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The External Urethral Barrier for Stress Incontinence: A Multicenter Trial of Safety and Efficacy

From Rush Presbyterian St. Luke’s Medical Center, Chicago, Illinois; the Incontinence & Pelvic Support Institute, Mission Viejo, California; University of Arizona, Tuscon, Arizona; University of Pennsylvania, Philadelphia, Pennsylvania; and Fairchild Medical Center, Yreka, California.

Address reprint requests to: Linda Brubaker, MD Rush Presbyterian St. Luke’s Medical Center 1653 West Congress Parkway Chicago, IL 60612-3865 E-mail: lbrubake{at}rush.edu

Objective: To assess the efficacy and safety of an external urethral barrier for the management of mild to moderate stress urinary incontinence in adult women.

Methods: Four hundred eleven women with the symptom of stress urinary incontinence in 12 United States centers participated. Additional inclusion and exclusion criteria were applied before protocol device use, and ultimately 390 subjects began device use. Outcome measures for efficacy and safety were assessed. Efficacy was evaluated by the number of leakage episodes using a voiding diary, subjective urinary leakage severity, incontinence impact scores, and pad testing. Safety was evaluated by symptom assessment, urinalysis, urine culture, measurement of postvoid residual urine volume, vulvar cytology, vaginal culture, and (n = 81) cystometric testing.

Results: Efficacy was indicated by statistically significant reductions in the number of leakage episodes, subjective leakage severity scores, incontinence impact scores, and pad-test loss during device use. The data also indicated that the device was safe, as evidenced by the lack of statistically significant changes in the percentage of subjects with urinary tract infections during device use or in postvoid residual urine volume and cystometric indices. Symptoms of vulvar irritation or lower urinary tract discomfort occurred in a small percentage of subjects but were generally transient, and only three women discontinued using the device.

Conclusion: The external urethral barrier appears to be a safe nonsurgical alternative to absorbent products for the management of mild to moderate stress urinary incontinence in adult women.