Bulking agents for minimally invasive correction of stress urinary incontinence in women

BACKGROUND:The study is relevant due to the widespread prevalence of stress urinary incontinence in women and the search for minimally invasive and safe treatment methods. AIM:The aim of this study was to present data based on modern evidence-based information on the effectiveness of urethral bulking agents and their safety in stress urinary incontinence treatment in women. MATERIALS AND METHODS:A review of the literature (original articles, systematic reviews) on the use of urethral bulking agents for stress urinary incontinence treatment in women was carried out. RESULTS:Urethral bulking agents for stress urinary incontinence treatment are effective due to the creation of additional bulk in the paraurethral area without fibrosis or because of inflammation followed by fibrous tissue formation. The efficacy and complications depend on the properties of the used urethral bulking agents. Since the performed studies are heterogeneous and the methods for evaluating the use of bulking fillers in stress urinary incontinence treatment vary, it is difficult to comparatively characterize urethral bulking agents to determine the most effective one. The search is being conducted for an ideal proper filler, which should be biocompatible and non-immunogenic and maintain a long-term therapeutic effect. CONCLUSIONS:Urethral bulking injections are an alternative therapy for women with stress urinary incontinence who are informed about its short-term effect and are expecting to avoid the risk of possible complications after surgery. Promising is to be regarded as the use of new urethral bulking agents based on hyaluronic acid with an optimal choice of concentration, degree of crosslinking and type of crosslinking agent to ensure maximum duration of action and minimum side effects.

Five-year data on the first UK experience of using urethral bulking agents in treating men with stress urinary incontinence

Level of evidence: 4

Stress Urinary Incontinence I: Nonsurgical Management

Conservative management of stress urinary incontinence (SUI) is generally offered as first-line treatment. Such treatment options include behavioral therapy, pelvic floor muscle therapy, vaginal devices, pharmacologic therapy, and urethral bulking agents. Weight loss management is an example of an effective behavioral strategy in obese patients. Pelvic floor physical therapy alone or under the supervision of skilled providers can significantly improve SUI; however, long-term effects are harder to maintain. Pessaries, vaginal cones, and vaginal inserts have been widely used for treatment of SUI and are beneficial in patients who are motivated to use them. Currently in the United States, there is no FDA-approved medication for the treatment of SUI. Conversely, the European Union has approved and used duloxetine. Urethral bulking agents are indicated for patients with intrinsic sphincter deficiency and sometimes used in patients who are not able to undergo surgical procedures for SUI or who have failed said procedures. Three materials are currently FDA approved for urethral bulking in the United States. Many options exist for the nonsurgical management of SUI. This review contains 5 tables and 47 references Key words: Stress Urinary Incontinence, conservative treatment, urethral bulking, pelvic floor exercises, incontinence pessaries.