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Particulate Versus Non-Particulate Bulking Agents In The Treatment Of Stress Urinary Incontinence

Authors Chapple C, Dmochowski R

Received 21 June 2019

Accepted for publication 24 September 2019

Published 12 November 2019 Volume 2019:11 Pages 299—310

DOI https://doi.org/10.2147/RRU.S220216

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Nicola Ludin

Peer reviewer comments 2

Editor who approved publication: Dr Jan Colli


Christopher Chapple,1 Roger Dmochowski2

1Department of Urology, Royal Hallamshire Hospital, Sheffield, UK; 2Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA

Correspondence: Christopher Chapple
Department of Urology, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UK
Tel +44 114 271 3048
Fax +44 114 279 7841
Email c.r.chapple@shef.ac.uk

Abstract: Stress urinary incontinence (SUI) has been treated surgically with the midurethral sling but in recent years, this option has come under scrutiny and the risk–benefit balance continues to be reviewed. The low-risk alternative for women with uncomplicated SUI is the bulking agent, which aims to achieve continence through coaptation of the urethra. Two classes of bulking agents can be identified: those made from solid microparticles in an absorbable liquid or gel carrier (particulate agents) and those comprising a homogenous gel (non-particulates) that resists absorption. Polydimethylsiloxane®, carbon-coated zirconium oxide®, calcium hydroxyapatite® and polyacrylate polyalcohol copolymer® are currently marketed particulate agents. With the exception of calcium hydroxyapatite, the particles are non-degradable. Each agent achieves its long-term bulking effect through reactive changes around the persisting particles while the carrier volume is lost. Bulkamid® is a non-particulate agent with the bulking effect resulting from the volume of gel injected. The lasting network of fine fibers formed by the host tissue anchors the gel in situ. Foreign-body granulomas, erosion and migration/material extrusion and loss of bulk have been observed in connection with the particle-based products. Bulkamid may be mechanistically less liable to these events; however, there are minimal data directly comparing the two types of bulking agent. The question of durability is inevitable based on their differing modes of action.

Keywords: stress urinary incontinence, bulking agents, safety, particulate, non-particulate

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