Effectiveness and safety of bulking agents versus surgical methods in women with stress urinary incontinence: a systematic review and meta-analysis

Pivazyan, L.G.; Kasyan, George; Grigoryan, Bagrat; Pushkar, Dmitry

doi:10.1007/s00192-021-04937-1

Cited by 23 publications

(9 citation statements)

References 41 publications

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“…The lower effectiveness of PDMS-U than MUS surgery is in line with a meta-analysis comparing surgical treatment with urethral bulk injection therapy (subjective improvement relative risk [RR = 0.70, 95% CI 0.53-0.92]). 26 The long-lasting, non-absorbable PDMS-U distinguishes itself from other bulking agents. In the light of costeffectiveness, this seems relevant.…”

Section: Discussionmentioning

confidence: 99%

Cost‐effectiveness of urethral bulking polydimethylsiloxane‐Urolastic® compared with mid‐urethral sling surgery for stress urinary incontinence: A two‐arm cohort study

Casteleijn

Vries

et al. 2023

BJOG

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Objective To investigate the cost‐effectiveness of urethral bulking polydimethylsiloxane‐Urolastic® (PDMS‐U) compared with mid‐urethral sling (MUS) surgery for stress urinary incontinence (SUI) at 1‐year follow‐up. Design Prospective, two‐arm cohort study with 2‐year follow‐up. Setting International multicentre. Population Women with moderate to severe SUI. Main outcome measures Primary outcome was subjective cure (Patient Global Impression of Improvement). Secondary outcomes: objective cure (negative cough stress test), Urogenital Distress Inventory (UDI‐6), complications and re‐interventions. Cost‐effectiveness outcomes: total costs, quality‐adjusted life year (QALY) using IIQ7‐scores (Incontinence Impact Questionnaire) and EQ‐5D‐5L, incremental cost‐effectiveness ratio (ICER) and monetary benefit (adjusted for baseline confounders). Results In all, 131 PDMS‐U and 153 MUS surgery patients were treated. Subjective cure rates for MUS surgery and PDMS‐U were, respectively: 101/112 (90%) versus 40/87 (46%), adjusted odds ratio (aOR; for age, body mass index [BMI], severity, type of urinary incontinence and previous SUI procedure) was 4.9. Objective cure rates for MUS surgery and PDMS‐U were respectively: 98/109 (90%) versus 58/92 (63%), aOR 5.4. Average total costs for PDMS‐U and MUS surgery were €3567 and €6688. ICER for MUS surgery cost €15 598 per IIQ QALY and €37 408 per EQ‐5D‐5L QALY. With a willingness to pay (WTP) of €25 000, MUS has a 84% chance of being cost‐effective using IIQ, whereas PDMS‐U has a 99% chance of being cost‐effective using EQ‐5D‐5L. Conclusion MUS surgery is more cost‐effective in realising improved disease‐specific quality of life (QoL), while PDMS‐U is more cost‐effective in realising improved generic QoL.

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Section: Discussionmentioning

confidence: 99%

Cost‐effectiveness of urethral bulking polydimethylsiloxane‐Urolastic® compared with mid‐urethral sling surgery for stress urinary incontinence: A two‐arm cohort study

Casteleijn

Vries

et al. 2023

BJOG

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“…Conservative therapy includes behavioral therapy, biofeedback, insertion of vaginal pessary, and pelvic floor muscle training [ 17 , 18 ]. More invasive procedures may be recommended to restore urethral continence if conservative treatments fail and can involve implantation of a midurethral mesh sling [ 5 ], injection of bulking agents [ 6 ], and Burch colposuspension [ 4 ]. These procedures achieve approximately 80% continence 1 year after surgery, but the continence rate has been shown to decrease over time [ 19 ].…”

Section: Urrent Therapies For Stress Urinary Incontinencementioning

confidence: 99%

“…Surgical treatments for anatomical incontinence include bladder neck suspension [ 4 ] and insertion of a midurethral sling [ 5 ]. Surgical treatment for ISD involves sling implantation and urethral submucosal injection of blocking agents (fat tissue, Teflon, collagen, or silicone) [ 6 ]. Nevertheless, an optimal treatment for all types of incontinence has not been established.…”

