{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T15:30:09Z","timestamp":1748964609586,"version":"3.37.3"},"reference-count":16,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2016,3,14]],"date-time":"2016-03-14T00:00:00Z","timestamp":1457913600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100004348","name":"Stockholms L\u00e4ns Landsting","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004348","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004047","name":"Karolinska Institutet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2016,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The efficacious and safe use of transurethral injections of polyacrylamide hydrogel (Bulkamid<jats:sup><jats:bold>\u00ae<\/jats:bold><\/jats:sup>) in women with stress urinary incontinence suggests that it may be suitable also for treatment of anal incontinence. We aimed to determine the effectiveness and safety of polyacrylamide hydrogel when used as a transanal submucosal bulking agent in women with anal incontinence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>Thirty women with a diagnosis of anal incontinence and a Cleveland Clinic Incontinence Score (<jats:styled-content style=\"fixed-case\">CCIS<\/jats:styled-content>) &gt;10 were randomized to three different techniques of transanal submucosal injections using polyacrylamide hydrogel. Follow up was performed at 2, 6 and 12 months using <jats:styled-content style=\"fixed-case\">CCIS<\/jats:styled-content> and the Fecal Incontinence Quality of Life scale (<jats:styled-content style=\"fixed-case\">FIQL<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In all, 29 of the 30 women completed the follow up. Approximately half of the women requested a re\u2010injection at the 6\u2010month visit. The overall <jats:styled-content style=\"fixed-case\">CCIS<\/jats:styled-content> improved significantly from baseline (14.7. <jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content> 2.5) to 1 year (12.4. <jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content> 3.1) (<jats:italic>p<\/jats:italic> = 0.003). There was a significant improvement with regard to the occurrence of loose fecal incontinence (<jats:italic>p<\/jats:italic> = 0.014) but not for solid fecal incontinence (<jats:italic>p<\/jats:italic> = 0.28). At 1 year the <jats:styled-content style=\"fixed-case\">FIQL<\/jats:styled-content> domains of coping\u2010behavior, depression, and embarrassment showed significant improvements (<jats:italic>p<\/jats:italic> = 0.012, <jats:italic>p<\/jats:italic> = 0.007 and <jats:italic>p<\/jats:italic> = 0.007, respectively). We recorded no adverse events related either to the injection technique or the biomaterial. There were no significant differences between the treatment groups in either <jats:styled-content style=\"fixed-case\">CCIS<\/jats:styled-content> or <jats:styled-content style=\"fixed-case\">FIQL<\/jats:styled-content> scores.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Transanal submucosal injection of polyacrylamide hydrogel resulted in a modest although significant overall improvement in anal incontinence symptom scores with corresponding improvements in several domains of quality of life, regardless of injection volume.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.12866","type":"journal-article","created":{"date-parts":[[2016,2,11]],"date-time":"2016-02-11T14:50:41Z","timestamp":1455202241000},"page":"528-533","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Transanal submucosal polyacrylamide gel injection treatment of anal incontinence: a randomized controlled trial"],"prefix":"10.1111","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0648-3758","authenticated-orcid":false,"given":"Daniel","family":"Altman","sequence":"first","affiliation":[{"name":"Stockholm Urogynecological Clinic Stockholm Sweden"},{"name":"Department of Clinical Sciences Karolinska Institute Danderyd Hospital Danderyd Sweden"},{"name":"Department of Statistics and Quantitative Methods University of Milano\u2010Bicocca Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2635-5996","authenticated-orcid":false,"given":"Fredrik","family":"Hjern","sequence":"additional","affiliation":[{"name":"Division of Surgery Department of Clinical Sciences Karolinska Institute Danderyd Hospital Danderyd Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9656-8394","authenticated-orcid":false,"given":"Jan","family":"Zetterstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Karolinska Institute Danderyd Hospital Danderyd Sweden"},{"name":"Gynecological Clinic Sophiahemmet Hospital Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2016,3,14]]},"reference":[{"key":"e_1_2_9_2_1","first-page":"2","article-title":"Perianal injectable bulking agents as treatment for faecal incontinence in adults","volume":"28","author":"Maeda Y","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-012-1761-8"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2014.03.109"},{"volume-title":"International Classification of Diseases and Health 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