Clinical and urodynamic evaluation in women with stress urinary incontinence treated by periurethral collagen injection

Collagen-Based Medical Devices for Regenerative Medicine and Tissue Engineering

Assisted reproductive technologies are key to solving the problems of aging and organ defects. Collagen is compatible with living tissues and has many different chemical properties; it has great potential for use in reproductive medicine and the engineering of reproductive tissues. It is a natural substance that has been used a lot in science and medicine. Collagen is a substance that can be obtained from many different animals. It can be made naturally or created using scientific methods. Using pure collagen has some drawbacks regarding its physical and chemical characteristics. Because of this, when collagen is processed in various ways, it can better meet the specific needs as a material for repairing tissues. In simpler terms, collagen can be used to help regenerate bones, cartilage, and skin. It can also be used in cardiovascular repair and other areas. There are different ways to process collagen, such as cross-linking it, making it more structured, adding minerals to it, or using it as a carrier for other substances. All of these methods help advance the field of tissue engineering. This review summarizes and discusses the current progress of collagen-based materials for reproductive medicine.

An Update on the Clinical Efficacy and Safety of Collagen Injectables for Aesthetic and Regenerative Medicine Applications

Soft tissues diseases significantly affect patients quality of life and usually require targeted, costly and sometimes constant interventions. With the average lifetime increase, a proportional increase of age-related soft tissues diseases has been witnessed. Due to this, the last two decades have seen a tremendous demand for minimally invasive one-step resolutive procedures. Intensive scientific and industrial research has led to the recognition of injectable formulations as a new advantageous approach in the management of complex diseases that are challenging to treat with conventional strategies. Among them, collagen-based products are revealed to be one of the most promising among bioactive biomaterials-based formulations. Collagen is the most abundant structural protein of vertebrate connective tissues and, because of its structural and non-structural role, is one of the most widely used multifunctional biomaterials in the health-related sectors, including medical care and cosmetics. Indeed, collagen-based formulations are historically considered as the "gold standard" and from 1981 have been paving the way for the development of a new generation of fillers. A huge number of collagen-based injectable products have been approved worldwide for clinical use and have routinely been introduced in many clinical settings for both aesthetic and regenerative surgery. In this context, this review article aims to be an update on the clinical outcomes of approved collagen-based injectables for both aesthetic and regenerative medicine of the last 20 years with an in-depth focus on their safety and effectiveness for the treatment of diseases of the integumental, gastrointestinal, musculoskeletal, and urogenital apparatus.

Should prophylactic anti-incontinence procedures be performed at the time of prolapse repair? Systematic review

INTRODUCTION AND HYPOTHESIS

Women with high-grade pelvic organ prolapse (POP) are considered at risk of developing postoperative stress urinary incontinence (SUI) once the prolapse has been repaired. The probable explanation for patients remaining subjectively continent is that POP can cause urethral kinking or compression. We hypothesized that performing prophylactic anti-incontinence procedures during surgical POP correction in women with no symptoms for urinary incontinence (UI) may prevent SUI postoperatively.

METHODS

A systematic review of randomized trials was performed. Participants were women with severe POP and no symptoms of SUI. The primary outcomes were UI or treatment for this condition after the surgical procedure. Results are presented as relative risk (RR), with 95% confidence interval (95% ).

RESULTS

Initially, 5,618 studies were identified by the search strategy, but only seven trials met the inclusion criteria. We performed a meta-analysis with common variables of studies and with the same scale of quantification. We found that performing an anti-incontinence procedure at the same time of prolapse repair reduced the incidence of SUI postoperatively (RR 0.51; 95% CI 0.38-0.68). However, when the types of anti-incontinence procedure were analyzed separately, we found different results. The subgroup of patients who underwent retropubic midurethral sling surgery was the only group that benefited from the anti-incontinence procedure, with a decrease in the incidence of SUI (RR 0.09; 95% 0.02-0.36).

CONCLUSIONS

Prophylactic treatment of women with severe POP using retropubic midurethral sling was the only procedure that reduced the risk of UI.

Fat Augmentation of the Anterior Vaginal Wall: A Novel Use of Fat Augmentation in Enhancing the Female Sexual Experience

This is a case series of 2 female patients with long-standing histories of decreased sexual function and pelvic organ prolapse who underwent augmentation of the anterior vaginal wall using autologous fat grafting, in conjunction with other cosmetic procedures. Fat augmentation of the anterior vaginal wall with its enhanced permanence could be a safe and long-lasting alternative to improve female sexual function in this group.

Retrospective evaluation of urethral bovine cross-linked collagen implantation for treatment of urinary incontinence in female dogs

BACKGROUND

Transurethral collagen injections are an alternative treatment for canine urinary incontinence. There is controversy regarding the long-term effectiveness of collagen and the impact urethral coaptation and injection site have on outcome.

HYPOTHESIS/OBJECTIVES

To evaluate outcome and client satisfaction after urethral collagen injections, and correlation between degree of urethral coaptation and collagen placement with outcome.

ANIMALS

Thirty-six procedures on 31 dogs, 10 with ureteral ectopia.

METHODS

Retrospective review of records and video evaluation of injection procedures. Follow-up communication with owners was performed between 1 and 56 months after bovine cross-linked collagen implantation to evaluate duration of continence, need for additional medical therapy, and owner satisfaction. Continence score was evaluated before and after the procedure, and after additional medical therapy, if needed. Injection location and degree of urethral coaptation was assessed with respect to duration of continence.

RESULTS

Dogs had a significant increase in continence score after the procedure. Mean (SD) duration of continence in dogs without addition of medication was 16.4 (15.2) months, and 5.2 (4.3) months in dogs needing additional medical therapy. No significant difference was found with respect to degree of coaptation. Median client satisfaction with the procedure was 100%.

CONCLUSIONS AND CLINICAL IMPORTANCE

Transurethral collagen implantation may be a viable option for treatment of female dogs with urethral sphincter mechanism incompetence, particularly after medical failure. Duration and degree of improvement are variable. Client satisfaction was excellent despite lack of complete continence in some dogs, and highlights the importance of discussing outcome expectations with owners.

Urinary incontinence

Urinary incontinence is a major health problem that becomes more common with increasing age. A thorough history and examination can help determine the type of incontinence: stress, urge, mixed, or other. Initial treatments may include lifestyle and behavioral modifications, pelvic floor exercises, and anticholinergic medications. Urologic referral is appropriate when initial treatment measures fail or in complex cases, such as previous incontinence surgery or irradiation.

Urethral bulking agents: techniques and outcomes

Stress urinary incontinence is a common health problem affecting women and interfering with their quality of life. The use of bulking agents for urethral augmentation seems to be a beneficial way of restoring continence in these patients while avoiding the risk of surgical intervention. Many agents are available for injection, but the ideal choice should be durable, nonmigratory, and hypoallergenic, while evoking healing with minimal scarring. We reviewed the literature to provide an update on the best techniques of bulking agent injection, to describe the different available injectable agents, and to give their outcome and possible complications.