Abstract
The aim of the study was to asses the effectiveness of periurethral injection of autologous fat for the treatment of stress incontinence caused by inherent sphincter weakness in women following the repair of obstetric urogenital fistulae. Ten patients with symptomatic stress incontinence following repair of vesicovaginal or urethrovaginal fistula of obstetric origin were assessed clinically, by cystourethroscopy, and by Valsalva leak-point pressure (VLPP). Four showed some degree of bladder neck mobility and were treated by bladder neck suspension procedures. Six appeared to have pure sphincter weakness and were treated by periurethral injection of autologous fat. For logistic reasons, the initial follow-up was undertaken 2 weeks postoperatively, including clinical assessment and VLPP. Two patients were subjectively cured, 2 improved and 2 perceived no change in their symptoms following the procedure. The symptomatic changes correlated with the operative appearance, and with the subsequent changes in VLPP. Although numbers are small and follow-up short, we feel that these preliminary results justify further investigation of the technique in this most difficult group of patients.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Ashworth F. Urinary vaginal fistulae: a series of 152 patients treated in a small hospital in Ghana.West Afr M J 1973;22:39–43
Lawson JB. Injuries to the urinary tract. In: Lawson JB, Stewart DB, eds. Obstetrics and gynaecology in the tropics and developing countries. London: Edward Arnold, 1967:481–522
Waaldijk K. The surgical management of bladder fistula in 775 women in Northern Nigeria MD Thesis, Utrecht, 1989
Waaldijk K, Armiya'u YD. The obstetric fistula: a major public health problem still unsolved.Int Urogynecol J 1993;4:126–128
Martius H. Die operative Wiederherstellung der vollkommen fehlenden Harnrohre und des Schiessmuskels derselben.Zentralbl Gynäkol 1928;52:480
Hudson CN, Hendrickse JP de V, Ward A. An operation for restoration of urinary continence following total loss of the urethra.Br J Obstet Gynaecol 1975;82:501–504
Politano VA, Small MP, Harper JM, Lynne CM. Periurethral Teflon injection for urinary incontinence.J Urol 1974;111:180–183
Garibay SG, Jimeno C, York M, Gomez P, Borruell S. Autotransplantation endoscopique de tissu graisseux dans le trâitement de l'incontinence urinaire chez la femme.Jo d'Urol 1989;95:363–366
Santarosa RP, Blaivas JG. Periurethral injection of autologous fat for the treatment of sphincteric incontinence.J Urol 1994; 151:607–611
Scotti RJ, Zahreddine N, Mendelovici R Autologous periurethral fat injection for urinary incontinence. Proceedings of the International Urogynecologists Association, Nimes, France.Int Urogynecol J 1993;4:326A
Sand PK, Bowen LW, Panganiban R, Ostergard DR. The low pressure urethra as a factor in failed retropubic urethropexy.Obstet Gynecol 1987;69:399–402
Bowen LW, Sand PK, Ostergard DR, Franti CE. Unsuccessful Burch retropubic urethropexy: a case controlled urodynamic study.Am J Obstet Gynecol 1989;160:452–458
Hilton P. Clinical algorithms: urinary incontinence in women.Br Med J 1987;295:425–432
Cervigni M, Pericone C, Panei M. Periurethral autologous fat injection: long-term urodynamic and ultrasound follow-up. Proceedings of the International Urogynecologists Association, Toronto, Canada.Int Urogynecol J 1994;5:323A
Hilton P: Urodynamic findings in patients with urogenital fistulae. Proceedings of the International Urogynecologists Association, Kuala Lumpur, Malaysia.Int Urogynecol J 1995;6:243A
Nguyen A, Pasyk KA, bouvier TN, Hassett CA, Argenta LC. Comparative study of survival of autologous adipose tissue taken and transplanted by different techniques.Plast Reconstruct Surg 1990;85:387–389
Ersek RA. Transplantation of purified autologous fat: a 3-year follow-up is disappointing.Plas Reconstruct Surg 1991;87:219–227
Eppley BL, Sidner RA, Platis JM, Sadove AM. Bioactivation of free-fat transfers: a potential new approach to improving graft survical.Plast Reconstruct Surg 1992;90:1022–1030
Author information
Authors and Affiliations
Additional information
EDITORIAL COMMENT: The authors report an original concept for the treatment of intrinsic sphincter deficiency following obstetrical vesicovaginal fistula repair. Although preliminary, based on the authors' experience with a small group of patients and with minimal follow-up, this pilot study paves the way for future work in this area. The patients served have limited options for treatment from several aspects, including the severity of their incontinence, tissue health in the urogenital area, overall health, limited availability of other surgical options and general inaccessibility of medical care. The use of autologous fat for periurethral injection in this population of patients, where medical resources are limited, represents a simple, minimally invasive and relatively inexpensive option with possibly realistic success rates. Further investigation on the use of this technique to treat post-vesicovaginal fistula repair of intrinsic sphincter deficiency is needed to fully assess its applicability and success.
Rights and permissions
About this article
Cite this article
Hilton, P., Ward, A., Molloy, M. et al. Periurethral injection of autologous fat for the treatment of post-fistula repair stress incontinence: A preliminary report. Int Urogynecol J 9, 118–121 (1998). https://doi.org/10.1007/BF01982221
Issue Date:
DOI: https://doi.org/10.1007/BF01982221