Autologous

Whereas autologous fat is one of the bulking agents that is approved by the FDA, several other autologous materials are under consideration, such as autologous chondrocytes and bladder muscle cells. Periurethral autologous fat has been used as an inexpensive, biocompatible, and readily available periurethral bulking agent. The main disadvantages to using fat are the variability of reabsorption (50%-90%) attributed to lack of graft survival and the degree of eventual connective tissue replacement. As in all autologous grafts, survival depends on minimal handling that is afforded through the use of low suction pressure during liposuction and the use of large-bore needles. The procedure involves harvesting abdominal wall fat by lipo-suction usually under general anesthesia. The injection is usually performed via the periurethral/submucosal approach with a 16- or 18-gauge needle, to reduce the sheering forces generated through the longer needle of the transurethral approach.

Short-term success rates of autologous fat injection for ISD have ranged from 56% to 66%. Long-term survival rates of fat grafts of 10% to 50% have been reported. In 2001, Lee et al.4 reported a randomized, double-blind, placebo-controlled trial comparing autologous fat for periurethral injection versus saline. They reported a cure/improvement rate at 3-month follow-up of 22%. Interestingly, the cure/improvement rate for the placebo group was 20.7%. Haab et al.5 reported in a nonrandomized, prospective comparison of periurethral fat versus collagen injections. At 7-month follow-up, 13% of the fat group and 24% of the collagen group were cured. They also reported that the mean percentage of subjective improvement was significantly greater in the collagen group than in the fat group. The failure rate was significantly greater in the fat group compared with the collagen group.

Complications related to periurethral fat injections have been rare and include voiding difficulties (7.6%), de novo instability (3.8%), rectus muscle hematoma formation (3.4%), and urinary tract infection (3.4%-4.7%). Complications from the donor graft site harvest, such as abdominal wall pain, hematoma, and infection are expected depending on the size of graft harvest. Additional complications of urethral pseudolipoma and fat embolism, one of which was fatal, have been reported.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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