuer, H., Peker, H. & Cam, C. The role of urethral hypermobility and intrinsic sphincter deficiency on the outcome of transobturator tape procedure: a prospective study with 2-year follow-up. Int. Urogynecol. J. 21, 173–178 (2010).

    Article  PubMed  Google Scholar 

  42. Goktolga, U. et al. Tension-free vaginal tape for surgical relief of intrinsic sphincter deficiency: results of 5-year follow-up. J. Min. Invasive Gynecol. 15, 78–81 (2008).

    Article  Google Scholar 

  43. Soulié, M. et al. The tension-free transvaginal tape procedure in the treatment of female urinary stress incontinence: a French prospective multicentre study. Eur. Urol. 39, 709–715 (2001).

    Article  PubMed  Google Scholar 

  44. Liapis, A., Bakas, P., Salamalekis, E., Botsis, D. & Creatsas, G. Tension-free vaginal tape (TVT) in women with low urethral closure pressure. Eur. J. Obstet. Gynecol. Reprod. Biol. 116, 67–70 (2004).

    Article  PubMed  Google Scholar 

  45. Paick, J. et al. Tension free vaginal tape procedure for urinary incontinence with low valsalva leak point pressure. J. Urol. 172, 1370–1373 (2004).

    Article  PubMed  Google Scholar 

  46. Rezapour, M., Falconer, C. & Ulmsten, U. Tension-free vaginal tape (TVT) in stress incontinent women with intrinsic sphincter deficiency (ISD)—a long-term follow-up. Int. Urogynecol. J. Pelvic Floor Dysfunct. 12 (Suppl. 2), S12–S14 (2001).

    Article  PubMed  Google Scholar 

  47. Bai, S. W. et al. Treatment outcome of tension-free vaginal tape in stress urinary incontinence: comparison of intrinsic sphincter deficiency and nonintrinsic sphincter deficiency patients. Int. Urogynecol. J. Pelvic Floor Dysfunct. 18, 1431–1434 (2007).

    Article  PubMed  Google Scholar 

  48. Anast, J. W., Skolarus, T. A., Yan, Y. & Klutke, C. G. Transobturator sling with intraoperative cough test is effective for patients with low valsalca leak point pressure. Can. J. Urol. 15, 4153–4157 (2008).

    PubMed  Google Scholar 

  49. Güngördük, K., Celebi, I., Ark, C., Celikkol, O. & Yildirim, G. Which type of mid-urethral sling procedure should be chose for treatment of stress urinary incontinence with intrinsic sphincter deficiency? Tension-free vaginal tape or transobturator tape. Acta Obstet. Gynecol. Scand. 88, 920–926 (2009).

    Article  PubMed  Google Scholar 

  50. Moore, R. D., Gamble, K. & Miklos, J. R. Tension-free vaginal tape sling for recurrent stress incontinence after transobturator tape sling failure. Int. Urogynecol. J. 18, 309–313 (2007).

    Article  Google Scholar 

  51. Segal, J. L., Vassallo, B. J., Kleeman, S. D., Hungler, M. & Karram, M. M. The efficacy of the tension-free vaginal tape in the treatment of five subtypes of stress urinary incontinence. Int. Urogynecol. J. Pelvic Floor Dysfunct. 17, 120–124 (2006).

    Article  PubMed  Google Scholar 

  52. Meschia, M., Pifarotti, P., Buonaguidi, A., Gattei, U. & Spennacchio, M. Tension free vaginal tape (TVT) for treatment of stress urinary incontinence in women with low-pressure urethra. Eur. J. Obstet. Gynecol. Reprod. Biol. 122, 118–121 (2005).

    Article  PubMed  Google Scholar 

  53. Jeon, M. J., Jung, H. J., Chung, S. M., Kim, S. K. & Bai, S. W. Comparison of the treatment outcome of pubovaginal sling, tension-free vaginal tape, and transobturator tape for stress urinary incontinence with intrinsic sphincter deficiency. Am. J. Obstet. Gynecol. 199, 76.e1–e4 (2008).

    Article  Google Scholar 

  54. Rardin, C. et al. Outcomes of tension-free vaginal tape in women with intrinsic sphincter deficiency with or without urethral hypermobility. J. Pelvic Med. Surg. 11, 321–327 (2005).

