{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T19:44:46Z","timestamp":1791229486427,"version":"4.1.0"},"reference-count":34,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2024,9,28]],"date-time":"2024-09-28T00:00:00Z","timestamp":1727481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Mixed urinary incontinence (MUI) has always represented a major therapeutic challenge and the management of this type of incontinence is often complicated by uncertain outcomes. Surgical options include interventions targeting both stress urinary incontinence (SUI) and urge urinary incontinence (UUI), although there are no international published guidelines that dictate whether it is better to start with surgical management to address the SUI or UUI component after the failure of conservative treatment. The aim of the present study is to evaluate the effectiveness of the Macroplastique (MPQ) procedure on overactive bladder (OAB) symptoms in women with MUI with a minimum follow-up of 1 year. Methods: A retrospective analysis of prospectively collected data was performed in two tertiary reference centers. We enrolled all women complaining of symptoms of SUI and OAB, dry or wet, with a urodynamically confirmed diagnosis of MUI [urodynamic stress incontinence (USI) with detrusor overactivity (DO)], who took a previous ineffective antimuscarinic treatment and underwent the MPQ procedure. We considered as objectively cured women who did not leak urine during the stress test and with a 1 h pad-test negative, while International Consultation on Incontinence Questionnaire\u2013Short Form (ICIQ-SF), ICIQ-OAB, Patient Global Impression of Improvement (PGI-I) scale, and a Visual Analogue Scale (VAS) were used to assess subjective outcomes. Results: A total of forty-six patients who met the inclusion criteria and who underwent the MPQ procedure were considered for the analysis. At the 1-year mark of follow-up, 72% of patients were objectively cured at stress test and 65% were objectively cured at pad-test, while 72% of women declared themselves subjectively cured. OAB symptoms significantly improved after MPQ and a complete resolution of OAB was recorded in 35% of patients. Conclusions: This study demonstrated that MPQ is a safe and effective option for the treatment of female MUI. Furthermore, MPQ significantly improves the symptoms of OAB and is able to completely cure this condition in a relevant percentage of women with MUI when pharmacological treatment fails.<\/jats:p>","DOI":"10.3390\/jcm13195810","type":"journal-article","created":{"date-parts":[[2024,9,30]],"date-time":"2024-09-30T06:39:35Z","timestamp":1727678375000},"page":"5810","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Urethral Bulking Agents for the Treatment of Urinary Incontinence: Efficacy, Safety, and Impact on the Overactive Bladder Symptoms with an Underlying Detrusor Overactivity"],"prefix":"10.3390","volume":"13","author":[{"given":"Maurizio","family":"Serati","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Rosaria","family":"Campitiello","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology and Physiopathology of Human Reproduction, ASL Salerno, 84131 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8853-5760","authenticated-orcid":false,"given":"Marco","family":"Torella","sequence":"additional","affiliation":[{"name":"Department of Gyanecology, Obstetric and Reproductive Science, Second University of Naples, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giada","family":"Mesiano","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Scancarello","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3949-5410","authenticated-orcid":false,"given":"Fabio","family":"Ghezzi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, 21100 Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Papadia","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Ente Ospedaliero Cantonale\u2014Civico Hospital, 6900 Lugano, Switzerland"},{"name":"Faculty of Biomedical Sciences, Universit\u00e0 della Svizzera Italiana, 6900 Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0483-7126","authenticated-orcid":false,"given":"Elena","family":"Gamarra","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetology, EOC\u2014Civico Hospital, 6900 Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"Caccia","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, EOC\u2014Beata Vergine Hospital, 6850 Mendrisio, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4877-0640","authenticated-orcid":false,"given":"Andrea","family":"Braga","sequence":"additional","affiliation":[{"name":"Faculty of Biomedical Sciences, Universit\u00e0 della Svizzera Italiana, 6900 Lugano, Switzerland"},{"name":"Department of Obstetrics and Gynecology, EOC\u2014Beata Vergine Hospital, 6850 Mendrisio, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,9,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s00192-009-0976-9","article-title":"An International Urogynecological Association (IUGA)\/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction","volume":"21","author":"Haylen","year":"2010","journal-title":"Int. Urogynecol. J."