Применение объемообразующего вещества на основе гиалуроновой кислоты при стрессовом недержании мочи у женщин
Применение объемообразующего вещества на основе гиалуроновой кислоты при стрессовом недержании мочи у женщин
Жевлакова М.М., Русина Е.И., Шелаева Е.В., Ярмолинская М.И. Применение объемообразующего вещества на основе гиалуроновой кислоты при стрессовом недержании мочи у женщин. Гинекология.
2024;26(1):59–67. DOI: 10.26442/20795696.2024.1.202623
Zhevlakova MM, Rusina EI, Shelaeva EV, Yarmolinskaya MI. The use of hyaluronic acid based bulking agent for stress urinary incontinence in women: A prospective controlled study. Gynecology. 2024;26(1):59–67.
DOI: 10.26442/20795696.2024.1.202623
Применение объемообразующего вещества на основе гиалуроновой кислоты при стрессовом недержании мочи у женщин
Жевлакова М.М., Русина Е.И., Шелаева Е.В., Ярмолинская М.И. Применение объемообразующего вещества на основе гиалуроновой кислоты при стрессовом недержании мочи у женщин. Гинекология.
2024;26(1):59–67. DOI: 10.26442/20795696.2024.1.202623
Zhevlakova MM, Rusina EI, Shelaeva EV, Yarmolinskaya MI. The use of hyaluronic acid based bulking agent for stress urinary incontinence in women: A prospective controlled study. Gynecology. 2024;26(1):59–67.
DOI: 10.26442/20795696.2024.1.202623
Введение. Парауретральное введение объемообразующих веществ у женщин – одна из малоинвазивных технологий лечения стрессового недержания мочи (СНМ). Эффективность и безопасность данного метода зависят от свойств вводимого вещества. Цель. Оценить результаты парауретральных инъекций гиалуроновой кислоты, «сшитой» 1,4-бутандиол диглицидиловым эфиром (EsteFILL® intim), в лечении СНМ у женщин репродуктивного и перименопаузального возраста. Материалы и методы. Обследованы 18 пациенток 45,8±5,0 года с СНМ легкой степени тяжести в сочетании с опущением половых органов 1–2-й степени. После общеклинического и специального исследований (дневники мочеиспускания, опросники Кинга и PISQ-12, кашлевой тест, комплексное уродинамическое исследование, ультразвуковое исследование уретровезикального сегмента и тазового дна с компрессионной эластографией) проведено парауретральное введение 4,0 мл препарата EsteFILL® intim. Изучены результаты терапии через 1 и 6 мес после процедуры. Результаты. Установлено, что введение препарата способствовало увеличению жесткости парауретральных тканей в 1,5 раза в течение 6 мес после процедуры. По результатам эластографии до лечения среднее значение коэффициента деформации парауретральных тканей задней стенки проксимального отдела уретры составило 0,66±0,46 (0,42–0,91), через 1 и 6 мес – 0,99±0,45 (0,76–1,23) и 1,00±0,36 (0,78–1,22) соответственно; р=0,009 и 0,018. Эффективность препарата EsteFILL® intim в лечении легких форм СНМ у женщин через 1 и 6 мес по результатам кашлевого теста составила 88,2 и 71,4%, согласно данным дневников мочеиспускания – 88,9 и 66,7%. В течение всего периода наблюдения пациентки отмечали уменьшение степени дискомфорта из-за СНМ и улучшение качества жизни. Заключение. Парауретральное введение препарата EsteFILL® intim способствует повышению жесткости поддерживающих структур уретры у пациенток с СНМ. Данный метод лечения СНМ эффективен для женщин репродуктивного и перименопаузального возраста с легкой степенью тяжести заболевания, не планирующих оперативное лечение, заинтересованных в достижении быстрого результата терапии и проинформированных о снижении эффекта с течением времени после процедуры.
