title: Polyacrylamide hydrogel (Bulkamid®) for stress urinary incontinence in women: a systematic review of the literature.
abstract: OBJECTIVE
  Polyacrylamide hydrogel (PAHG, Bulkamid®) is one of several injectable agents currently used for the treatment of women with urinary stress incontinence. Although bulking agents appear to have lower efficacy rates compared to other surgical treatments, current evidence based on large prospective or comparative studies as well as systematic reviews is limited. The purpose of this study was to conduct a systematic review on the efficacy of PAHG in the treatment of female patients with stress urinary incontinence with regard to reproducibility, feasibility, safety and clinical outcome.
  
  
  METHODS
  We searched MEDLINE (1966-2015), Scopus (2004-2015), POPLINE (1974-2015) and ClinicalTrials.gov (2008-2015) along with reference lists of electronically retrieved studies. Observational studies, prospective, retrospective and randomized controlled studies were included. Two reviewers independently selected studies, assessed the risk of bias and tabulated data to structured forms.
  
  
  RESULTS
  We included 8 studies, which enrolled a total of 767 patients who received treatment with PAHG. We found that 186 of 767 women (24.3 %, range 12-35 %) required reinjection in order to achieve adequate efficacy. The most frequent adverse effects were pain at the site of injection (4-14 %) and urinary tract infections (3-7 %). Both the number of incontinence episodes/24 h and the number of ml/24 h were significantly reduced 1 year following treatment and the quality of life of patients was significantly improved.
  
  
  CONCLUSIONS
  PAHG is a safe intervention for treating women with stress urinary incontinence, but repeat injections are often required. Further research is mandated in the field in order to compare its efficacy to other bulking agents.
authors.affiliation: Department of Obstetrics and Gynaecology, Urogynaecology Unit, St. George's University Hospitals NHS Foundation Trust, London, SW17 0QT, UK. dranushuya@gmail.com.
authors.forename: Anushuya Devi
authors.initials: AD
authors.lastname: Kasi
authors.affiliation: Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Medical School, University of Athens, Athens, Greece. pergialiotis@hotmail.com.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Pergialiotis
authors.affiliation: Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Medical School, University of Athens, Athens, Greece. dperrea@lessr.eu.
authors.forename: Despina N
authors.initials: DN
authors.lastname: Perrea
authors.affiliation: Department of Obstetrics and Gynaecology, Urogynaecology Unit, St. George's University Hospitals NHS Foundation Trust, London, SW17 0QT, UK. azarkhunda@yahoo.co.uk.
authors.forename: Azar
authors.initials: A
authors.lastname: Khunda
authors.affiliation: Department of Obstetrics and Gynaecology, Urogynaecology Unit, St. George's University Hospitals NHS Foundation Trust, London, SW17 0QT, UK. sdoum@yahoo.com.|Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Medical School, University of Athens, Athens, Greece. sdoum@yahoo.com.
authors.forename: Stergios K
authors.initials: SK
authors.lastname: Doumouchtsis
mesh_terms: D000180:Acrylic Resins / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D020100:Hydrogels / Q000627:therapeutic use*; D014550:Urinary Incontinence, Stress / Q000628:therapy*
chemical_list: D000180:Acrylic Resins; C528271:Bulkamid; D020100:Hydrogels
keywords: Bulkamid; Polyacrylamide hydrogel; Stress urinary incontinence