Advertisement

Current Bladder Dysfunction Reports

, Volume 10, Issue 1, pp 46–51 | Cite as

Bulking Agents for Stress Incontinence: Are They a Real Option?

  • Stephen Mock
  • W. Stuart Reynolds
Stress Incontinence and Prolapse (R Dmochowski, Section Editor)
  • 167 Downloads
Part of the following topical collections:
  1. Topical Collection on Stress Incontinence and Prolapse

Abstract

Urethral bulking agents are used in the treatment of female stress urinary incontinence in a wide variety of patients. Numerous materials have been approved for use in the USA, each with inherent properties that can affect its efficacy and safety profile, but none with characteristics deemed ideal to be used as an injectable implant. Few comparative studies are available to clearly define superiority of one agent over another. Nevertheless, bulking agents have demonstrated efficacy in appropriately selected and informed patients and do represent a viable option for women who do not want more invasive therapy and who understand efficacy and duration are inferior to other surgical options.

Keywords

Female Stress urinary incontinence Bulking agent Collagen 

Notes

Compliance with Ethics Guidelines

Conflict of Interest

Stephen Mock and W. Stuart Reynolds declare that they have no conflict of interest.

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.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61:37–49.CrossRefPubMedGoogle Scholar
  2. 2.
    Luber KM. The definition, prevalence, and risk factors for stress urinary incontinence. Rev Urol. 2004;6:S3.PubMedCentralPubMedGoogle Scholar
  3. 3.
    Hampel C, Wienhold D, Benken N, et al. Definition of overactive bladder and epidemiology of urinary incontinence. Urology. 1997;50:4.CrossRefPubMedGoogle Scholar
  4. 4.
    Osborn DJ, Strain M, Gomelsky A, Rothschild J, Dmochowski R. Obesity and female stress urinary incontinence. Urology. 2013;82:759–63.CrossRefPubMedGoogle Scholar
  5. 5.•
    Dmochowski RR, Blaivas JG, Gormley A, et al. Update of AUA guideline on the surgical management of female stress urinary incontinence. J Urol. 2010;183:1906–14. A good summary of efficacy and adverse events of the surgical modalities for the treatment of female SUI based on a meta-analysis of the available literature.CrossRefPubMedGoogle Scholar
  6. 6.
    Murless BC. The injection treatment of stress incontinence. J Obstet Gynecol Br Emp. 1938;45:521–4.CrossRefGoogle Scholar
  7. 7.
    Anger JT, Weinberg AE, Albo ME, et al. Trends in surgical management of stress urinary incontinence among female Medicare beneficiaries. Urology. 2009;74:283–87.CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Zoorob D, Karram M. Bulking agents: a urogynecology perspective. Urol Clin N Am. 2012;39:273–7.CrossRefGoogle Scholar
  9. 9.•
    Reynolds WS, Dmochowski RR. Urethral bulking: a urology perspective. Urol Clin N Am. 2012;39(3):279–87. A easy to read article on urethral bulking therapy, including historical and currently available agents.CrossRefGoogle Scholar
  10. 10.
    Beisang AA, Ersek RA. Mammalian response to subdermal implantation of textured microimplants. Aesthet Plast Surg. 1992;16:83.CrossRefGoogle Scholar
  11. 11.
    Lucas MG, Bedretdinova D, Bosch JLHR, et al. Guidelines on urinary incontinence. © European Association of Urology (EAU). Urinary Incontinence-Update March 2013.Google Scholar
  12. 12.
    Appell RA, McGuire EJ, DeRidder PA, et al. Summary of effectiveness and safety in the prospective, open, multicenter investigation of Contigen implant for incontinence due to intrinsic sphincteric deficiency in females. J Urol. 1994;151:418A.Google Scholar
  13. 13.
    Striker P, Haylen B. Injectable collagen for type 3 female stress incontinence: the first 50 Australian patients. Med J Aust. 1993;158:89–91.Google Scholar
  14. 14.
    Swami SK, Eckford SD, Abrams P. Collagen injections for female stress incontinence: conclusions of a multistage analysis and results. J Urol. 1994;151:479A.Google Scholar
  15. 15.
    DeLustro F, Keefe J, Fong AT, et al. The biochemistry, biology, and immunology of injectable collagens: Contigen Bard collagen implant in treatment of urinary incontinence. Pediatr Surg Int. 1991;6:245–51.CrossRefGoogle Scholar
  16. 16.
    McPherson JM, Sawamura S, Armstrong R. An examination of the biologic response to injectable glutaraldehyde cross-linked collagen implants. J Biomed Mater Res. 1986;20:93–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Beavan A: Material properties and applications of Pyrolite® carbon. Materials Engineering 1990.Google Scholar
  18. 18.
    Appell RA. Collagen injection therapy for urinary incontinence. Urol Clin N Am. 1994;21:177–82.Google Scholar
  19. 19.
    Madjar S, Covington-Nichols C, Secrest CL. New periurethral bulking agent for stress urinary incontinence: modified technique and early results. J Urol. 2003;170:2327–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Lightner D, Calvosa C, Andersen R, 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;58:12–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Chrouser KL, Fick F, Goel A, et al. Carbon coated zirconium beads in beta–glucan gel and bovine glutaraldehyde cross-linked collagen injections for intrinsic sphincteric deficiency: continence and satisfaction after extended follow-up. J Urol. 2004;171:1152–5.CrossRefPubMedGoogle Scholar