Section: Introductionmentioning

confidence: 99%

Stem-cell therapy in stress urinary incontinence: A review

Ding¹,

Li²

2022

Tzu Chi Medical Journal

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A BSTRACT The incidence of urinary incontinence (UI) is approximately 10%–40% in women, affecting one to two hundred million women worldwide. Stress UI (SUI) is characterized by involuntary urination due to increased abdominal stress and urine leakage without bladder contraction. Surgical treatments include midurethral slings, bulking agents, and Burch colposuspension to restore urethral continence. Nevertheless, an optimal treatment for all types of incontinence has not yet been established. Stem-cell therapy has emerged as a novel treatment for many diseases. Stem cells can self-renew and can differentiate into other cell types. Adult stem cells are suitable for clinical applications because they can be easily obtained noninvasively or minimal invasively. Stem-cell therapy for SUI has been studied preclinically and clinically. Muscle-derived progenitors have been used to treat SUI by promoting the regeneration of rhabdomyosphincters. The human trial used transurethral injection of autologous muscle-derived stem cells to improve sphincter contractility and function. Other sources of stem cells have also been studied in SUI treatment, such as umbilical cord blood, amniotic fluid, bone marrow, urine, and adipose tissue. The success rate of stem-cell therapy for SUI ranges from 13% to 100%. This review aimed to summarize the current status of stem-cell treatments for SUI, with respect to clinical trials, cell types, transplantation routes, and dosage volume and frequency.

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“…Urethral bulking (UB) is a well-established technique in the treatment of female stress and mixed urinary incontinence. Nevertheless, its relative inferiority in terms of clinical outcomes when compared to mid-urethral slings (MUS) was clearly stated by several works [ 1 , 2 ]. In fact, according to literature, the dry rate of UB can range from 16% to 50% despite a high satisfaction rate (up to 80% according to some studies) [ 2 , 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Urethral Bulking in the Treatment of Stress and Mixed Female Urinary Incontinence: Results from a Multicenter Cohort and Predictors of Clinical Outcomes

Giammò

Geretto

Ammirati

et al. 2022

JCM

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The aim of the present study is to analyze the outcomes of urethral bulking in the treatment of non-neurogenic female stress and mixed urinary incontinence and to assess predictors of clinical outcomes. We retrospectively included all consecutive patients affected by stress or mixed urinary incontinence and treated with urethral bulking. Outcomes were evaluated via the PGI-I questionnaire and the 24-h pad test. Between January 2010 and January 2020, we treated 216 patients (Bulkamid n = 206; Macro-plastique n = 10). The median age at surgery was 66 years (IQR 55–73.75). The median follow-up was 12 months (IQR 12–24). In total, 23.8% of patients were subjected to prior incontinence surgery, 63.8% of patients were affected by genuine stress urinary incontinence, 36.2% reported mixed urinary incontinence, whereas detrusor overactivity was confirmed in only 24.9%. The dry rate was 32.9%; nevertheless, 69.9% of patients declared themselves “very improved” or “improved” (PGI-I1-2). Low complications were observed, mostly classified as Clavien I. After univariate and multivariate analyses, the only statistically significant independent predictor of “dry” outcome was the 24 h pad test, p < 0.001. Urethral bulking could be proposed with more expectations of success in patients with mild urinary incontinence. Patients affected by moderate–severe incontinence are less likely to obtain clinical success; therefore, they should be carefully counselled about clinical expectations before the procedure.

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Effectiveness and safety of bulking agents versus surgical methods in women with stress urinary incontinence: a systematic review and meta-analysis

Cited by 23 publications

References 41 publications

Cost‐effectiveness of urethral bulking polydimethylsiloxane‐Urolastic® compared with mid‐urethral sling surgery for stress urinary incontinence: A two‐arm cohort study

Cost‐effectiveness of urethral bulking polydimethylsiloxane‐Urolastic® compared with mid‐urethral sling surgery for stress urinary incontinence: A two‐arm cohort study

Stem-cell therapy in stress urinary incontinence: A review

Urethral Bulking in the Treatment of Stress and Mixed Female Urinary Incontinence: Results from a Multicenter Cohort and Predictors of Clinical Outcomes

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