Background. Paraurethral injection of bulking agents in women is one of the minimally invasive technologies for the treatment of stress urinary incontinence (SUI). The effectiveness and safety of this method depend on the properties of injected substance. Aim. To evaluate the results of paraurethral injections of 1,4-butanediol diglycidyl ether crosslinked high-density hyaluronic acid (EsteFILL® intim) in the treatment of SUI in women of reproductive and perimenopausal age. Materials and methods. We examined 18 patients aged 45.8±5.0 years with mild SUI in combination with grade I–II genital prolapse. After general clinical and special studies (urination diaries, King and PISQ-12 questionnaires, cough test, complex urodynamic study, urethrovesical segment and pelvic floor ultrasound with compression elastography) paraurethral injection of 4.0 ml EsteFILL® intim drug was performed. The results of therapy were studied 1 and 6 months after the procedure. Results. It was found that the injection of the drug contributed to an increase in the stiffness of paraurethral tissues by 1.5 times within 6 months after injection. According to the results of elastography before treatment, the average value of the strain ratio of paraurethral tissues of the proximal posterior wall of the urethra was 0.66±0.46 (0.42–0.91), after 1 and 6 months – 0.99±0.45 (0.76–1.23) and 1.00±0.36 (0.78–1.22) respectively; p=0.009 and 0.018. The effectiveness of EsteFILL® intim drug in the treatment of mild SUI in women after 1 and 6 months according to the results of a cough test was 88.2 and 71.4%, according to urination diaries – 88.9 and 66.7% respectively. During the entire observation period the patients noted a decrease in the degree of discomfort due to SUI and an improvement in the quality of life. Conclusion. Paraurethral injection of EsteFILL® intim drug helps to increase the stiffness of the urethra supporting structures in patients with SUI. This method of treating SUI is effective for women of reproductive and perimenopausal age with mild severity disease, 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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DOI:10.1055/s-0043-115736
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21. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13. DOI:10.1097/01.sla.0000133083.54934.ae
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1. Alves JO, Luz STD, Brandão S, et al. Urinary Incontinence in Physically Active Young Women: Prevalence and Related Factors. Int J Sports Med. 2017;38(12):937-41.
DOI:10.1055/s-0043-115736
2. AlQuaiz AM, Kazi A, AlYousefi N, et al. Urinary Incontinence Affects the Quality of Life and Increases Psychological Distress and Low Self-Esteem. Healthcare (Basel). 2023;11(12). DOI:10.3390/healthcare11121772
3. Sazonova NA, Kiseleva MG, Gadzhieva ZK, Gvozdev MYu. Urinary incontinence in women and its impact on quality of life. Urology. 2022;(2):136-9 (in Russian). DOI:10.18565/urology.2022.2.136-139
4. Kirchin V, Page T, Keegan PE, et al. Urethral injection therapy for urinary incontinence in women. Cochrane Database Syst Rev. 2017;7(7):CD003881. DOI:10.1002/14651858.CD003881.pub4
5. Neimark AI, Razdorskaia MV. Nederzhanie mochi u zhenshchin. Pod red. TA Nikolaevoi. Moscow: GEOTAR-Media, 2013 (in Russian).
