Urethral bulking agents for the treatment of stress urinary incontinence in women: A systematic review

Abstract

Aims: To perform a systematic review to assess and compare the efficacy and safety of all urethral bulking agents (UBAs) available for the treatment of stress urinary incontinence (SUI) in women.Methods: This systematic review was conducted in accordance with the PRISMA guideline. A systematic search was conducted using the Ovid Medline, Embase and PubMed databases. Studies were included if they involved women who underwent either Bulkamid®, Macroplastique®, Durasphere®, Coaptite®, or Urolastic® injections for the treatment of SUI. A total of 583 articles were screened with 56 articles included. A qualitative analysis was performed.Results: The newer synthetic UBAs are not inferior to Contigen®, with variable mean success rates of 30%-80% in the short-term. Better long-term success rates were found with Bulkamid® (42%-70%), Coaptite® (60%-75%), and Macroplastique® (21%-80%) on qualitative review. Urinary tract infection rates were similar between bulking agents (4%-10.6%) although temporary acute urinary retention was more commonly associated with Coaptite® (mean: 34.2%), and de novo urgency in Durasphere® (mean: 24.7%). Significant complications such as migration into lymph nodes was reported with Dura-sphere®. Erosion was reported with Macroplastique®, Coaptite®, and Urolastic®, with a rate as high as 24.6% in one study of Urolastic®. Conclusion: Available data support the use of Bulkamid® and Macro-plastique®, which has shown a short-term efficacy of 30%-90% and 40%-85% respectively, and long-term efficacy of 42%-70%, and 21%-80%, respectively. Bulkamid® appears to have a more favorable safety profile, with no cases of erosion or migration of product associated with its use. Direct comparisons of UBAs have not been performed.

Long‐term outcomes of polyacrylamide hydrogel treatment in women with stress urinary incontinence

“…The median reported pain score of 2 indicates that PAHG injections were generally well tolerated under local anaesthesia. The 5% UTI and 5% AUR rates in this study are comparable to the 1.6–40% UTI and 0.4–20% AUR rates reported by other studies [8]. No serious adverse event such as erosion or migration of product was noted in our study or in the literature, which is important when making comparisons with other UBAs in the long term.…”

Urinary Bladder Stone: A Late Complication of Bulkamid® Periurethral Bulking Injection

“…While no study directly compares polyacrylamide hydrogel (Bulkamid) to the other bulking agents, its safety and effectiveness profile has been demonstrated in numerous short-and medium-term studies. 5 Polyacrylamide hydrogel has widely been used in other medical specialities, including breast augmentation and facial fillers for cosmesis. Its suitability for in vivo soft tissue injection is owed to its non-biodegradability, non-toxicity, and resistance to migration and calcification long-term.…”

Sports Medicine and the Pelvic Floor

“…For a small number of athletes, conservative treatment and adjuncts for PFD will not be effective and onward referral to a (uro)gynecologist for the next step intervention is required. Depending on individual presentation, options range from urethral bulking agents (104) to surgical repair of pelvic organ support or a sling to support the bladder neck and continence mechanism (105). As with any invasive procedure, thorough multidisciplinary risk-benefit analyses with athlete centered decision making is important to identify whether surgical intervention is best indicated during or after their performance career.…”