Skip to main content

Advertisement

Log in

Urethral bulking agents: Techniques and outcomes

  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Stress urinary incontinence is a common health problem affecting women and interfering with their quality of life. The use of bulking agents for urethral augmentation seems to be a beneficial way of restoring continence in these patients while avoiding the risk of surgical intervention. Many agents are available for injection, but the ideal choice should be durable, nonmigratory, and hypoallergenic, while evoking healing with minimal scarring. We reviewed the literature to provide an update on the best techniques of bulking agent injection, to describe the different available injectable agents, and to give their outcome and possible complications.

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

Access this article

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

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Hampel C, Artibani W, Espuna Pons M, et al.: Understanding the burden of stress urinary incontinence in Europe: a qualitative review of the literature. Eur Urol 2004, 46:15–27.

    Article  PubMed  CAS  Google Scholar 

  2. Klarskov N, Lose G: Urethral injection therapy: what is the mechanism of action? Neurourol Urodyn 2008, 27:789–792.

    Article  PubMed  Google Scholar 

  3. Schafer W: Some biomechanical aspects of continence function. Scand J Urol Nephrol Suppl 2001, 207:44–60.

    PubMed  Google Scholar 

  4. Berne RM, Levy MN: Physiology, edn 3. St. Louis, MO: Mosby; 1993.

    Google Scholar 

  5. Kuhn A, Stadlmayr W, Lengsfeld D, Mueller MD: Where should bulking agents for female urodynamics stress incontinence be injected? Int Urogynecol J Pelvic Floor Dysfunct 2008, 19:817–821.

    Article  PubMed  Google Scholar 

  6. Petros PE, Ulmsten UI: An integral theory and its method for the diagnosis and management of female urinary incontinence. Scand J Urol Nephrol Suppl 1993, 153:1–93.

    PubMed  CAS  Google Scholar 

  7. Elia G, Bergman A: Periurethral collagen implant: ultrasound assessment and prediction of outcome. Int Urogynecol J Pelvic Floor Dysfunct 1996, 7:335–338.

    Article  PubMed  CAS  Google Scholar 

  8. Mitterberger M, Pinggera GM, Pelzer A, et al.: Comparison of the precision of transurethral endoscopic versus ultrasoundguided application of injectables. BJU Int 2008, 101:245–249.

    PubMed  Google Scholar 

  9. Schulz JA, Nager CW, Stanton SL, Baessler K: Bulking agents for stress urinary incontinence: short-term results and complications in a randomized comparison of periurethral and transurethral injections. J Urol 2005, 73:11–12.

    Google Scholar 

  10. Chapple CR, Brubaker L, Haab F, et al.: Patient perceived outcomes in the treatment of stress urinary incontinence: focus on urethral injection therapy. Int Urogynecol J Pelvic Floor Dysfunct 2007, 18:199–205.

    PubMed  Google Scholar 

  11. Kershen RT, Dmochowski RR, Appell RA: Beyond collagen: injectable therapies for the treatment of female stress urinary incontinence in the new millennium. Urol Clin North Am 2002, 29:559–574.

    Article  PubMed  Google Scholar 

  12. McGuire EJ, Appell RA: Transurethral collagen injection for urinary incontinence. Urology 1994, 43:413–415.

    Article  PubMed  CAS  Google Scholar 

  13. Bent AE, Foote J, Siegel S, et al.: Collagen implant for treating stress urinary incontinence in women with urethral hypermobility. J Urol 2001, 66:1354–1357.

    Google Scholar 

  14. Martins SB, Oliveira RA, Castro RA, et al.: Clinical and urodynamics evaluation in women with stress urinary incontinence treated by Periurethral collagen injection. Int Braz J Urol 2007, 33:695–703.

    Article  PubMed  CAS  Google Scholar 

  15. Corcos J, Fournier C: Periurethral collagen injection for the treatment of female stress urinary incontinence: 4 year follow up results. Urology 1999, 54:815–818.

    Article  PubMed  CAS  Google Scholar 

  16. Poon CI, Zimmern PE, Wilson TS, et al.: Three dimensional ultrasonography to assess long term durability of Periurethral collagen in women with stress urinary incontinence due to intrinsic sphincter deficiency. Urology 2005, 65:60–64.

