Skip to main content

Advertisement

SpringerLink
Log in

Update on Urethral Bulking for Stress Urinary Incontinence in Women

  • Female Urology (L Cox, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Urethral bulking agents are an effective treatment for stress urinary incontinence in select females. The material and techniques used for urethral bulking are constantly evolving. With the introduction of several new agents, there is an ongoing debate over which agent is the most effective, durable, and safe.

Recent Findings

Current available bulking agents include Bulkamid®, Macroplastiue®, Durasphere®, Coaptite®, or Urolastic®. Each of these agents has its own biophysical properties that affect its efficacy and safety. Evidence evaluating bulking agents has increased over time but there is no definitive data that suggest superiority of one agent over another.

Summary

The ideal urethral bulking agent for female stress incontinence has yet been identified. Currently available agents have acceptable short-term and medium-term efficacy with few adverse events.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Dwyer L, Weaver E, Rajai A, Cox S, Reid F. “Voice your choice”: a study of women’s choice of surgery for primary stress urinary incontinence. Int Urogynecol J. 2020;31(4):769–77.

    Article  PubMed  Google Scholar 

  2. Zacche MM, Mukhopadhyay S, Giarenis I. Changing surgical trends for female stress urinary incontinence in England. Int Urogynecol J. 2019;30(2):203–9.

    Article  PubMed  Google Scholar 

  3. Kobashi K, Albo M, Dmochowski R, Ginsberg D, Goldman Ho, Gomelsky A, et al. American Urologic Association Stress-Urinary-Incontinence guideline. 2017;33.

  4. Thüroff JW, Abrams P, Andersson KE, Artibani W, Chapple CR, Drake MJ, et al. EAU guidelines on urinary incontinence. Eur Urol. 2011;59(3):387–400.

    Article  PubMed  Google Scholar 

  5. Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37–49.

    Article  PubMed  Google Scholar 

  6. Winters JC, Dmochowski RR, Goldman HB, Herndon CDA, Kobashi KC, Kraus SR, et al. Urodynamic studies in adults: AUA/SUFU guideline. J Urol. 2012;188(6 Suppl):2464–72.

    Article  PubMed  Google Scholar 

  7. Sirls LT, Richter HE, Litman HJ, Kenton K, Lemack GE, Lukacz ES, et al. HHS public access. 2015;189(1):204–9.

    Google Scholar 

  8. Bent AE, Foote J, Siegel S, Faerber G, Chao R, Gormley EA. Collagen implant for treating stress urinary incontinence in women with urethral hypermobility. J Urol. 2001;166(4):1354–7.

    Article  PubMed  CAS  Google Scholar 

  9. Steele AC, Kohli N, Karram MM. Periurethral collagen injection for stress incontinence with and without urethral hypermobility. Obstet Gynecol. 2000;95(3):327–31.

    PubMed  CAS  Google Scholar 

  10. Koski ME, Enemchukwu EA, Padmanabhan P, Kaufman MR, Scarpero HM, Dmochowski RR. Safety and efficacy of sling for persistent stress urinary incontinence after bulking injection. Urology. 2011;77(5):1076–80.

    Article  PubMed  Google Scholar 

  11. Krhut J, Martan A, Jurakova M, Nemec D, Masata J, Zvara P. Treatment of stress urinary incontinence using polyacrylamide hydrogel in women after radiotherapy: 1-year follow-up. Int Urogynecol J. 2016;27(2):301–5.

    Article  PubMed  Google Scholar 

  12. Gomelsky A, Athanasiou S, Choo M-S, Cosson M, Dmochowski RR, Gomes CM, et al. Surgery for urinary incontinence in women: report from the 6th international consultation on incontinence. Neurourol Urodyn. 2019;38(2):825–37.

    Article  PubMed  Google Scholar 

  13. Appell RA, McGuire EJDP. Summary of effectiveness and safety in the prospective, open, multicenter investigation of Contigen implant for incontinence due to intrinsic sphincter deficiency in females. J Urol. 1994;151:418.

