Periurethral bulking agents for female stress urinary incontinence in Canada

Abstract

Urethral bulking aims to improve urethral mucosal coaptation, and thus outlet resistance, in an effort to limit stress-induced leakage. While efforts have been made to employ bulking agents to treat stress urinary incontinence (SUI) for more than 100 years, we remain wanting for the perfect injectable. Regardless of the agent studied, efficacy is modest at best, repeat injections are the norm, and longterm followup is conspicuously lacking. This treatment, however, fills an important need in our armamentarium against SUI, serving those patients who are not candidates for more invasive interventions and those with multiple prior failed surgeries. This review offers a contemporary discussion on the role of periurethral bulking therapy in Canada, along with practical aspects of its application.

Urethral bulking agents for female stress urinary incontinence

“…There have been several agents introduced to the market since, which were subsequently withdrawn following clinical and safety concerns . Polytetrafluroethylene (Teflon) as a UBA was first introduced in the 1970s, however, it was not FDA approved due to particle migration to lymph nodes and distant organs, granuloma formation and its carcinogenic potential …”

“…UBAs work by augmenting or restoring the normal mucosal coaptation. The agent is injected into the submucosal space providing increased bulk, increasing the urethral closure pressure and the resistance to the outflow of urine whilst having a minimal effect on voiding pressures . The increase in resistance prevents involuntary bladder neck opening during periods of increased intra‐abdominal pressure.…”

Agreement between simple catheter method and 3D transperineal ultrasound for assessing urethral length measurement before stress urinary incontinence treatment

“…Moreover, this intervention does not interfere with subsequent incontinence procedures and is highly useful in selected patients such as women planning other pregnancies or women with comorbidity, precluding anaesthesia . There are currently many bulking agents (eg, Durasphere, Macroplastique, and Bulkamid) available with similar efficacy . It should be underlined that urethral injection continues to evolve with, for instance, autologous muscle‐derived stem cells, with preliminary findings suggesting promising results .…”

“…6 There are currently many bulking agents (eg, Durasphere, Macroplastique, and Bulkamid) available with similar efficacy. 7 It should be underlined that urethral injection continues to evolve with, for instance, autologous musclederived stem cells, with preliminary findings suggesting promising results. 8 In addition to the material injected, the success of bulking agents depends on other variables such as the injection technique and the location of injection.…”

Stress urinary incontinence treatment: Focus should be on identifying best candidates for surgical success in the first place

“…Results from periurethral bulking to date are inferior to those reported with surgery. 2 Few would argue that surgery is the mainstay for SUI treatment, but the critics still challenge the safety of this surgery and thus its positioning as the best treatment option available.…”