6. Delancey JO. Why do women have stress urinary incontinence? Neurourol Urodyn. 2010;29(Suppl. 1):S13-7. DOI:10.1002/nau.20888
7. Serati M, Braga A, Salvatore S, et al. Up-to-Date Procedures in Female Stress Urinary Incontinence Surgery: A Concise Review on Bulking Agents Procedures. Medicina (Kaunas). 2022;58(6). DOI:10.3390/medicina58060775
8. Serati M, Braga A, Caccia G, et al. TVT-O for treatment of pure urodynamic stress urinary incontinence: Efficacy and adverse effects at 13-years follow-up. Neurourol Urodyn. 2020;39(5):1423-9. DOI:10.1002/nau.24358
9. Chapple C, Dmochowski R. Particulate Versus Non-Particulate Bulking Agents In The Treatment Of Stress Urinary Incontinence. Res Rep Urol. 2019;11:299-310. DOI:10.2147/RRU.S220216
10. Tsukanov AYu, Mirzakadiev AA, Dunkurs AV. Bulking agents in case of treatment of female stress urinary incontinence. Urology Herald. 2020;8(2):99-106 (in Russian). DOI:10.21886/2308-6424-2020-8-2-99-106
11. Bezhenar VF, Arakelyan BV, Krutova VA, et al. Urethral Bulking Agents in the Treatment of Stress Urinary Incontinence. Kuban Scientific Medical Bulletin. 2019;26(4):84-93 (in Russian). DOI:10.25207/1608-6228-2019-26-4-84-93
12. Tsukanov AYu, Mirzakadiev AA, Dunkurs AV. The first experience of injecting of bulking agents in mild stress incontinence in reproductive age womens. Experimental and Сlinical Urology. 2020;12(2):158-63 (in Russian). DOI:10.29188/2222-8543-2020-12-2-158-163
13. Galeeva AG. Lokal'noe izmenenie metabolizma kozhi pri vnutridermal'nom vvedenii nestabilizirovannoi gialuronovoi kisloty v eksperimente: avtoref. dis. …kand. med. nauk. Moscow, 2017 (in Russian).
14. Fundarò SP, Salti G, Malgapo DMH, Innocenti S. The Rheology and Physicochemical Characteristics of Hyaluronic Acid Fillers: Their Clinical Implications. Int J Mol Sci. 2022;23(18). DOI:10.3390/ijms231810518
15. Chechneva MA. Ul'trazvukovaia diagnostika prolapsa genitalii i nederzhaniia mochi u zhenshchin. Pod red. VI Krasnopol'skogo. Moscow: MEDpress-inform, 2016 (in Russian).
16. Rusina EI, Zhevlakova MM, Shelayeva EV, et al. Possibilities of elastography in the diagnosis of stress urinary incontinence in women. Journal of Obstetrics And Women’s Diseases. 2023;72(5):75-88 (in Russian). DOI:10.17816/JOWD501805
17. Rusina EI, Zhevlakova MM. Remote pelvic floor muscle training in the treatment of stress urinary incontinence in women. Journal of Obstetrics And Women’s Diseases. 2023;72(3):105-15 (in Russian). DOI:10.17816/JOWD430311
18. Pivazyan L, Kasyan G, Grigoryan B, Pushkar D. Effectiveness and safety of bulking agents versus surgical methods in women with stress urinary incontinence: a systematic review and meta-analysis. Int Urogynecol J. 2022;33(4):777-87. DOI:10.1007/s00192-021-04937-1
19. Hoe V, Haller B, Yao HH, O'Connell HE. Urethral bulking agents for the treatment of stress urinary incontinence in women: A systematic review. Neurourol Urodyn. 2021;40(6):1349-88. DOI:10.1002/nau.24696
20. Itkonen Freitas AM, Mentula M, Rahkola-Soisalo P, et al. Tension-Free Vaginal Tape Surgery versus Polyacrylamide Hydrogel Injection for Primary Stress Urinary Incontinence: A Randomized Clinical Trial. J Urol. 2020;203(2):372-8. DOI:10.1097/JU.0000000000000517
21. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13. DOI:10.1097/01.sla.0000133083.54934.ae
22. Rusina EI, Zhevlakova MM. Bulking agents for minimally invasive correction of stress urinary incontinence in women. Journal of Obstetrics and Women’s Diseases. 2023;72(5):75-88 (in Russian). DOI:10.17816/JOWD501805
23. Chapple CR, Haab F, Cervigni M, et al. An open, multicentre study of NASHA/Dx Gel (Zuidex) for the treatment of stress urinary incontinence. Eur Urol. 2005;48(3):488-94. DOI:10.1016/j.eururo.2005.05.007
24. Elzayat EA, Karsenty G, Bismar TA, Corcos J. Volume changes and histological response to injected dextranomer/hyaluronic acid copolymer (Zuidex) and collagen (Contigen) in rats. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(2):247-52. DOI:10.1007/s00192-007-0414-9
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