    Google Scholar 

  14. Ghoniem G, Corcos J, Comiter C, Bernhard P, Westney OL, Herschorn S. Cross-linked polydimethylsiloxane injection for female stress urinary incontinence: results of a multicenter, randomized, controlled, single-blind study. J Urol. 2009;181(1):204–10.

    Article  PubMed  Google Scholar 

  15. Stothers L, Goldenberg SL, Leone EF. Complications of periurethral collagen injection for stress urinary incontinence. J Urol. 1998;159(3):806–7.

    Article  PubMed  CAS  Google Scholar 

  16. Lee PE, Kung RC, Drutz HP. Periurethral autologous fat injection as treatment for female stress urinary incontinence: a randomized double-blind controlled trial. J Urol. 2001;165(1):153–8.

    Article  PubMed  CAS  Google Scholar 

  17. Sweat SD, Lightner DJ. Complications of sterile abscess formation and pulmonary embolism following periurethral bulking agents. J Urol. 1999;161(1):93–6.

    Article  PubMed  CAS  Google Scholar 

  18. Lightner D, Rovner E, Corcos J, Payne C, Brubaker L, Drutz H, et al. Randomized controlled multisite trial of injected bulking agents for women with intrinsic sphincter deficiency: mid-urethral injection of Zuidex via the Implacer versus proximal urethral injection of Contigen cystoscopically. Urology. 2009;74(4):771–5.

    Article  PubMed  Google Scholar 

  19. Hurtado E, McCrery R, Appell R. The safety and efficacy of ethylene vinyl alcohol copolymer as an intra-urethral bulking agent in women with intrinsic urethral deficiency. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(8):869–73.

    Article  PubMed  Google Scholar 

  20. Berg S. Polytef augmentation urethroplasty: correction of surgically incurable urinary incontinence by injection technique. Arch Surg [Internet]. 1973;107(3):379–81. Available from: https://doi.org/10.1001/archsurg.1973.01350210017006.

  21. Malizia AAJ, Reiman HM, Myers RP, Sande JR, Barham SS, Benson RCJ, et al. Migration and granulomatous reaction after periurethral injection of polytef (Teflon). JAMA. 1984;251(24):3277–81.

    Article  PubMed  Google Scholar 

  22. Claes H, Stroobants D, Van Meerbeek J, Verbeken E, Knockaert D, Baert L. Pulmonary migration following periurethral polytetrafluoroethylene injection for urinary incontinence. J Urol. 1989;142(3):821–2.

    Article  PubMed  CAS  Google Scholar 

  23. Christensen LH. Host tissue interaction, fate, and risks of degradable and nondegradable gel fillers. Dermatologic Surg Off Publ Am Soc Dermatologic Surg [et al]. 2009;35(Suppl 2):1612–9.

    Article  CAS  Google Scholar 

  24. Ghoniem GM, Miller CJ. A systematic review and meta-analysis of Macroplastique for treating female stress urinary incontinence. Int Urogynecol J. 2013;24(1):27–36.

    Article  PubMed  Google Scholar 

  25. Ghoniem G, Corcos J, Comiter C, Westney OL, Herschorn S. Durability of urethral bulking agent injection for female stress urinary incontinence: 2-year multicenter study results. J Urol. 2010;183(4):1444–9.

    Article  PubMed  Google Scholar 

  26. Hoe V, Haller B, Yao HH, O’Connell HE. Urethral bulking agents for the treatment of stress urinary incontinence in women: a systematic review. Neurourol Urodyn. 2021;40(6):1349–88.

    Article  PubMed  Google Scholar 

  27. Serati M, Soligo M, Braga A, Cantaluppi S, Coluccia AC, Di Dedda MC, et al. Efficacy and safety of polydimethylsiloxane injection (Macroplastique(®)) for the treatment of female stress urinary incontinence: results of a series of 85 patients with ≥3 years of follow-up. BJU Int. 2019;123(2):353–9.