},{"key":"ref_2","first-page":"567","article-title":"Management of mixed urinary Incontinence","volume":"8","author":"Grimshaw","year":"2012","journal-title":"Women\u2019s Health"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1002\/nau.20698","article-title":"Mixed Incontinence: Comparing Definitions in Women Having Stress Incontinence Surgery","volume":"28","author":"Brubaker","year":"2009","journal-title":"Neurourol. Urodyn."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1007\/s11934-014-0461-y","article-title":"Mixed Incontinence: What Takes Precedence in Its Management?","volume":"15","author":"Lee","year":"2014","journal-title":"Curr. Urol. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1007\/s00192-023-05694-z","article-title":"Management of mixed urinary incontinence: IUGA committee opinion","volume":"35","author":"Jha","year":"2024","journal-title":"Int. Urogynecol. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1007\/s00192-011-1406-3","article-title":"Effectiveness of midurethral slings in mixed urinary incontinence: A systematic review and meta-analysis","volume":"22","author":"Jain","year":"2011","journal-title":"Int. Urogynecol. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/s00192-007-0449-y","article-title":"Follow-up of TVT operations in 1,113 women with mixed urinary incontinence at 7 and 38 months","volume":"19","author":"Husby","year":"2008","journal-title":"Int. Urogynecol. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.eururo.2022.01.045","article-title":"European Association of Urology Guidelines on the Diagnosis and Management of Female Non-neurogenic Lower Urinary Tract Symptoms. Part 1: Diagnostics, Overactive Bladder, Stress Urinary Incontinence, and Mixed Urinary Incontinence","volume":"82","author":"Nambiar","year":"2022","journal-title":"Eur. Urol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1097\/AOG.0000000000000929","article-title":"Change in Overactive Bladder Symptoms after Surgery for Stress Urinary Incontinence in Women","volume":"126","author":"Zyczynski","year":"2015","journal-title":"Obstet. Gynecol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1111\/j.1471-0528.2011.02915.x","article-title":"Persistence of urgency and urge urinary incontinence in women with mixed urinary symptoms after midurethral slings: A multivariate analysis","volume":"118","author":"Lee","year":"2011","journal-title":"Int. J. Obstet. Gynaecol."},{"key":"ref_11","first-page":"78","article-title":"Diagnosis, Evaluation, and Treatment of Mixed Urinary Incontinence in Women","volume":"17","author":"Chughtai","year":"2015","journal-title":"Rev. Urol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1111\/bju.14136","article-title":"Tension-free vaginal tape for treatment of pure urodynamic stress urinary incontinence: Efficacy and adverse effects at 17-year follow-up","volume":"122","author":"Braga","year":"2018","journal-title":"BJU Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1007\/s00192-022-05094-9","article-title":"The subjective and objective very long-term outcomes of TVT in the COVID era: A 20-year follow-up","volume":"33","author":"Braga","year":"2022","journal-title":"Int. Urogynecol. J."},{"key":"ref_14","unstructured":"Administration FDA (2021, August 16). Urogynecologic Surgical Mesh Implants, Available online: https:\/\/www.fda.gov\/medical-devices\/urogynecologic-surgical-mesh-implants\/fdas-activities-urogynecologic-surgical-mesh."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Serati, M., Braga, A., Salvatore, S., Torella, M., Di Dedda, M.C., Scancarello, C., Cimmino, C., De Rosa, A., Frigerio, M., and Candiani, M. (2022). Up-to-Date Procedures in Female Stress Urinary Incontinence Surgery: A Concise Review on Bulking Agents Procedures. Medicina, 58.","DOI":"10.3390\/medicina58060775"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.ejogrb.2015.03.025","article-title":"Urethral bulking agents versus other surgical procedures for the treatment of female stress urinary incontinence: A systematic review and meta-analysis","volume":"189","author":"Bogani","year":"2015","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Serati, M., Braga, A., Scancarello, C., De Rosa, A., Frigerio, M., Baruch, Y., Torella, M., Salvatore, S., and Ruffolo, A.F. (2023). Does the Polydimethylsiloxane Urethral Injection (Macroplastique\u00ae) Improve Sexual Function in Women, in Fertile Age, Affected by Stress Urinary Incontinence?. Medicina, 59.","DOI":"10.3390\/medicina59030580"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Serati, M., Scancarello, C., Mesiano, G., Cimmino, C., Campitiello, M.R., Salvatore, S., Ghezzi, F., Caccia, G., Papadia, A., and Braga, A. (Eur. Urol. Focus, 2024). Macroplastique Is a Safe