Bulking agents less effective than surgical methods in subjective improvement of stress urinary incontinence in women

Based on the above, Laura Pivazyan from Sechenov University Moscow in Russian Federations and colleagues suggested that the first and final surgery is considered the best.

The surgical management of stress urinary incontinence (SUI) in women has been controversial worldwide. There have been concerns about the possibility that surgical management of SUI in older women can lead to several postoperative side effects. However, safety concerns linked with using vaginal slings and tapes have emerged. The FDA has emphasized that practitioners obtain specialized training in each surgical technique they employ for SUI. The safety concerns have contributed to increased rates of alternative treatment - the injection of urethral bulking agents. However, the data is still limited regarding the safety and effectiveness of this novel remedy for SUI patients.

Due to the lack of evidence-based information that stresses differences between surgical and alternative techniques, Dr Pivazyan and colleagues aimed to assess the safety and efficacy of bulking agents compared with surgical methods for female stress urinary incontinence.

The study included women with stress urinary incontinence. A comparison was drawn between bulking agents versus any surgical treatment. Patients with other types of incontinence and therapy were excluded. The authors searched the electronic databases from 2000 until 2021 to identify articles assessing the safety and effectiveness of urethral bulking agents compared to surgical methods. The risk of bias in the included studies was evaluated using the Risk-of-bias assessment tools recommended by the Cochrane Society.

The primary analysis assessed objective and subjective success in achieving a better quality of life and continence of women with SUI. The secondary research was aimed at safety assessment based on the classification by Dindo et al.

The study led to the following findings:

• Six studies were included in the quantitative synthesis for 710 patients.
• The systematic review and meta-analysis showed that bulking agents are less effective than surgical procedures according to subjective improvement after treatment (RR = 0.70).
• The authors did not observe any statistically significant difference between these two methods concerning complications after the intervention (RR = 1.30).

The study's main limitation was the absence of a standard objective outcome measure to assess effectiveness.

"We found that bulking agents are less effective than surgical procedures based on subjective improvement after treatment," the researchers wrote. "Also, there was no statistical difference in complication after the intervention between these two methods. Hence, we believe first and final surgery to be the best."