    Article  PubMed  Google Scholar 

  17. Isom-Batz G, Zimmern PE: Collagen injection for female urinary incontinence after urethral or periurethral surgery. J Urol 2009, 181:701–704.

    Article  PubMed  CAS  Google Scholar 

  18. Koduri S, Goldberg RP, Kwon C, et al.: Factors influencing the long-term success of periurethral collagen therapy in the office. Int Urogynecol J Pelvic Floor Dysfunct 2006, 17:346–351.

    Article  PubMed  Google Scholar 

  19. 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, 19:643–647.

    Article  PubMed  Google Scholar 

  20. Poon CI, Zimmern PE: Is there a role for periurethral collagen injection in the management of urodynamically proven mixed urinary incontinence? Urology 2006, 67:725–729.

    Article  PubMed  Google Scholar 

  21. Kassouf W, Capolicchio G, Berardinucci G, Corcos J: Collagen injection for treatment of urinary incontinence in children. J Urol 2001, 165:1666–1668.

    Article  PubMed  CAS  Google Scholar 

  22. Block CA, Cooper CS, Hawtrey CE: Long term efficacy of periurethral collagen injection for the treatment of urinary incontinence secondary to myelomeningocele. J Urol 2003, 169:327–329.

    Article  PubMed  CAS  Google Scholar 

  23. Wilson S, Quek ML, Ginsberg DA: Transurethral injection of bulking agents for stress urinary incontinence following orthotopic neobladder reconstruction in women. J Urol 2004, 172:244–246.

    Article  PubMed  Google Scholar 

  24. 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 sphincter deficiency: continence and satisfaction after extended follow up. J Urol 2004, 171:1152–1155.

    Article  PubMed  CAS  Google Scholar 

  25. Madjar S, Covington-Nichols C, Secrest CL: New periurethral bulking agent for stress urinary incontinence: modified technique and early results. J Urol 2003, 170:2327–2329.

    Article  PubMed  Google Scholar 

  26. Madjar S, Sharma AK, Waltzer WC, et al.: Periurethral mass formations following bulking agent injection for the treatment of urinary incontinence. J Urol 2006, 175:1408–1410.

    Article  PubMed  CAS  Google Scholar 

  27. McCrery RJ, Appell RA: Safety for carbon bead injection for incontinence in patients taking warfarin. Urology 2006, 67:97–99.

    Article  PubMed  CAS  Google Scholar 

  28. Kuhn A, Stadlmayr W, Sohail A, Monga A: Long-term results and patients’ satisfaction after transurethral ethylene vinyl alcohol (Tegress) injections: a two-centre study. Int Urogynecol J Pelvic Floor Dysfunct 2008, 19:503–507.

    Article  PubMed  Google Scholar 

  29. 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, 18:869–873.

    Article  PubMed  Google Scholar 

  30. Erekson EA, Sung VW, Rardin CR, Myers DL: Ethylene vinyl alcohol copolymer erosions after use as a urethral bulking agent. Obstet Gynecol 2007, 109(2 Pt 2):490–492.

    PubMed  CAS  Google Scholar 

  31. 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, 44:573–582.

    Article  PubMed  Google Scholar 

  32. Zullo M, Plotti F, Bellati F, et al.: Transurethral polydimethylsiloxane implantation: a valid option for the treatment of stress urinary incontinence due to intrinsic sphincter deficiency without urethral hypermobility. J Urol 2005, 173:898–902.

    Article  PubMed  CAS  Google Scholar 

  33. Ghoneim G, Corcos J, Comiter C, et al.: Cross-linked polydimethylsiloxane injection for female stress urinary incontinence: results of a multicenter, randomized, controlled, single-blind study. J Urol 2009, 181:204–210.

    Article  Google Scholar 

  34. Plotti F, Zullo MA, Sansone M, et al.: Post radical hysterectomy urinary incontinence: a prospective study of transurethral bulking agents injection. Gynecol Oncol 2009, 112:90–94.

    Article  PubMed  Google Scholar 

  35. Plotti F, Zullo MA, Palaia I, et al.: Urinary incontinence after radical vulvectomy treated with Macroplastique implantation. J Minim Invasive Gynecol 2008, 15:113–115.

