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Injection Therapy for Urinary Incontinence

Sender Herschorn

Questions

1.Which of the following has been shown to be the ideal injectable agent?

a.Coaptite (Bioform Medical, San Mateo, CA)

b.Macroplastique (Cogentix Medical, Minnetonka, MN)

c.Durasphere EXP

d.Bulkamid (Contura International, Soeborg, Denmark)

e.None of the above

2.Which of the following statements about the mechanism of action of injectables is most correct?

a.It augments urethral mucosa.

b.Its mechanism is not yet defined.

c.It improves hermetic seal.

d.It creates obstruction.

e.It improves urethral coaptation.

3.Injectable agents are indicated for the treatment of stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD). Which of the following statements about urodynamics for ISD is TRUE?

a.The diagnostic and predictive value of urethral pressure profilometry in characterizing ISD has been proved.

b.The presence of hypermobility always raises the leak-point pressure (LPP), thus excluding ISD.

c.ISD is not present if the LPP is > 90 cm H2O.

d.Many studies have not confirmed the value of LPP in quantifying ISD.

e.A low urethral pressure profile (UPP) characteristically predicts the presence of ISD.

4.Which of the following statements about the usefulness of cystoscopy before injection is TRUE?

a.The relative degree of ISD versus hypermobility can be ascertained.

b.Adverse urethral factors such as scarring or diverticula can be assessed.

c.The amount of SUI can be assessed.

d.Bladder neck hypermobility, which contraindicates injectables, can be measured.

e.Cystoscopy should not be done before injectable agents.

5.Which of the following statements about injection techniques is TRUE?

a.Both the periurethral and transurethral techniques have shown similar results.

b.The transurethral technique can only be done with cystoscopic monitoring.

c.The periurethral technique always requires a general anesthetic.

d.The transurethral technique is more painful for patients.

e.The periurethral approach is more commonly done.

6.Which of the following injectable agents requires the use of a ratcheted injection gun?

a.Silicone microimplants (Macroplastique)

b.Carbon-coated zirconium beads (Durasphere)

c.Polyacrylamide hydrogel (Bulkamid)

d.Calcium hydroxylapatite (Coaptite)

e.Hyaluronic acid detranomer (Deflux) (Salix Pharmaceuticals, Raleigh, NC)

7.Which of the following statements regarding antibiotic prophylaxis for the use of injectable agents is TRUE?

a.One week of a second-generation cephalosporin is required.

b.Intravenous aminoglycoside must be given 1 hour pretreatment.

c.A fluoroquinolone or trimethoprim-sulfamethoxazole for 24 hours or less can be recommended.

d.A 3-day course of a fluoroquinolone has been shown in randomized studies of injectable agents to be most effective.

e.Prophylactic antibiotics are not effective for prevention of urinary tract infection (UTI).

8.Which of the following statements about reinjections is TRUE?

a.Reinjections never restore continence.

b.Reinjections should always be done within 1 week.

c.The site of reinjection should always be away from the previous injection site.

d.Long-term reinjections are superior to short-term.

e.The minimum timing for reinjections is variable and depends on the agent.

9.Which of the following methods of reporting injectable results may lead to an overestimate in success rate?

a.Eliminating the failures from the denominator

b.Reporting results after the first rather than the last treatment

c.Accounting for missing data by imputing a value based on a previous result (last observation carried forward, LOCF)

d.Use of a Kaplan-Meier curve to depict efficacy

e.a, b, and c are correct

.Which of the following is a rare complication of collagen injections for SUI?

a.Urinary infection

b.Urethrovaginal fistula

c.Hematuria

d.Urgency incontinence

e.Retention

.Which injectable agent was reported to migrate to pelvic lymph nodes seen in radiograph?

a.Porcine collagen

b.Silicone macroparticles

c.Carbon-coated zirconium beads

d.Bovine collagen

e.Autologous fat

.What is the minimum threshold for particle size that determines migration risk?

a.20 μm

b.40 μm

c.60 μm

d.80 μm

e.100 μm

.Which of the following complications were seen more frequently in the carbon-coated zirconium bead arm of collagen versus carbon-coated zirconium bead study?