Obstetrics & Gynaecology Forum Volume 29 | Issue 3 | 2019

O&G Forum 2019; 29: 7 - 10 REVIEW guide practice. Additionally, the review mentions that the discovery that placebo saline injection results in equivalent improvement in symptoms raises concerns about the actual mechanism of e ect in bulking agents. 21 In a 2015 article, Pai and Al-Singary report on three year follow up of patients who underwent bulking with Bulkamid in Worthing Hospital in the United Kingdom. Local anaesthetic was used in the majority of cases, with a mean procedure time of 9 minutes, no adverse reactions, and no signi cant safety issues. At three months, 82% of patients reported improvement of subjective cure, with the satisfaction preserved at 38 month follow up, demonstrated in the VAS as well as the ICIQ scores. 22 A 2016 systematic review by Kasi et al which included 8 studies (n= 767) found a signi cant reduction of the number of incontinence epi- sodes/24 hours, number of ml/24 hour and signi cant improvement in quality of life at 1 year following treatment with Bulkamid2. 23 2.6. Arti cial Urinary Sphincter (AUS): ere is a paucity of good data with regards to the use of the arti cial urinary sphincter in women. 11 ere are few studies quoting actual e cacy rates, but with proper patient selection and adequate surgical expertise, e cacy in females is thought to be adequate, although dura- bility in the long term is unproven. 11 Indications for use include female urinary incontinence are refractory stress urinary incontinence second- ary to intrinsic sphincter de ciency in bladders with normal compliance and detrusor function. It works best in patients who are motivated and dexterous enough to use the pump. 24 e 6 th ICI recommends that the use of AUS in females should be restricted to select individuals, a er meticulous counselling focused on the possible need for revision, as well as the scarcity of long term, good quality data. 11 2.7. Stem Cells: Stem cell technology has been proposed for use in stress urinary inconti- nence for more than 10 years. Its use is not advised in patients currently other than in the setting of research or for clinical trials. 11 Special considerations: Previous epidemiological studies have suggested a higher prevalence of SUI in younger women, who tend also to be more physically active. However, it continues to play a signi cant role in incontinence in the elderly. Management of the condition has generally focused on middle aged women, with data pertaining to SUI at the extremes of age being limited. Robinson et al published a 2015 review of the albeit scanty data available on the treatment of SUI in the young (less than 40 years of age, pre-menopausal) and the elderly. ey suggest that in the younger pa- tient with SUI, cardinal concerns are the possibility of future child-bear- ing, as well as the safety and durability of any proposed anti-incon- tinence procedure. Treatment of elderly patients who may be frail or have multiple comorbidities may be centred around minimally invasive techniques with low complication rates and morbidity. 25 References: 1. Haylen BT, de Ridder D, Freeman R, Swi SE, Berghmans B, Lee J, Monga A, et al. An international urogynaecological association (IUGA)/International continence society (ICS) joint report on the terminology for female pelvic oor dysfunction. Int Urogynecol J. 2009;21(1):5-26 2. Linda Cardozo and David Staskin. Textbook of Female Urology and Urogynecology, Fourth Edition - Two-Volume Set (p. 551). CRC Press. Kindle Edition 3. American Urological Association and the Society of Urodynamics. Diagnosis and treatment algorithm: AUA/SUFU guideline on non-neurogenic overactive bladder in adults. Linthicum, MD 2014. 4. White N, Iglesia CB. Overactive bladder. Obstet Gynecol Clin N Am. 2016;43:59–68 http://dx.doi.org/10.1016/j.ogc.2015.10.002 5. Duthie JB, Vincent M, Herbison GP, Wilson DI, Wilson D. Botulinum toxin injections for adults with overactive bladder syndrome. Cochrane Database of Systematic Reviews 2011, Issue 12. Art. No.: CD005493. DOI: 10.1002/14651858.CD005493.pub3 6. John Heesakkers J, van Breda J. Peripheral Neuromodulation. In: Cardozo L, and Staskin D (ed)s. Textbook of Female Urology and Urogynecology, Fourth Edition - Two-Volume Set (p. 548- 547). CRC Press. Kindle Edition. 