and Effective Long-term Surgical Treatment for Stress Urinary Incontinence: Prospective Study with 10-Year Follow-up, Eur. Urol. Focus, In Press.","DOI":"10.1016\/j.euf.2024.07.010"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.maturitas.2019.12.007","article-title":"Efficacy and effectiveness of bulking agents in the treatment of stress and mixed urinary incontinence: A systematic review and meta-analysis","volume":"133","author":"Capobianco","year":"2020","journal-title":"Maturitas"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/S0002-9378(96)70243-0","article-title":"The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction","volume":"175","author":"Bump","year":"1996","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1002\/nau.23124","article-title":"International Continence Society Good Urodynamic Practices and Terms 2016: Urodynamics, uroflowmetry, cystometry, and pressure-flow study","volume":"36","author":"Rosier","year":"2016","journal-title":"Neurourol. Urodyn."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1002\/nau.20922","article-title":"Mixed incontinence: Comparing definitions in non-surgical patients","volume":"30","author":"Brubaker","year":"2011","journal-title":"Neurourol. Urodyn."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1007\/s00192-013-2213-9","article-title":"Reasons for dissatisfaction ten years after TVT procedure","volume":"25","author":"Aigmueller","year":"2014","journal-title":"Int. Urogynecol. J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1111\/luts.12262","article-title":"Pathophysiology of refractory overactive bladder","volume":"11","author":"Chen","year":"2019","journal-title":"Low. Urin. Tract Symptoms"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.ogc.2015.10.002","article-title":"Overactive Bladder","volume":"43","author":"White","year":"2016","journal-title":"Obstet. Gynecol. Clin. N. Am."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1016\/j.eururo.2019.02.038","article-title":"A Comprehensive Review of Overactive Bladder Pathophysiology: On the Way to Tailored Treatment","volume":"75","author":"Peyronnet","year":"2019","journal-title":"Eur. Urol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1097\/00005392-199907000-00069","article-title":"Urethral afferent nerve activity affects the micturition reflex; implication for the relationship between stress incontinence and detrusor instability","volume":"162","author":"Jung","year":"1999","journal-title":"J. Urol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1016\/j.juro.2013.10.068","article-title":"Solifenacin in women with de novo overactive bladder after tension-free obturator vaginal tapedis it effective?","volume":"191","author":"Serati","year":"2014","journal-title":"J. Urol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.1007\/s00192-017-3417-1","article-title":"De novo overactive bladder following midurethral sling procedures: A systematic review of the literature and meta-analysis","volume":"28","author":"Pergialiotis","year":"2017","journal-title":"Int. Urogynecol. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.maturitas.2022.05.007","article-title":"Urethral bulking agents for the treatment of recurrent stress urinary incontinence: A systematic review and meta-analysis","volume":"163","author":"Braga","year":"2022","journal-title":"Maturitas"},{"key":"ref_31","first-page":"747","article-title":"Bulking agents for the treatment of recurrent stress urinary incontinence: A suitable option?","volume":"74","author":"Serati","year":"2022","journal-title":"Minerva Urol. Nephrol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1111\/bju.14550","article-title":"Efficacy and safety of polydimethylsiloxane injection (Macroplastique\u00ae) for the treatment of female stress urinary incontinence: Results of a series of 85 patients with \u22653 years of follow-up","volume":"123","author":"Serati","year":"2019","journal-title":"BJU Int."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1002\/nau.1016","article-title":"Urethral instability: Clinical and urodynamic characteristics","volume":"20","author":"McLennan","year":"2001","journal-title":"Neurourol. Urodyn."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1111\/j.1464-410X.1993.tb06451.x","article-title":"Prevalence and significance of urethral instability in women with detrusor instability","volume":"72","author":"Wise","year":"1993","journal-title":"Br. J. Urol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/19\/5810\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:06:07Z","timestamp":1760112367000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/19\/5810"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,28]]},"references-count":34,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2024,10]]}},"alternative-id":["jcm13195810"],"URL":"https:\/\/doi.org\/10.3390\/jcm13195810","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,28]]}}}