    Article  PubMed  Google Scholar 

  36. Bano F, Barrington JW, Dyer R: Comparison between porcine dermal implant (Permacol) and silicone injection (Macroplastique) for urodynamic stress incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2005, 16:147–150.

    Article  PubMed  CAS  Google Scholar 

  37. Mayer RD, Dmochowski RR, 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, 69:876–880.

    Article  PubMed  CAS  Google Scholar 

  38. 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, 17:670–671.

    Article  PubMed  Google Scholar 

  39. Ko EY, Williams BF, Petrou SP: Bulking agent induced early urethral prolapse after distal urethrectomy. Int Urogynecol J Pelvic Floor Dysfunct 2007, 18:1511–1513.

    Article  PubMed  Google Scholar 

  40. Lai HH, Hurtado EA, Appell RA: Large urethral prolapse formation after calcium hydroxylapatite (Coaptite) injection. Int Urogynecol J Pelvic Floor Dysfunct 2008, 19:1315–1317.

    Article  PubMed  Google Scholar 

  41. Van Kerrebroeck P, ter Meulen F, Larsson G, et al.: Efficacy and safety of a novel system (NASHA/Dx copolymer using the Implacer device) for treatment of stress urinary incontinence. Urology 2004, 4:76–81.

    Google Scholar 

  42. Chapple CR, Haab F, Cervigni M, et al.: An open, multicentre study of NASHA/Dx Gel (Zuidex) for the treatment of stress urinary incontinence. Eur Urol 2005, 48:488–494.

    PubMed  CAS  Google Scholar 

  43. Kobelt G, Fianu-Jonasson A: Treatment of stress urinary incontinence with non-animal stabilised hyaluronic acid/dextranomer (NASHA/Dx) gel: an analysis of utility and cost. Clin Drug Investig 2006, 26:583–591.

    Article  PubMed  Google Scholar 

  44. Papanikolaou NS, Ducket J: Treating urethral sphincter damage caused by long-term urethral catheterisation with a Zuidex periurethral injection and suprapubic catheter. J Obstet Gynaecol 2008, 28:361–362.

    Article  PubMed  CAS  Google Scholar 

  45. Fianu-Jonasson A, Edwall L, Wiberg MK: Magnetic resonance imaging to evaluate NASHA/Dx gel (Zuidex) for stress urinary incontinence. Int J Clin Pract 2006, 10:1181–1186.

    Article  Google Scholar 

  46. Abdelwahab HA, Ghoniem GM: Obstructive suburethral mass after transurethral injection of dextranomer/hyaluronic acid copolymer. Int Urogynecol J Pelvic Floor Dysfunct 2007, 18:1379–1380.

    Article  PubMed  Google Scholar 

  47. Castillo-Vico MT, Checa-Vizcaino MA, Paya-Panades A, et al.: Periurethral granuloma following injection with dextranomer/hyaluronic acid copolymer for stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2007, 18:95–97.

    Article  PubMed  Google Scholar 

  48. Hagemeier T, Blau U, Gauruder-Burmester A, Tunn R: Paraurethral abscess developing after mid-urethral Zuidex-injection in women with stress urinary incontinence ? Management of complications and retrospective comparison with bladder neck located injection technique. Zentralbl Gynakol 2006, 128:68–70.

    Article  PubMed  CAS  Google Scholar 

  49. Loisel C, Secco M, Rocher-Barrat A, et al.: Periurethral pseudocysts following urethral injections of Zuidex: review of the literature. Prog Urol 2008, 18:1038–1043.

    Article  PubMed  CAS  Google Scholar 

  50. Mitterberger M, Marksteiner R, Schwaiger W, et al.: Can autologous myoblasts be used as a potential bulking agent? BJU Int 2008, 102:1731–1736.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jacques Corcos.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kotb, A.F., Campeau, L. & Corcos, J. Urethral bulking agents: Techniques and outcomes. Curr Urol Rep 10, 396–400 (2009). https://doi.org/10.1007/s11934-009-0062-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-009-0062-3

Keywords

Navigation