Review of the available urethral bulking agents.
OBJECTIVE
Newer tissue bulking agents used to treat stress urinary incontinence and vesicoureteral reflux provide for similar rates of success as older agents, but with greater safety and hopefully with greater durability. We review the new studies on the development and on the current trials of bulking agents.


RESULTS
Recent reports suggest that periurethral bulking agents are as effective for genuine stress urinary continence as for intrinsic sphincter deficiency, expanding the indications for injectable agents to include patients desiring less invasive procedures due to personal preference or as a result of medical necessity. Newer bulking agents, Durasphere and Macroplastique, appear safe and as efficacious as older agents in early trials. Durability remains a question for these agents. Injectable tissue matrices and autologous cells may prove useful in the future.


CONCLUSIONS
If durable and safe, these minimally invasive bulking agents may prove useful for all types of stress urinary incontinence. The price of minimal invasiveness may be lower efficacy, but their use does not compromise further therapy, should it be needed.
Lightner
Deborah J
DJ
Mayo Clinic, Rochester, Minnesota 55905, USA. lightner.deborah@mayo.edu
D001672:Biocompatible Materials / Q000627:therapeutic use; D003094:Collagen / Q000627:therapeutic use; D005936:Glucans / Q000627:therapeutic use; D006801:Humans; D019736:Prostheses and Implants; D012826:Silicone Elastomers / Q000627:therapeutic use; D014550:Urinary Incontinence, Stress / Q000188:drug therapy*; D014718:Vesico-Ureteral Reflux / Q000188:drug therapy*; D015040:Zirconium / Q000627:therapeutic use
D001672:Biocompatible Materials; D005936:Glucans; D012826:Silicone Elastomers; C431745:durasphere; C048470:glutaraldehyde-cross-linked collagen; D003094:Collagen; D015040:Zirconium