Abstract
Stress urinary incontinence (SUI) is primarily managed by conservative strategies. When these methods fail, minimally invasive treatments, if effective, safe, and durable, can result in a considerable reduction in current medical costs for this common condition. Injection of currently available bulking agents is a safe, minimally invasive procedure and offers a degree of efficacy. The long-term durability of several of these agents is yet to be determined. The use of bulking agents for the treatment of anatomic SUI has been demonstrated to produce success rates similar to those observed when these materials are used in patients with intrinsic sphincter deficiency, opening up new therapeutic options for women with SUI. We review the current basic science and clinical research into the development of newer agents for soft-tissue bulking.
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Herschorn S, Glazer AA: Early experience with small volume periurethral polytetrafluoroethylene for female stress urinary incontinence. J Urol 2000, 163:1838–1842.
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.
Winters JC, Chiverton A, Scarpero HM, Prats LJ Jr: Collagen injection therapy in elderly women: long-term results and patient satisfaction. Urology 2000, 55:856–861.
Gorton E, Stanton S, Monga A, et al.: Periurethral collagen injection: a long-term follow-up study. BJU Int 1999, 84:966–971.
Beckingham IJ, Wemyss-Holden G, Lawrence WT: Long-term follow-up of women treated with periurethral Teflon injections for stress incontinence. Br J Urol 1992, 69:580–583.
Barranger E, Fritel X, Kadoch O, et al.: Results of transurethral injection of silicone micro-implants for females with intrinsic sphincter deficiency. J Urol 2000, 164:1619–1622.
Groutz A, Blaivas JG, Kesler SS, et al.: Outcome results of transurethral collagen injection for female stress incontinence: assessment by urinary incontinence score. J Urol 2000, 164:2006–2009.
Leach GE, Dmochowski RR, Appell RA, et al.: Female Stress Urinary Incontinence Clinical Guidelines Panel summary report on surgical management of female stress urinary incontinence. The American Urological Association. J Urol 1997, 158:875–880.
Lee PE, Kung RC, Drutz HP: Periurethral autologous fat injection as treatment for female stress urinary incontinence: a randomized double-blind controlled trial. J Urol 2001, 165:153–158. This report on a randomized trial proves that autologous fat injections are of no clinical utility.
Harrison SC, Brown C, O’Boyle PJ: Periurethral Teflon for stress urinary incontinence: medium-term results. Br J Urol 1993, 71:25–27.
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, doubleblind study of Durasphere. Urology 2001, 58:12–15. The results of this prospective randomized multisite trial proved that Durasphere is safe and effective for the treatment of SUI.
Radley SC, Chapple CR, Mitsogiannis IC, Glass KS: Transurethral implantation of macroplastique for the treatment of female stress urinary incontinence secondary to urethral sphincter deficiency. Eur Urol 2001, 39:383–389. The authors propose that successful treatment correlates with complete filling of the proximal urethra after Macroplastique injection. Macroplastique appears effective even after previously unsuccessful surgery.
Berman CJ, Kreder KJ: Comparative cost analysis of collagen injection and fascia lata sling cystourethropexy for the treatment of type III incontinence in women. J Urol 1997, 157:122–124.
Bent AE, Tutrone RT, McLennan MT, et al.: Treatment of intrinsic sphincter deficiency using autologous ear chondrocytes as a bulking agent. Neurourol Urodyn 2001, 20:157–165. This article discusses autologous material as a possible new bulking agent, a method that shows early promise.
Lopez A, Padron O, Patsias G, Politano V: Transurethral polytetrafluoroethylene injection in female patients with urinary incontinence. J Urol 1993, 150:856–858.
Mayer R, Lightfoot M, Jung I: Preliminary evaluation of calcium hydroxylapatite as a transurethral bulking agent for stress urinary incontinence. Urology 2001, 57:434–438. This is a report of a provocative new material with potential use as a bulking agent.
Herschorn S, Radomski SB: Collagen injections for genuine stress urinary incontinence: patient selection and durability. Int Urogynecol J Pelvic Floor Dysfunct 1997, 8:18–24.
Faerber GJ: Endoscopic collagen injection therapy in elderly women with type I stress urinary incontinence. J Urol 1996, 155:512–514.
Swami S, Batista JE, Abrams P: Collagen for female genuine stress incontinence after a minimum 2-year follow-up. Br J Urol 1997, 80:757–761.
Cross CA, English SF, Cespedes RD, McGuire EJ: A followup on transurethral collagen injection therapy for urinary incontinence. J Urol 1998, 159:106–108.
Smith DN, Appell RA, Winters JC, Rackley RR: Collagen injection therapy for female intrinsic sphincter deficiency. J Urol 1997, 157:1275–1278.
Haab F, Zimmern PE, Leach GE: Urinary stress incontinence due to intrinsic sphincteric deficiency: experience with fat and collagen periurethral injections. J Urol 1997, 157:1283–1286.
Appell RA: Collagen injection therapy for urinary incontinence. Urol Clin North Am 1994, 21:177–182.
Stanton SL, Monga AK: Incontinence in elderly women: is periurethral collagen an advance? Br J Obstet Gynaecol 1997, 104:154–157.
