Bulking agents: an analysis of 500 cases and review of the literature

Abstract

Introduction and hypothesis Stress urinary incontinence (SUI) is common, impacts women's quality of life, and generates high costs. Physiotherapy is the first-line therapy, and if it fails, suburethral slings are the gold standard in SUI surgery. Bulking agents injected periurethrally might be a beneficial alternative, but there is a paucity of data on bulking therapy. The aim of this study was to prospectively analyze the efficacy and safety of bulking agents in the setting of a tertiary referral center. Methods In the last 13 years, 514 elderly women with SUI were treated by injection therapy with either collagen (Contigen®), hyaluronic acid (Zuidex®), ethylene vinyl alcohol (Tegress®), or polyacrylamide hydrogel (Bulkamid®). Subjective and objective outcome was recorded at the 12-month postoperative appointment using the King's Health Questionnaire, visual analogue scale (VAS) describing their incontinence severity, standardized pad test, and urethral pressure profile.Results Demographic data were equally distributed in all four groups of agents used. Sixty-one patients were lost to follow-up (10.6 %). Statistically significant changes were found for maximum urethral closure pressure (MUCP), pad weight, and VAS before and after bulking for the four agents used. Pad test was negative in 73.2 % of patients after bulking therapy. Subjective assessment showed improvements in general health and role limitations. The overall complication rate was low for all agents. Conclusions This study shows improvement in incontinence after bulking therapy according to subjective and objective outcomes in an elderly population. In contrast to earlier reports, side effects due to injections were few and mild. We can advocate bulking therapy for treating SUI, as it is simple, safe, and shows both objective and subjective improvement and relief.

Urolastic—A New Bulking Agent for the Treatment of Women with Stress Urinary Incontinence: Outcome of 12 Months Follow Up

“…However, there is lack and inconsistency of data comparing the outcomes of these agents; therefore, a decision to be made on selecting a bulking agent to treat SUI would be made depending on the availability, safety, ease of use, and surgeons preference [11, 12]. …”

Polyacrylamide hydrogel (Bulkamid®) for stress urinary incontinence in women: a systematic review of the literature

“…This study also showed 0 % complication rate with PAHG. Moreover, this study had a study design different from our systematic review and was a case series [28]. Finally, a sixth study was excluded because it evaluated only the impact of PAHG on the sexual function outcome of women with urinary incontinence [29].…”

Diagnosis and Management of Bladder Outlet Obstruction in Women

“…Bulking agent injection for SUI is simple, safe, and effective . Temporary BOO after injection is common, and BOO usually resolved within hours to days .…”