Is Injection Therapy for Stress Urinary Incontinence Dead? Yes

摘要

Urethral bulking agents were first developed in the early 1970s and refined in an age before mid-urethral slings as a less-invasive therapy for female stress urinary incontinence. At their inception, the only alternative therapies available to women were either vastly more invasive, as in the case of open culposuspension and autologous fas-cial sling, or of questionable durability, as in the case of vaginal needle suspensions. Secondary to the ease in placement and perceived low rates of complication, this type of therapy persisted and continued to evolve, despite the known deficiencies in efficacy and durability.1'3 However, since the introduction by Ulmsten in 19954 of the transvaginal tape (TVT) procedure, a true alternative to more invasive procedures has evolved. Modern mid-urethral slings not only have low complication rates, but also equal rates of efficacy compared with previous standards of therapy that bulking agents have aspired to but never achieved. The TVT is considered by some to be the new reference standard of therapy for stress urinary incontinence and, in assuming that role, has obviated the need for injectable therapy