Abstract
This review will define the populations and indications for using urethral bulking agents. It will also provide information on safety, ease of use and durability of currently available urethral bulking agents, as well as the transurethral technologies that are in the process of investigation. Urethral bulking agents have been used in the treatment of stress urinary incontinence for more than four decades. The advantages are a minimally invasive technique, low complication rates and ease of administration. Urinary leakage in women caused by intrinsic sphincteric deficiency, in patients with neurologic disease, or in men with post-prostatectomy incontinence, may be effectively treated with urethral bulking agents. Urethral hypermobility in women does not appear to influence the success of bulking agents. Patients choosing use of urethral bulking agents should generally expect cure in a third, improvement in a third and failure in a third for these agents. Four US FDA-approved agents are in current clinical use: Contigen®, Durasphere® EXP, Coaptite® and Macroplastique®. There is no clearly superior bulking agent in clinical use. While both efficacy and durability are inferior to surgical treatment, these agents have a role in treating stress urinary incontinence.
Acknowledgements
This paper is in memory of my dear friend, Dr Rodney Appell, who contributed so much to this field and to the lives of so many of us.
We acknowledge and appreciate the efforts of Pamela Schroeder in manuscript preparation and submission.
Financial & competing interests disclosures
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.