Intraurethral bulking agents for the management of female stress urinary incontinence: a systematic review

Abstract

There are a range of complications associated with UBAs, the most common being urinary tract infection. However, it remains a very well tolerated procedure in the majority of patients. UBAs should be considered as an alternative in patients unsuitable for more invasive procedures and those willing to accept the need for repeat injections. The majority of the literature focuses on subjective improvement measures rather than objective improvement measures. Further randomized controlled trials directly comparing UBAs are required to indicate the most effective agent.

Complications of urethral bulking therapy for female stress urinary incontinence

“…Meta‐analyses have been reported for single agents, such as Macroplastique . Recently, a systematic review which focused principally on the safety and efficacy of Macroplastique and Bulkamid has been published . However, there exists no meta‐analyses or systematic reviews evaluating all of the recently available bulking agents in the treatment of SUI.…”

“…In their recent systematic review focusing mainly on Bulkamid™ and Macroplastique™, Siddiqui et al have found out that urinary tract infection (UTI) was the most common adverse effect of UBT, with an overall incidence approximating 11%. Implantation site pain and acute urinary and dysuria were the other leading complications which were encountered in 5‐10% of the patients . de Vries et al, who conducted a more extensive literature review on complications associated with the bulking agents used in the clinical practice in the last 15 years, identified a total of 2095 complications in 6462 patients and 110 complications in 49 patients who were involved in 79 original studies and 38 case reports, respectively .…”

“…However, there is a need for less invasive alternatives especially for patients who are unfit for and/or unwilling to undergo surgeries, for those who have recurrent SUI after failed anti‐incontinence procedure(s) and for those in whom surgical options are limited (eg, prior radical pelvic surgery or pelvic radiotherapy) . Additionally, the use of midurethral slings has been recently questioned in relation to mesh complications including infection, chronic pain and erosion, which have led to their withdrawal from the market in several countries . Urethral bulking therapy (UBT) can have a role in the management of these “non‐index” clinical scenarios as well as some selected primary cases, since it is a minimally invasive, well tolerated, outpatient procedure which is associated with acceptable success rates especially in the short‐term.…”

How cure rates drive patients' preference for urethral bulking agent or mid‐urethral sling surgery as therapy for stress urinary incontinence

“…Cohort studies of bulking agent Urolastic report results lower to this threshold with subjective and objective cure rates of 56% to 68% and 59% to 65%, respectively, after 6‐ and 12‐month follow‐up . A systematic review of other bulking agents show on the other hand subjective and objective success rates up to 89% and 73% …”

“…With a low complication rate of 0% to 5.7%, the safety profile seems to be better than MUS surgery . Variable clinical success rates of UBA of 50% to 89% after 1‐year follow‐up are reported . The National Institute for Health and Care Excellence and the European Association of Urology (EAU) guidelines recommend UBA to be used for short‐term management of SUI if conservative management has failed.…”