Bulking agents - An analysis of 500 cases and review of the literature

Abstract

Introduction: Stress urinary incontinence (SUI) is common, impacts women's quality of life and generates high costs. Physiotherapy is the first line therapy and if it fails, suburethral slings are currently the gold standard in SUI surgery. Bulking agents injected periurethrally might be a beneficial alternative, but there is a paucity of data on bulking therapy. Aim of the current study was to analyze the efficacy and safety of bulking agents in the setting of a tertiary referral center prospectively. Materials and Methods: In the last 13 years 514 elderly women with SUI were treated by injection therapy with either collagen, hyaluronic acid, ethylene vinyl alcohol or Polyacrylamide hydrogel. Subjective and objective outcomes were recorded at the 12 month post-operative appointment using the King's Health Questionnaire (KHQ) and Visual Analogue Scale (VAS) to describe their incontinence severity, standardized Pad-Test, and urethral pressure profile. Results: Demographic data were equally distributed in all four groups of agents used. Sixty-one patients were lost to follow-up (10.6%). Statistically significant changes were found for maximum urethral closure pressure (MUCP), pad weight, and VAS before and after bulking for the four agents used. Pad-Test was negative in 73.2% of patients after bulking therapy. Subjective assessment showed improvements in general health and role limitations. The overall complication rate was low for all agents. Conclusions: The current study shows an improvement of incontinence after bulking therapy applying subjective and objective outcomes in an elderly population. In contrast to earlier reports, side effects due to injections were few and mild. We can advocate bulking therapy for the treatment of SUI as it is simple, safe, and shows both objective and subjective improvements and relief.