The efficacy and safety of urethral injection therapy for urinary incontinence in women: a systematic review

Abstract

To evaluate the efficacy and safety of different bulking agents for treating urinary incontinence in women, a systematic review including only randomized controlled trials was performed. The subjects were women with urinary incontinence. The primary outcomes were clinical and urodynamic parameters. The results were presented as a weighted mean difference for non-continuous variables and as relative risk for continuous variables, both with 95% confidence intervals. Initially, 942 studies were identified. However, only fourteen eligible trials fulfilled the prerequisites. Altogether, the review included 1814 patients in trials of eight different types of bulking agents, and all studies were described and analyzed. The measured outcomes were evaluated using a large variety of instruments. The most common complications of the bulking agents were urinary retention and urinary tract infection. Additionally, there were certain major complications, such as one case of death after use of autologous fat. However, the lack of adequate studies, the heterogeneous populations studied, the wide variety of materials used and the lack of long-term follow-up limit guidance of practice. To determine which substance is the most suitable, there is a need for more randomized clinical trials that compare existing bulking agents based on standardized clinical outcomes.

Periurethral bulking agents for female stress urinary incontinence in Canada

“…Many agents have been introduced to the market and since removed due to clinical concerns or marketing reasons. 5 Polyacrylamid hydrogel (PAHG, Bulkamid™) is the only injectable bulking agent currently approved and marketed in Canada with an indication for female SUI. Non-animal hyaluronic acid/dextranomer gel (NASHA/Dx) was previously available and marketed with an Implacer device as Zuidex™; 6 however, concerns were raised regarding its efficacy and development of sterile abscesses with this product, and it was not approved in the U.S.…”

The use of urethral bulking agents in the treatment of stress urinary incontinence

“…A recent systematic review looking at complications of urethral bulking agents in over 1800 women suggests that most adverse effects are minor and transient, with urinary retention and infection being the most common . A further review of over 6000 cases by de Vries et al reported an overall complication rate of 32%, with most complications being minor and transient.…”

The Novel and Minimally Invasive Treatment Modalities for Female Pelvic Floor Muscle Dysfunction; Beyond the Traditional

“…However, their long-term (greater than 15 months) economic viability is questionable when compared with that of traditional sling surgery for SUI ( 35 ). Common complications following the injection of IBAs include urinary retention (up to 30%) and urinary tract infection (up to 25%) ( 38 ). Rare complications include abscess formation following collagen injection and fat embolism after autologous fat injection ( 38 ).…”

“…Common complications following the injection of IBAs include urinary retention (up to 30%) and urinary tract infection (up to 25%) ( 38 ). Rare complications include abscess formation following collagen injection and fat embolism after autologous fat injection ( 38 ).…”