    Article  Google Scholar 

  55. Hsaio, S. M., Chang, T. C., Chen, C. H. & Lin, H. H. Sequential comparisons of postoperative urodynamic changes between retropubic and transobturator midurethral tape procedures. World J. Urol. 26, 643–648 (2008).

    Article  Google Scholar 

  56. Chartier-Kastler, E. et al. Artificial urinary sphincter (AMS 800) implantation for women with intrinsic sphincter deficiency: a technique for insiders? BJU Int. 107, 1618–1626 (2010).

    Article  PubMed  Google Scholar 

  57. Mandron, E., Bryckaert, P. E. & Paptsoris, A. G. Laparoscopic artificial urinary sphincter implantation for female genuine stress urinary incontinence: technique and 4-year experience in 25 patients. BJU Int. 106, 1194–1198 (2010).

    Article  PubMed  Google Scholar 

  58. Rouprêt, M. et al. Laparoscopic approach for artificial urinary sphincter implantation in women with intrinsic sphincter deficiency incontinence: a single-centre preliminary experience. Eur. Urol. 57, 499–504 (2010).

    Article  PubMed  Google Scholar 

  59. Chung, E. & Cartmill, R. A. 25-year experience in the outcome of artificial urinary sphincter in the treatment of female urinary incontinence. BJU Int. 106, 1664–1667 (2010).

    Article  PubMed  Google Scholar 

  60. Vayleux, B. et al. Female urinary incontinence and artificial urinary sphincter: study of efficacy and risk factors for failure and complications. Eur. Urol. 59, 1048–1053 (2011).

    Article  PubMed  Google Scholar 

  61. Costa, P. et al. Long-term results of artificial urinary sphincter for women with type III stress urinary incontinence. Eur. Urol. http://dx.doi.org/10.1016//j.eururo.2012.03.008.

  62. Costa, P. et al. The use of an artificial urinary sphincter in women with type III incontinence and a negative Marshall test. J. Urol. 165, 1172–1176 (2001).

    Article  CAS  PubMed  Google Scholar 

  63. Ngninkeu, B. N., van Heugen, G., di Gregorio, M., Debie, B. & Evans, A. Laparoscopic artificial urinary sphincter in women for type III incontinence: preliminary results. Eur. Urol. 47, 793–797 (2005).

    Article  PubMed  Google Scholar 

  64. Pycha, A., Klinger, C. H., Haitel, A., Heinz-Peer, G. & Marberger, M. Implantable microballoons: an attractive alternative in the management of intrinsic sphincter deficiency. Eur. Urol. 33, 469–475 (1998).

    Article  CAS  PubMed  Google Scholar 

  65. Kocjancic, E. et al. Adjustable continence therapy for severe intrinsic sphincter deficiency and recurrent female stress urinary incontinence: long-term experience. J. Urol. 184, 1017–1021 (2010).

    Article  PubMed  Google Scholar 

  66. Bent, A. E. et al. Treatment of intrinsic sphincter deficiency using autologous ear chondrocytes as a bulking agent. Neurourol. Urodyn. 20, 157–165 (2001).

    Article  CAS  PubMed  Google Scholar 

  67. Stamey, T. A. Endoscopic suspension of the vesical neck for urinary incontinence. Surg. Gynecol. Obstet. 136, 547–554 (1973).

    CAS  PubMed  Google Scholar 

  68. Iglesias, X. & Espuña, M. Surgical treatment of urinary stress incontinence using a method for postoperative adjustmant of sling tension (Remeex system). Int. Urogynecol. J. Pelvic Floor Dysfunct. 14, 326–330 (2003).

    Article  PubMed  Google Scholar 

  69. Araco, F., Gravante, G., Dati, S., Bulzomi, V., Sesti, F. & Piccione, E. Results of 1 year after the Reemex system was applied for the treatment of stress urinary incontinence caused by intrinsic sphincter deficiency. Int. Urogynecol. J. 19, 783–786 (2008).

    Article  CAS  Google Scholar 

  70. Giberti, C., Gallo, F., Cortese, P. & Schenone, M. The suburethral tension adjustable sling (REMEEX system) in the treatment of female urinary incontinence due to 'true' intrinsic sphincter deficiency: results after 5 years of mean follow-up. BJU Int. 108, 1140–1144 (2011).