  22. 22.
    23 Hurtado EA, Appell, RA. Surgery for stress urinary incontinence: minimally invasive procedures. In Badlani GH, Davila GW, Michel MC, de la Rosette J Continence. Springer London 2009, pp 149–164.Google Scholar
  23. 23.
    Berger MB, Morgan DM. Delayed presentation of pseudoabscess secondary to injection of pyrolytic carbon-coated beads bulking agent. Female Pelvic Med Reconstr Surg. 2012;18(5):303–5.CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Ghoniem GM, Khater U. Urethral prolapse after durasphere injection. Int Urogynecol J Pelvic Floor Dysfunct. 2006;17(3):297–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Starkman JS, Scarpero H, Dmochowski RR. Emerging periurethral bulking agents for female stress urinary incontinence: is new necessarily better? Curr Urol Rep. 2006;7(5):405–13.CrossRefPubMedGoogle Scholar
  26. 26.
    Belafsky PC, Postma GN. Vocal fold augmentation with calcium hydroxylapatite. Otolaryngol Head Neck Surg. 2004;131(4):351–4.CrossRefPubMedGoogle Scholar
  27. 27.
    Dmochowski RR, Appell RA. Injectable agents in the treatment of stress urinary incontinence in women: where are we now? Urology. 2000;45(6 Suppl 1):32–40.CrossRefGoogle Scholar
  28. 28.
    Mayer R, Dmochowski R, Appell RA, et al. Multicenter prospective randomized 52-week trial of calcium hydroxylapatite versus bovine dermal collagen for treatment of stress urinary incontinence. Urology. 2007;69:876–80.CrossRefPubMedGoogle Scholar
  29. 29.
    Lai HH, Hurtado EA, Appell RA. Large urethral prolapse formation after calcium hydroxylapatite (Coaptite) injection. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:1315–17.CrossRefPubMedGoogle Scholar
  30. 30.
    Palma PC, Riccetto CL, Martins MH, 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;17:670–1.CrossRefPubMedGoogle Scholar
  31. 31.
    Ghoniem G, Corcos J, Comiter C, et al. Durability of urethral bulking agent injection for female stress urinary incontinence: 2 yr mulitcenter study results. J Urol. 2010;183:1444–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Ghoniem G, Miller CJ. A systemic review and meta-analysis of Macroplastique for treating female stress urinary incontinence. Int Urogynecol J. 2013;24:27–36.CrossRefPubMedCentralPubMedGoogle Scholar
  33. 33.
    Ter Meulen PH, Berghmans LC, van Kerrebroeck PE. Systematic review: efficacy of silicone microimplants (Macroplastique) therapy for stress urinary incontinence in adult women. Eur Urol. 2003;44:573–82.CrossRefPubMedGoogle Scholar
  34. 34.•
    Herschorn S. Injection therapy for urinary incontinence. In Wein A, Kavoussi LR, Novick AC (10th edition) Campbell-Walsh urology. Philadelphia: Saunders Elsevier 2012, pp2168-85. This chapter from the definitive textbook of Urology provides an in depth background and review of bulking therapy for female SUI. Google Scholar
  35. 35.
    Madjar S, Sharma AK, Waltzer WC, et al. Periurethral mass formation following bulking agent injection for the treatment of urinary incontinence. J Urol. 2001;166(4):1350–3.CrossRefGoogle Scholar
  36. 36.
    Henly DR, Barrett DM, Weiland TL, et al. Particulate silicone for use in periurethral injections: local tissue effects and search for migration. J Urol. 1995;153:2039–43.CrossRefPubMedGoogle Scholar
  37. 37.
    Christensen LH, Nielsen JB, Mouritsen L, et al. Tissue integration of polyacryamide hydrogel: an experimental study of periurethral, perivesical, and mammary gland tissue in the pig. Dermatol Surg, Suppl. 2008;34:S68.Google Scholar
  38. 38.
    Bano F, Barrington JW, Dyer R. Comparison between porcine dermal implant (Permacol) and silicone injection (macroplastique) for urodynamic stress incontinence. Int Urogynecol J. 2005;16:147–50.CrossRefGoogle Scholar
  39. 39.•
    Sokol ER, Karram MM, Dmochowski R. Efficacy and safety of polyacrylamide hydrogel for the treatment of female stress incontinence: a randomized, prospective, mulitcenter North American Study. J Urol. 2014;192:843–9. A large RCT on the newest available bulking agent and whose study criteria included nearly one third of patients who were still symptomatic after other incontinence procedures.CrossRefPubMedGoogle Scholar
  40. 40.
    Yokoyama T, Yoshimura N, Dhir R, et al. Persistence and survival of autologous muscle derived cells versus bovine collagen as potential treatment of stress urinary incontinence. J Urol. 2001;165:271–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Chermansky JC, Cannon TW, Torimoto K, et al. A model of instrinsic sphincteric deficiency in the rat: electrocauterization. Neurourol Urodyn. 2004;23:166–71.CrossRefPubMedGoogle Scholar
  42. 42.
    Cannon TW, Lee JY, Somogyi G, et al. Improved sphincter contractility after allogenic muscle-derived progenitor cell injection into denervated rat urethra. Urology. 2003;62:958–63.CrossRefPubMedGoogle Scholar
  43. 43.•
    Peters KM, Dmochowski RR, Carr LK, et al. Autologous muscle derived cells for treatment of stress urinary incontinence in women. J Urol. 2014;192:469–76. This paper describes a novel therapy whose mechanism of action differs from traditional bulking agents and which has the potential to change the landscape of urethral bulking therapy.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Urologic SurgeryVanderbilt University Medical CenterNashvilleUSA

Personalised recommendations