    Article  PubMed  CAS  Google Scholar 

  28. Tamanini JTN, D’Ancona CAL, Netto NR. Macroplastique implantation system for female stress urinary incontinence: long-term follow-up. J Endourol. 2006;20(12):1082–6.

    Article  PubMed  Google Scholar 

  29. Mayer RD, Dmochowski RR, Appell RA, Sand PK, Klimberg IW, Jacoby K, et al. Multicenter prospective randomized 52-week trial of calcium hydroxylapatite versus bovine dermal collagen for treatment of stress urinary incontinence. Urology. 2007;69(5):876–80.

    Article  PubMed  CAS  Google Scholar 

  30. Palma PCR, Riccetto CLZ, Martins MHT, Herrmann V, de Fraga R, Billis A, et al. Massive prolapse of the urethral mucosa following periurethral injection of calcium hydroxylapatite for stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(6):670–1.

    Article  PubMed  Google Scholar 

  31. Lightner D, Calvosa C, Andersen R, Klimberg I, Brito CG, Snyder J, et al. A new injectable bulking agent for treatment of stress urinary incontinence: results of a multicenter, randomized, controlled, double-blind study of Durasphere. Urology. 2001;58(1):12–5.

    Article  PubMed  CAS  Google Scholar 

  32. Chrouser KL, Fick F, Goel A, Itano NB, Sweat SD, Lightner DJ. Carbon coated zirconium beads in beta-glucan gel and bovine glutaraldehyde cross-linked collagen injections for intrinsic sphincter deficiency: continence and satisfaction after extended followup. J Urol. 2004;171(3):1152–5.

    Article  PubMed  CAS  Google Scholar 

  33. Sokol ER, Aguilar VC, Sung VW, Myers DL. Combined trans- and periurethral injections of bulking agents for the treatment of intrinsic sphincter deficiency. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(5):643–7.

    Article  PubMed  Google Scholar 

  34. Pannek J, Brands FH, Senge T. Particle migration after transurethral injection of carbon coated beads for stress urinary incontinence. J Urol. 2001;166(4):1350–3.

    Article  PubMed  CAS  Google Scholar 

  35. Madjar S, Sharma AK, Waltzer WC, Frischer Z, Secrest CL. Periurethral mass formations following bulking agent injection for the treatment of urinary incontinence. J Urol. 2006;175(4):1408–10.

    Article  PubMed  CAS  Google Scholar 

  36. Casteleijn FM, Kowalik CR, Berends C, Blaganje M, Lasić Pecev M, van der Linden E, et al. Patients’ satisfaction and safety of bulk injection therapy Urolastic for treatment of stress urinary incontinence: a cross-sectional study. Neurourol Urodyn. 2020;39(6):1753–63.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  37. De Vries AM, Van Breda HMK, Fernandes JG, Venema PL, Heesakkers JPFA. Para-urethral injections with Urolastic® for treatment of female stress urinary incontinence: subjective improvement and safety. Urol Int. 2017;99(1):91–7.

    Article  PubMed  CAS  Google Scholar 

  38. Futyma K, Miotła P, Gałczyński K, Baranowski W, Doniec J, Wodzisławska A, et al. An open multicenter study of clinical efficacy and safety of urolastic, an injectable implant for the treatment of stress urinary incontinence: one-year observation. Biomed Res Int. 2015;2015: 851823.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Lose G, Sørensen HC, Axelsen SM, Falconer C, Lobodasch K, Safwat T. An open multicenter study of polyacrylamide hydrogel (Bulkamid®) for female stress and mixed urinary incontinence. Int Urogynecol J. 2010;21(12):1471–7.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Christensen LH, Nielsen JB, Mouritsen L, Sørensen M, Lose G. Tissue integration of polyacrylamide hydrogel: an experimental study of periurethral, perivesical, and mammary gland tissue in the pig. Dermatologic surgery. 2008 Jun;34:S68–77.