Steele AC, Kohli N, Karram MM: Periurethral collagen injection for stress incontinence with and without urethral hypermobility. Obstet Gynecol 2000, 95:327–331.
Bent AE, Foote JE, Siegel S, et al.: Collagen implant for treating stress urinary incontinence in women with urethral hypermobility. J Urol 2001, 166:1354–1357.
Su TH, Wang KG, Hsu CY, et al.: Periurethral fat injection in the treatment of recurrent genuine stress incontinence. J Urol 1998, 159:411–414.
Koelbl H, Saz V, Doerfler D, et al.: Transurethral injection of silicone microimplants for intrinsic urethral sphincter deficiency. Obstet Gynecol 1998, 92:332–336.
Dmochowski RR, Appell RA: Delivery of injectable agents for treatment of stress urinary incontinence in women: evolving techniques. Tech Urol 2001, 7:110–117.
Sweat SD, Lightner DJ: Complications of sterile abscess formation and pulmonary embolism following periurethral bulking agents. J Urol 1999, 161:93–96.
Heit M: Prolonged urinary retention after collagen periurethral injections: a sequela of humoral immunity. Obstet Gynecol 1997, 90:693–695.
Wainstein MA, Klutke CG: Periurethral pseudocyst following cystoscopic collagen injection. Urology 1998, 51:835–836.
Clemens JQ, Bushman W: Urethral diverticulum following transurethral collagen injection therapy. Obstet Gynecol 1998, 92:650–652.
McLennan MT, Bent AE: Suburethral abscess: a complication of periurethral collagen injection therapy. Obstet Gynecol 1998, 92:650–652.
Khalill A, Ghazeeri G, Chammas M, et al.: Teflonoma presenting as a cystourethrocele. Clin Exp Obstet Gynecol 2001, 28:58–59.
Harris RL, Cundiff GW, Coates KW, et al.: Urethral prolapse after collagen injection. Am J Obstet Gynecol 1998, 178:614–615.
Hanke CW, Higley HR, Jolivette DM, et al.: Abscess formation and local necrosis after treatment with Zyderm or Zyplast collagen implant. J Am Acad Dermatol 1991, 25:319–326.
Carlin BI, Klutke CG: Development of urethrovaginal fistula following periurethral collagen injection. J Urol 2000, 164:124.
Pruthi RS, Petrus CD, Bundrick WJ: New onset vesicovaginal fistula after transurethral collagen injection in women who underwent cystectomy and orthotopic neobladder creation: presentation and definitive treatment. J Urol 2000, 164:1638–1639.
Pannek J, Brands FH, Senge T: Particle migration after transurethral injection of carbon coated beads for stress urinary incontinence. J Urol 2001, 166:1350–1353.
Matthews K, Govier FE: Osteitis pubis after periurethral collagen injection. Urology 1997, 49:237–238.
Stenberg A, Larsson E, Lindholm A, et al.: Injectable dextranomer-based implant: histopathology, volume changes and DNA-analysis. Scan J Urol Nephrol 1999, 33:355–361.
Stenberg A, Larsson G, Johnson P, et al.: DiHA Dextran Copolymer, a new biocompatible material for endoscopic treatment of stress incontinent women. Short term results. Acta Obstet Gynecol Scand 1999, 78:436–442.
Diamond DA, Caldamone AA: Endoscopic correction of vesicoureteral reflux in children using autologous chondrocytes: preliminary results. J Urol 1999, 162:1185–1188.
Pettis GY, Kaban LB, Glowacki J: Tissue response to composite ceramic hydroxyapatite/demineralized bone implants. J Oral Maxillofac Surg 1990, 48:1068–1074.
Rowley JA, Madlambayan G, Mooney DJ: Alginate hydrogels as synthetic extracellular matrix materials. Biomaterials 1999, 20:45–53.
Loebsack A, Greene K, Wyatt S, et al.: In vivo characterization of a porous hydrogel material for use as a tissue bulking agent. J Biomed Mater Res 2001, 57:575–581. This basic science article examines hydrogel alginate beads as a potential new bulking agent.
Chancellor MB, Yokoyama T, Tirney S, et al.: Preliminary results of myoblast injection into the urethra and bladder wall: a possible method for the treatment of stress urinary incontinence and impaired detrusor contractility. Neurourol Urodyn 2000, 19:279–287. This paper discussed myoblast formation of new myotubes and myofibers in a xenograft model for potential application in both urethral and bladder dysfunction.
Furness PD 3rd, Kolligian ME, Lang SJ, et al.: Injectable small intestinal submucosa: preliminary evaluation for use in endoscopic urological surgery. J Urol 2000, 164:1680–1685. Based on canine studies, the authors suggest that small intestinal mucosa may be useable as an injectable agent.
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Lightner, D.J., Itano, N.B., Sweat, S.D. et al. Injectable agents: Present and future. Curr Urol Rep 3, 408–413 (2002). https://doi.org/10.1007/s11934-002-0086-4
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DOI: https://doi.org/10.1007/s11934-002-0086-4