    Article  PubMed  Google Scholar 

  71. Rutman, M. P., Deng, D. Y., Shah, S. M., Raz, S. & Rodríguez, L. V. Spiral sling salvage anti-incontinence surgery in female patients with a nonfunctional urethra: technique and initial results. J. Urol. 175, 1794–1799 (2006).

    Article  PubMed  Google Scholar 

  72. O'Donnell, P. D. & Doyle, R. Biofeedback therapy technique for treatment of urinary incontinence. Urology 37, 432–436 (1991).

    Article  CAS  PubMed  Google Scholar 

  73. Autry, M. G., Davis, J. W. & Sanders, R. Type III stress urinary incontinence: response to interdisciplinary pelvic physiotherapy. Urol. Nurs. 22, 251–255 (2002).

    PubMed  Google Scholar 

  74. Cardoza, L., Drutz, H. P., Baygani, S. K. & Bump, R. C. Pharmacological treatment of women awaiting surgery for stress urinary incontinence. Obstet. Gynecol. 104, 511–519 (2004).

    Article  CAS  Google Scholar 

  75. Viktrup, L. & Bump, R. C. Pharmacological agents used for the treatment of stress urinary incontinence in women. Curr. Med. Res. Opin. 19, 485–490 (2003).

    Article  CAS  PubMed  Google Scholar 

  76. Thor, K. B. Serotonin and norepinephrine involvement in efferent pathways to the urethral rhabdosphincter: implications for treating stress urinary incontinence. Urology 62 (4 Suppl. 1), 3–9 (2003).

    Article  PubMed  Google Scholar 

  77. Dmochowski, R. R. & Appell, R. A. Injectable agents in the treatment of stress urinary incontinence in women: where are we now? Urology 56 (6 Suppl. 1), 32–40 (2000).

    Article  CAS  PubMed  Google Scholar 

  78. Billings, E. Jr & May, J. W. Jr. Historical review and present status of free fat graft autotransplantation in plastic and reconstructive surgery. Plast. Reconstr. Surg. 83, 368–381 (1989).

    Article  PubMed  Google Scholar 

  79. Sweat, S. W. & Lightner, D. J. Complications of sterile abscess formation and pulmonary embolism following periurethral bulking agents. J. Urol. 161, 93–96 (1999).

    Article  CAS  PubMed  Google Scholar 

  80. Haab, F., Zimmern, P. E. & Leach, G. E. Urinary stress incontinence due to intrinsic sphincter deficiency: experience with fat and collagen periurethral injections. J. Urol. 157, 1283–1286 (1997).

    Article  CAS  PubMed  Google Scholar 

  81. Cross, C. A., English, S. F., Cespedes, R. D. & McGuire, E. J. A followup on transurethral collagen injection therapy for urinary incontinence. J. Urol. 159, 106–108 (1998).

    Article  CAS  PubMed  Google Scholar 

  82. Lightner, D. et al. A new injectable bulking agent for treatment of stress urinary incontinence: results of a multicenter, randomized, controlled, double-blind study of Durasphere. J. Urol. 58, 12–15 (2001).

    Article  CAS  Google Scholar 

  83. Ghoniem, G. et al. Cross-linked polydimethylsiloxane injection for female stress urinary incontinence: results of a multicenter, randomized, controlled, single-blind study. J. Urol. 181, 204–210 (2009).

    Article  PubMed  Google Scholar 

  84. Steele, A. C., Kohli, N. & Karram, M. M. Periurethral collagen injection for stress incontinence with and without urethral hypermobility. Obstet. Gynecol. 95, 327–331 (2000).

    CAS  PubMed  Google Scholar 

  85. FDA. Medical Devices: Device Approvals and Clearances: Coaptite®—P040047 [online], (2009).

  86. Misiek, D. J., Kent, J. N. & Carr, R. F. Soft tissue responses to hydroxylapatite particles of different shapes. J. Oral Maxillofac. Surg. 42, 150–160 (1984).

    Article  CAS  PubMed  Google Scholar 

  87. Mayer, R. D. et al. Multicenter prospective randomized 52-week trial of calcium hydroxylapatite versus bovine dermal collagen for treatment of stress urinary incontinence. J. Urol. 69, 876–880 (2007).

