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Effectiveness and safety of bulking agents versus surgical methods in women with stress urinary incontinence: a systematic review and meta-analysis

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Abstract

Introduction and hypothesis

The objective was to evaluate the efficacy and safety of bulking agents compared with surgical methods for female stress urinary incontinence.

Methods

Inclusion and exclusion criteria: women with stress urinary incontinence. Bulking agents versus any surgical treatment as a comparison. Patients with other types of incontinence and treatment were excluded. Electronic databases (PubMed, MEDLINE, and the Cochrane Library) were searched from 2000 until 2021 to identify articles evaluating the effectiveness and safety of urethral bulking agents versus surgical methods. Risk-of-bias assessment tools recommended by the Cochrane Society were used to evaluate the risk of bias in the studies included.

Results

Six studies were included in the quantitative synthesis for a total of 710 patients. Our systematic review and meta-analysis showed that bulking agents are less effective than surgical procedures according to subjective improvement after treatment (RR = 0.70, 95% CI: 0.53 to 0.92, p = 0.01). There was no statistically significant difference between these two methods with regard to complications after the intervention (RR = 1.30, 95% CI: 0.30 to 5.66, p = 0.73).

Conclusion

The main limitation of this systematic review and meta-analysis was the absence of a common objective outcome measure to evaluate effectiveness. However, it shows that bulking agents are less effective than surgical procedures in subjective improvement. Safety analysis showed no significant difference between these methods. Hence, we believe that the first and final surgery is considered to be the best.

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Authors

Contributions

Laura Pivazyan: data collection, Manuscript writing; George Kasyan: project development, manuscript editing; Bagrat Grigoryan: data collection, manuscript writing; Dmitry Pushkar: project development, manuscript editing.

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Correspondence to George Kasyan.

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This systematic review has been registered in the PROSPERO international prospective register of systematic reviews by the National Institute for Health Research (NIHR). The registration number is PROSPERO 2021 CRD42021227128 [9].

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Pivazyan, L., Kasyan, G., Grigoryan, B. et al. Effectiveness and safety of bulking agents versus surgical methods in women with stress urinary incontinence: a systematic review and meta-analysis. Int Urogynecol J 33, 777–787 (2022). https://doi.org/10.1007/s00192-021-04937-1

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