Hypothesis / aims of study
Urinary incontinence is a recognized complication in men undergoing prostatic surgery for cancer or benign prostatic hyperplasia despite advances in operative technique. Bulking agents may be an attractive treatment option in men who leak very small volumes, are unfit for or wish to avoid more invasive options such as male slings or artificial sphincters. An updated literature review on outcomes in men treated with currently commercially available bulking agents was performed to determine whether this is a reasonable option in selected patients.
Study design, materials and methods
The review adhered to the PRISMA framework of systematic reviews. A comprehensive search of PubMed, Medline and Embase was undertaken. Abstracts were independently screened by two independent investigators to include men with stress urinary incontinence treated with peri-urethral injection of bulking agents currently available on the market. Additional records were identified through manual search of referenced articles. Full articles were assessed according to a pre-agreed protocol made public in a prospective register of systematic reviews
Only 7 original articles met the inclusion criteria. The bulking agents used were Macroplastique in 5 studies (total 123 patients), Durasphere and Urolastic in one study each (7 and 2 patients respectively). Only one study was randomized; Macroplastique and AUS being used in men with mild or total incontinence. The included populations were heterogeneous and encompassed endoscopic, perineal, abdominal and laparoscopic prostate surgery as well as spinal cord injuries and urethral sphincter insufficiency. Significant dissimilarity was evident for the duration of incontinence (9-108 months), mean volume of bulking agent used (2.5-13.5ml), number of cushions (1-5), depth and position of the cushions. The outcomes varied significantly, with reported dry rates between 5.3 and 83%. Outcomes were limited by relatively short follow up time in most studies.
Interpretation of results
Some studies have suggested encouraging, if short term outcomes, but future studies are needed in this field to support recommendations for widespread use.