    Article  CAS  Google Scholar 

  88. Lightner, D. et al. Randomized controlled multisite trial of injected bulking agents for women with intrinsic sphincter deficiency: mid-urethral injection of Zuidex via the implacer versus proximal urethral injection of Contigen cystoscopically. J. Urol. 74, 771–775 (2009).

    Article  Google Scholar 

  89. Lightner, D. J., Fox, D. & Klingele, C. Cystoscopic injections of dextranomer hyaluronic acid into proximal urethra for urethral incompetence: efficacy and adverse outcomes. J. Urol. 75, 1310–1314 (2010).

    Article  Google Scholar 

  90. Hurtado, E., McCrery, R. & Appell, R. The safety and efficacy of ethylene vinyl alcohol copolymer as an intra-urethral bulking agent in women with intrinsic urethral deficiency. Int. Urogynecol. J. Pelvic Floor Dysfunct. 18, 869–873 (2007).

    Article  PubMed  Google Scholar 

  91. Radley, S. C., Chapple, C. R. & Lee, J. A. Transurethral implantation of silicone polymer for stress incontinence: evaluation of a porcine model and mechanism of action in vivo. BJU Int. 85, 646–650 (2000).

    Article  CAS  PubMed  Google Scholar 

  92. Tamanini, J. T., D'Ancona, C. A. & Netto, N. R. Macroplastique implantation system for female stress urinary incontinence: long term follow-up. J. Endourol. 20, 1082–1086 (2006).

    Article  PubMed  Google Scholar 

  93. Maher, C. F. et al. Pubovaginal sling versus transurethral macroplastique for stress urinary incontinence and intrinsic sphincter deficiency: a prospective randomized controlled trial. BJOG 112, 797–801 (2005).

    Article  PubMed  Google Scholar 

  94. Koelbl, H. et al. Transurethral injection of silicone microimplants for instrinsic urethral sphincter deficiency. Obstet. Gynecol. 92, 332–336 (1998).

    CAS  PubMed  Google Scholar 

  95. Barranger, E., Fritel, X., Kadoch, O., Liou, U. & Pigné, A. Results of transurethral injection of silicone micro-implants for females with intrinsic sphincter deficiency. J. Urol. 164, 1619–1622 (2000).

    Article  CAS  PubMed  Google Scholar 

  96. Radley, S. C., Chapple, C. R., Mitsogiannis, I. C. & Glass, K. S. Transurethral implantation of macroplastique for the treatment of female stress urinary incontinence secondary to urethral sphincter deficiency. Eur. Urol. 39, 83–389 (2001).

    Article  Google Scholar 

  97. Zullo, M. A. et al. Transurethral polydimethylsiloxane implantation: a valid option for the treatment of stress urinary incontinence due to intrinsic sphincter deficiency without urethral hypermobility. J. Urol. 173, 898–902 (2004).

    Article  CAS  Google Scholar 

  98. Ghoniem, G., Corcos, J., Comiter, C., Westney, O. L. & Herschorn, S. Durability of urethral bulking agent injection for female stress urinary incontinence: 2-year multicenter study results. J. Urol. 183, 1444–1449 (2010).

    Article  PubMed  Google Scholar 

  99. Gumus, I. I., Kaygusuz, I., Derbent, A., Simavli, S. & Kafali, H. Effect of the macroplastique implantation system for stress urinary incontinence in women with or without a history of an anti-incontinence operation. Int. Urogynecol. 22, 743–749 (2011).

    Article  Google Scholar 

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  1. Sol and Margaret Berger Department of Urology, Beth Israel Medical Center Phillips Ambulatory Care Center, 10 Union Square East, Suite 3A, New York, 10003, NY, USA

    Sovrin M. Shah & Geoffrey S. Gaunay

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Correspondence to Sovrin M. Shah.

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S. M. Shah has received honoraria from American Medical Systems. G. S. Gaunay declares no competing interests.

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Shah, S., Gaunay, G. Treatment options for intrinsic sphincter deficiency. Nat Rev Urol 9, 638–651 (2012). https://doi.org/10.1038/nrurol.2012.177

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