Injectable Biological Bulking Agent to Treat Stress Urinary Incontinence in Women: A Feasibility Pilot Study

Background: Urinary incontinence mainly affects women regardless of age and, as it affects their quality of life, influences work, sex life and independence for activities of daily living. The treatment of stress urinary incontinence including urethral volume injection therapy can provide an intermediate option over non-surgical and surgical therapies. One of the mechanisms for stress continence depends on the effective coaptation of the urethra during the increase in intra-abdominal pressure. The bulking agents can be injected transurethral or periurethral retrogradely, using direct vision from a cystoscope. Purpose: To evaluate the feasibility and preliminary outcome performance of the bacterial polysaccharide gel used as biological bulking agent applied in female patients with stress urinary incontinence. Methods: A prospective clinical pilot study was performed, in a single institution, including female patients who were admitted to the urologic outpatient clinic with Stress Urinary Incontinence (SUI) without previous treatments and they were selected and underwent bulking agent procedure. The evaluation was performed at the time of enrollment and 6 months after treatment. The primary outcome was Quality of Life (QOL) using the ICIQ-SF Questionnaire. The amount of urine leakage measured by the 1-HOUR PAD-TEST was the second outcome. Results: Fifteen women (with an average age of 53 years) were submitted to the application of bacterial cellulose gel and she was analyzed. Only two patients presented unchanged incontinence. The study considered as primary outcome the improvement or disappearance of symptoms after six months of intervention. Post-intervention Quality of Life (QOL) questionnaire indicated that all of these patients related a better quality of life (62.5%). Through the PAD-test it was possible to observe a decrease in urinary leak of 85% comparing the results pre and post-intervention (BCA—Bacterial Cellulose Application) with p-value equal to 0.000009. Conclusions: The results of this pilot study suggest that the use of biological bulking agent is a promising approach to treat stress urinary incontinence in female patients. Trial registration: Registration number and date of registration should be instated in this section.

Endoscopicandimagingappearanceafterinjectionofanano-rectalbulking agent

The use of hyaluronic acid and dextranomer (Solesta, Salix) injection in the anal canal is an emerging modal-ity in the treatment of fecal incontinence. However, little is known regarding the endoscopic and radiological appearance following injection of this ano-rectal bulking agent. We report computed tomography and endoscopic findings after hyaluronic acid/dextranomer injection in the ano-rectal area.

Effects of adding bulking agents on the biodrying of kitchen waste and the odor emissions produced

The effects of adding a bulking agent on the performance and odor emissions（ammonia and eight sulfur-containing odorous compounds） when biodrying kitchen waste were investigated. Three treatments were considered： the addition of either cornstalks（CS） or wood peat（WP） to kitchen waste as a bulking agent before biodrying, and a control treatment（CK）. The water-removal rates for CK, CS, and WP treatments were 0.35, 0.56, and0.43 kg/kg, respectively. Addition of bulking agents to kitchen waste produced less leachate,higher moisture-removal rates, and lower consumption of volatile solids. The CS treatment had the highest biodrying index（4.07）, and those for the WP and CK treatments were 3.67 and 1.97, respectively. Adding cornstalks or wood peat decreased NH3 emissions by 55.8%and 71.7%, respectively. Total sulfur losses were 3.6%–21.6% after 21 days biodrying, and H2 S and Me2 SS were the main（〉 95%） sulfur compounds released. The smallest amounts of sulfur-containing odorous compounds were emitted when cornstalks were added, and adding cornstalks and wood peat decreased total sulfur losses by 50.6%–64.8%.

Influence of bulking agents on CH_4,N_2O,and NH_3 emissions during rapid composting of pig manure from the Chinese Ganqinfen system

Mismanagement of the composting process can result in emissions of CH4,N2O,and NH3,which have caused severe environmental problems.This study was aimed at determining whether CH4,N2O,and NH3 emissions from composting are affected by bulking agents during rapid composting of pig manure from the Chinese Ganqinfen system.Three bulking agents,corn stalks,spent mushroom compost,and sawdust,were used in composting with pig manure in 60 L reactors with forced aeration for more than a month.Gas emissions were measured continuously,and detailed gas emission patterns were obtained.Concentrations of NH3 and N2O from the composting pig manure mixed with corn stalks or sawdust were higher than those from the spent mushroom compost treatment,especially the sawdust treatment,which had the highest total nitrogen loss among the three runs.Most of the nitrogen was lost in the form of NH3,which accounts for 11.16% to 35.69% of the initial nitrogen.One-way analysis of variance for NH3emission showed no significant differences between the corn stalk and sawdust treatments,but a significant difference was noted between the spent mushroom compost and sawdust treatments.The introduction of sawdust reduced CH4emission more than the corn stalks and spent mushroom compost.However,there were no significant differences among the three runs for total carbon loss.All treatments were matured after 30 d.

Effect of airflow on biodrying of gardening wastes in reactors

Biodrying consists of reducing moisture by using the heat from aerobic bio-degradation.The parameters that control the process are：aeration,temperature during the process,initial moisture of biowaste,and temperature and relative humidity of the input air.Lawn mowing and garden waste from the gardens of the University Jaume I,Castellón（Spain）were used as a substrate.Biodrying was performed in 10 reactors with known air volumes from 0.88 to 6.42 L/（min·kg dry weight）.To promote aeration,5 of the reactors had 15% of a bulking agent added.The experiment lasted 20 days.After the experiments it was found that the bulking agent led to greater weight loss.However,the increased airflow rate was not linearly proportional to the weight loss.

Internal anal sphincter augmentation and substitution

There is an increasing recognition of the importance of internal anal sphincter(IAS)dysfunction presenting as passive faecal incontinence.This problem may manifest after anal sphincterotomy or following the more minimally invasive operations for haemorrhoids,as well as with advancing age.Because of the poor results of IAS plication and the beneficial outcomes with peri-urethral bulking agents in urology,these materials have been developed for use in IAS dysfunction.This review outlines the basic purported mechanisms of action,defining the materials in clinical use,their methods of deployment,complications and reported outcomes.There is still much that is unknown concerning the ideal agent or the volume and the technique of deployment,which will only be answered by powerful,prospective,randomized,controlled trials.The specific role of autologous stem cells designed to regenerate the sphincters in cases of functional impairment or muscle loss is yet to be seen.