  41. Sokol ER, Karram MM, Dmochowski R. Efficacy and safety of polyacrylamide hydrogel for the treatment of female stress incontinence: a randomized, prospective, multicenter North American study. J Urol. 2014;192(3):843–9.

    Article  PubMed  CAS  Google Scholar 

  42. Itkonen Freitas A-M, Mentula M, Rahkola-Soisalo P, Tulokas S, Mikkola TS. Tension-free vaginal tape surgery versus polyacrylamide hydrogel injection for primary stress urinary incontinence: a randomized clinical trial. J Urol. 2020;203(2):372–8.

    Article  PubMed  Google Scholar 

  43. Brosche T, Kuhn A, Lobodasch K, Sokol ER. Seven-year efficacy and safety outcomes of Bulkamid for the treatment of stress urinary incontinence. Neurourol Urodyn. 2021;40(1):502–8.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Pai A, Al-Singary W. Durability, safety and efficacy of polyacrylamide hydrogel (Bulkamid(®)) in the management of stress and mixed urinary incontinence: three year follow up outcomes. Cent Eur J Urol. 2015;68(4):428–33.

    CAS  Google Scholar 

  45. Plotti F, Montera R, Terranova C, Luvero D, Marrocco F, Miranda A, et al. Long-term follow-up of bulking agents for stress urinary incontinence in older patients. Menopause. 2018;25(6):663–7.

    Article  PubMed  Google Scholar 

  46. ter Meulen PH, Berghmans LCM, Nieman FHM, van Kerrebroeck PEVA. Effects of Macroplastique Implantation System for stress urinary incontinence and urethral hypermobility in women. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(2):177–83.

    Article  PubMed  Google Scholar 

  47. Corcos J, Collet JP, Shapiro S, Herschorn S, Radomski SB, Schick E, et al. Multicenter randomized clinical trial comparing surgery and collagen injections for treatment of female stress urinary incontinence. Urology. 2005;65(5):898–904.

    Article  PubMed  CAS  Google Scholar 

  48. Maher CF, O’Reilly BA, Dwyer PL, Carey MP, Cornish A, Schluter P. Pubovaginal sling versus transurethral Macroplastique for stress urinary incontinence and intrinsic sphincter deficiency: a prospective randomised controlled trial. BJOG. 2005;112(6):797–801.

    Article  PubMed  Google Scholar 

  49. Kirchin V, Page T, Keegan PE, Atiemo K, Cody JD, McClinton S. Urethral injection therapy for urinary incontinence in women. Cochrane Database Syst Rev. 2012;(2):CD003881.

  50. Jankowski RJ, Tu LM, Carlson C, Robert M, Carlson K, Quinlan D, et al. A double-blind, randomized, placebo-controlled clinical trial evaluating the safety and efficacy of autologous muscle derived cells in female subjects with stress urinary incontinence. Int Urol Nephrol. 2018;50(12):2153–65.

    Article  PubMed  CAS  Google Scholar 

  51. Stangel-Wojcikiewicz K, Jarocha D, Piwowar M, Jach R, Uhl T, Basta A, et al. Autologous muscle-derived cells for the treatment of female stress urinary incontinence: a 2-year follow-up of a Polish investigation. Neurourol Urodyn. 2014;33(3):324–30.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Medical University of South Carolina, 96 Jonathan Lucas St., CSB 644, Charleston, SC, 29425, USA

    Yu Zheng & Eric Rovner

Authors
  1. Yu Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eric Rovner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eric Rovner.

Ethics declarations

Conflict of Interest

The authors do not have existing conflict of interest. Eric Rovner is a consultant for Axonics.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Female Urology

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zheng, Y., Rovner, E. Update on Urethral Bulking for Stress Urinary Incontinence in Women. Curr Urol Rep 23, 203–209 (2022). https://doi.org/10.1007/s11934-022-01099-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-022-01099-5

Keywords

Search

Navigation