7. EAU Guidelines. Edn. presented at the EAU Annual Congress Copenhagen 2018. ISBN 978-94-92671-01-1. EAU Guidelines O ce, Arnhem, e Netherlands. http://uroweb.org/guidelines/compilations-of-all-guidelines/ 8. De Wall LL, Heesakkers JPFA. E ectiveness of percutaneous tibial nerve stimulation in the treatment of overactive bladder syndrome. Res Rep Urol. 2017:9 145–157 9. Ruud Bosch JLH. Sacral Neuromodulation in the Treatment of Female Overactive Bladder Syndrome and Nonobstructive Urinary Retention. In: In: Cardozo L, and Staskin D (ed)s. Textbook of Female Urology and Urogynecology, Fourth Edition - Two-Volume Set (p. 557- 564). CRC Press. Kindle Edition. 10. Gormley EA, Lightner DJ, Faraday M, et al. Diagnosis and treatment of overactivebladder (non-neurogenic) in adults: AUA/SUFU guideline. J Urol 2015;193(5):1572–80 11. Rovner E, Athanasiou S, Choo M, Cossin M, Dmochowski R, Gomelsky A, et al. Surgery for urinary incontinence in women. In P Abrams, L Cardozo, S Khoury, and A Wein, eds. WHO-ICUD International Consultation on Incontinence, 6th ed. Paris, France, 2017, pp. 1743– 1854 12. Herbison GP, Arnold EP.Sacral neuromodulation with implanted devices for urinary storage and voiding dysfunction in adults. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD004202. DOI: 10.1002/14651858.CD004202.pub2 13. Amundsen CL, Richter HE, Menefee SA, Komesu YM, Arya LA, Gregory TW, et al. Onabotulinumtoxin A vs Sacral Neuromodulation on Refractory Urgency Urinary Incontinence in Women: A Randomized Clinical Trial. JAMA 2016; 316(13): 1366–1374. doi:10.1001/jama.2016.14617 14. Reyblat P, Ginsberg DA. Augmentation cystoplasty: what are the indications? Curr Urol Rep 2008;9: 452-458. https://doi.org/10.1007/s11934-008-0078-0 15. Novara G, Artibani W, Barber MD, Chapple CR, Costantini E, Ficarra V, et al. Updated Systematic Review and Meta-Analysis of the Comparative Data on Colposuspensions, Pubovaginal Slings, and Midurethral Tapes in the Surgical Treatment of Female Stress Urinary Incontinence. Eur Urol. 2017; 58: 218-238. 16. Glazener CMA, Cooper K, Mashayekhi A. Anterior vaginal repair for urinary incontinence in women. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD001755. DOI: 10.1002/14651858.CD001755.pub2. 17. Lapitan MCM, Cody JD, Mashayekhi A. Open retropubic colposuspension for urinary incontinence in women. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD002912. DOI: 10.1002/14651858.CD002912.pub7. 18. Brothers A, Osborn DJ, Kaufman MR, Reynolds WS, Dmochowski RR. Fascial slings. In: Cardozo L, and Staskin D (ed)s. Textbook of Female Urology and Urogynecology, Fourth Edition - Two-Volume Set (p. 830- 837). CRC Press. Kindle Edition. 19. Nilsson CG. Tension-Free Vaginal Tape Procedure For Treatment of Female Urinary Stress Incontinence. In: Cardozo L, and Staskin D (ed)s. Textbook of Female Urology and Urogynecology, Fourth Edition - Two-Volume Set (p. 838- 845). CRC Press. Kindle Edition. 20. Linder BJ, Wanzek P, Lightner DJ. Injectable Bulking Agents in the Treatment of Female Stress Urinary Incontinence. In: Cardozo L, and Staskin D (ed)s. Textbook of Female Urology and Urogynecology, Fourth Edition - Two-Volume Set (p. 564- 572). CRC Press. Kindle Edition. 21. Kirchin V, Page T, Keegan PE, Atiemo KOM, Cody JD, McClinton S, Aluko P. Urethral injection therapy for urinary incontinence in women. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD003881. DOI: 10.1002/14651858.CD003881.pub4. 22. Pai A, Al-Singary W. Durability, safety and e cacy of polyacrylamide hydrogel (Bulkamid®) in the management of stress and mixed urinary incontinence: three year follow up outcomes. Cent European J Urol. 2015; 68: 428-433 23. Kasi AD, Pergialiotis V, Perrea DN, Khunda A, Stergios K. Polyacrylamide hydrogel(BulkamidR) for stress urinary incontinence in women: a systematic review of the literature. Int Urogynecol J. 2016; 27(3): 367-375 24. Castro-Diaz D, Staskin D, Dmochowski RR. Arti cial Urinary Sphincter for Treatment of Stress Urinary Incontinence in Women In: Cardozo L, and Staskin D (ed)s. Textbook of Female Urology and Urogynecology, Fourth Edition - Two-Volume Set (p. 885-890). CRC Press. Kindle Edition. 25. Robinson D, Castro-Diaz D, Giarenis I, Toozs-Hobson P, Anding R, Burton C, Cardozo L. What is the best surgical intervention for stress urinary incontinence in the very young and the very old? An international Consultation on incontinence research society update. Int Urogynecol J. 2015;26:1599–1604 DOI 10.1007/s00192-015-2783-9 OBSTETRICS & GYNAECOLOGY FORUM 2019 | ISSUE 3 | 10