Bulking agents for the treatment of recurrent stress urinary incontinence: a suitable option?

Serati, Maurizio; Giammò, Alessandro; Carone, Roberto; Ammirati, Enrico; Gubbiotti, Marilena; Ruffolo, Alessandro Ferdinando; Salvatore, Stefano; Scancarello, Chiara; Castronovo, Fabiana; Caccia, Giorgio; Braga, Andrea

doi:10.23736/s2724-6051.21.04269-5

Cited by 5 publications

(21 citation statements)

References 30 publications

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“…At a follow-up of 12 to 36 months, the subjective success rate was reported in two studies resulting at 32.7% [21] and 83% [26], while the objective success rate reported was between 32.7% and 83.6%. The reported reinjection rate resulted between 10.6% and 22.4%.…”

Section: Bulking Agents For Recurrent Stress Urinary Incontinencementioning

confidence: 95%

“…Further, 33 articles were reviewed and excluded because they did not satisfy the eligibility criteria. Nineteen studies concerning the efficacy and safety of UBAs for the treatment of SUI were included in this review: two of them were RCTs [9,10], while the other 17 studies [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] presented a prospective non-controlled or non-randomized design.…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…Eight studies [9,11,12,[17][18][19]21,22] subjectively assessed patient's satisfaction related to improvement in urinary symptoms on a 0-10 or 0-100 VAS. The International Consultation on Incontinence Questionnaire (ICIQ) was adopted in five studies [10,16,18,19,26]. Moreover, four studies evaluated the subjective success of bulking procedures through the Stamey Incontinence Score [21][22][23][24], four studies adopted the PGI-I score [16,17,20,26], one study used the KHQ [15] and two studies used the UDI-6 [14,26].…”

Section: Bulking Agents Outcomesmentioning

confidence: 99%

“…The International Consultation on Incontinence Questionnaire (ICIQ) was adopted in five studies [10,16,18,19,26]. Moreover, four studies evaluated the subjective success of bulking procedures through the Stamey Incontinence Score [21][22][23][24], four studies adopted the PGI-I score [16,17,20,26], one study used the KHQ [15] and two studies used the UDI-6 [14,26]. The scores assessed a significant improvement in urinary incontinence post-operatively in all included studies.…”

Section: Bulking Agents Outcomesmentioning

confidence: 99%

“…However, few data exist on the role of UBAs for the exclusive treatment of recurrent SUI. Indeed, three studies [13,21,26] that evaluated only women affected by recurrent SUI after a previous anti-incontinence procedure presented the criteria to be included in the current review.…”

Section: Bulking Agents For Recurrent Stress Urinary Incontinencementioning

confidence: 99%

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Up-to-Date Procedures in Female Stress Urinary Incontinence Surgery: A Concise Review on Bulking Agents Procedures

et al. 2022

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To avoid complications related to mid-urethral slings (MUS), alternative procedures to treat stress urinary incontinence (SUI), such as urethral bulking agents (UBAs) have been adopted. The aim of this review is to narratively report the efficacy and safety of UBAs for SUI treatment. For this review, research from PubMed and EMBASE was performed to evaluate relevant studies that were undertaken from January 2012 to January 2022. Nineteen prospective studies were included. Several definitions of subjective and objective success were adopted. At a follow-up of <24 months, significant improvement was widely observed, even if with a heterogeneous rate of success between 32.7–90%, and a reinjection rate of 8.3–77.3%. Compared with other procedures, MUS resulted as significantly superior to UBAs but was balanced by a higher complication rate. Acute urinary retention, urinary tract infection and de novo urgency, and other complications, such as injection site rupture, urethral erosion and particle migration have been described after UBAs. SUI after UBAs treatment resulted in improvements in all studies and can be considered a safe and effective option to treat SUI. However, homogenous and longer-term data lack, limiting general recommendations. Thus, larger RCTs evaluating long-term effects are required.

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Section: Bulking Agents For Recurrent Stress Urinary Incontinencementioning

confidence: 95%

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Section: Bulking Agents Outcomesmentioning

confidence: 99%

Section: Bulking Agents Outcomesmentioning

confidence: 99%

Section: Bulking Agents For Recurrent Stress Urinary Incontinencementioning

confidence: 99%

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Up-to-Date Procedures in Female Stress Urinary Incontinence Surgery: A Concise Review on Bulking Agents Procedures

et al. 2022

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Urethral bulking agents for the treatment of recurrent stress urinary incontinence: A systematic review and meta-analysis

et al. 2022

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Can urethral re-bulking improve the outcomes of a prior urethral bulking?

Giammò

Ammirati

Geretto

et al. 2022

Therapeutic Advances in Urology

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Aims: To analyze the outcomes of urethral re-bulking in the treatment of female stress urinary incontinence. Materials and Methods: We performed a multicenter observational retrospective study, which included all consecutive patients treated with urethral re-bulking for the treatment of persistent stress or mixed urinary incontinence after a previous urethral bulking. Objective outcomes were evaluated with the 24 h pad-test, while PGI-I questionnaires were administered to evaluate subjective outcomes. Clinical outcomes were assessed before re-bulking procedure and at last follow-up. Mann–Whitney’s U test was used for subgroup analysis. Shapiro-Wilk’s tests were used as normality tests. Results: In total, 62 patients who underwent urethral re-bulking between 2013 and 2020 in a multicenter setting were included. Most patients did not reach complete continence after the first procedure (n = 56) while the remainder reported recurrence of urinary incontinence after initial benefit. Median age at surgery was 66 (IQR: 55-73). Median overall follow-up was 30 months (IQR: 24-41). Median time occurred between the first procedure and reintervention was 12 months (IQR: 7-27). Bulking agents for the re-bulking procedures were bulkamid(n = 56), macroplastique(n = 4), and Prolastic(n = 2). A statistically significant reduction of median 24 h pad test from 100 g(IQR: 40-200) to 35 g(IQR: 0-120) was observed (p = 0.003). Dry rate after rebulking was 36.6%, while 85.4% patients declared themselves ‘very much improved’ or ‘much improved’ (PGI-I 1-2). Very few low-grade complications were observed (n = 4). A single case of major complication occurred. Conclusions: Urethral re-bulking can be an effective technique for the treatment of stress urinary incontinence refractory to a previous urethral bulking and can determine a cumulative benefit after the first procedure.

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Bulking agents for the treatment of recurrent stress urinary incontinence: a suitable option?

Cited by 5 publications

References 30 publications

Up-to-Date Procedures in Female Stress Urinary Incontinence Surgery: A Concise Review on Bulking Agents Procedures

Up-to-Date Procedures in Female Stress Urinary Incontinence Surgery: A Concise Review on Bulking Agents Procedures

Urethral bulking agents for the treatment of recurrent stress urinary incontinence: A systematic review and meta-analysis

Can urethral re-bulking improve the outcomes of a prior urethral bulking?

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