Complications of urethral bulking therapy for female stress urinary incontinence

Abstract

Aims To review, report, and discuss the complications associated with urethral bulking therapy in female stress urinary incontinence. Methods An extensive nonsystematic literature review on complications associated with injectable bulking agents used in the clinical practice was conducted. We reviewed articles published in English and indexed in the PubMed, Embase, and Google Scholar databases. Original articles, case reports, and case series were taken into consideration. Data regarding the safety of injectable bulking agents and the complications associated with their utility within the context of urethral bulking therapy for female stress urinary incontinence were extracted and discussed. Results Approximately, 1/3 of the patients experience some type of a complication after urethral bulking therapy. The majority of these complications are of low grade, transient, do not necessitate additional surgical intervention, and amenable to treatment with conservative measures such as clean intermittent catheterization and antibiotics. However, more serious complications such as abscess formation, delayed hypersensitivity reactions, and vaginal erosion have been reported. Some of the injectable bulking agents have been withdrawn from the market because of their unfavorable adverse effect profile. Conclusions Urethral bulking therapy can be considered as a low‐risk procedure. However, it is not without complications which can be severe in rare instances. The search for the ideal urethral bulking agent is ongoing and future comparative studies assessing the safety and efficacy of these compounds in randomized controlled settings are warranted.

Patients' satisfaction and safety of bulk injection therapy Urolastic for treatment of stress urinary incontinence: A cross‐sectional study

“…Bulk injection therapy is known for the attractive safety profile, with having less complications as compared with open surgery 6,7 . Complications occur in one out of three patients and are mostly transient without requiring surgical treatment 21 . Our study shows a higher risk of complications (60% vs 24%) and higher number of reinterventions (18% vs 11%) compared with PDMS‐U outcomes reported in a systematic review 14 .…”

Bladder neck and urethral erosions after Macroplastique injections

“…When considering the use of a UBA in the treatment of SUI, the patient's previous medical and surgical history should be given serious consideration in order to avoid a potential future erosion or complication 13 . Patients who may be at risk for MPQ erosion include those who have undergone a prior midurethral sling removal, who may have damaged urethral walls from prior anti‐incontinence procedures, 6 patients with a previous history of pelvic radiotherapy, older patients who are receiving chemotherapy, those with a prior history of a urethral diverticulum repair, and older postmenopausal patients with thin poorly estrogenized tissues and an atrophic urethra.…”

“…Sx, symptom; UTI, urinary tract infection are likely to happen (80% in this series), and patients need to be appropriately counseled that they may ultimately need an autologous fascial sling. Involvement of a multidisciplinary team with experience in managing such complications is key to ensure the best outcomes.When considering the use of a UBA in the treatment of SUI, the patient's previous medical and surgical history should be given serious consideration in order to avoid a potential future erosion or complication 13. Patients who may be at risk for MPQ erosion include those who…”

Experience in application of modified sling in treatment of Moderate Stress Urinary Incontinence

“…Urethral dilation with appropriate strength can achieve obvious effect. 17 At present, there are many kinds of sling that can be used in clinic. Some of them are hard, always with postoperative complications such as local discomfort in the vagina and coital pain.…”