Can bulking agents fix failed urethral slings?

This study looked at the effectiveness of bulking agents being used to rescue failed urethral slings in patients with stress urinary incontinence (SUI). It concluded that bulking agents could improve persistent SUI symptoms after urethral sling surgery. 

Stress urinary incontinence (SUI) is urine leakage when there is pressure on the bladder. It is often observed when a patient coughs, sneezes or exercises. SUI happens as a result of weak muscles around the bladder. These muscles hold urine in. 

Urinary incontinence can be treated by pelvic floor exercises, drug therapy, pessaries (to support the walls of the bladder) or nerve stimulation. Surgery can also be an option when these treatments do not work. Surgery usually involves implanting a urethral sling which supports urinary muscles. Surgery however, can carry risk of complications or can be unsuccessful. 

Bullking agents may be an alternative to surgery in SUI. Bulking agents are injected into the urethra (the tube which carries urine out of the body) to thicken it. The thickened urethra can then support the surrounding urinary muscles. Macroplastique is a type of bulking agent made up of a medication called polydimethylsiloxane. Collagen is another type of bulking agent. 

73 female patients were included in the study. These patients had previously had a urethral sling fit. The sling was unsuccessful and SUI symptoms returned. 38 patients had macroplastique injections. 35 patients had collagen injections. Repeat injections were given depending on the patient's symptoms and doctor opinion. Patients were assessed for urinary and incontinence symptoms through questionnaires. 

Patients had an average of 2.6 injections. 71% of patients reported at least partial symptom improvement at the first follow-up visit. 18 of the patients reported total cure of SUI at the first follow-up visit. Patients used an average of 1.1 less incontinence pads per day after treatment. 40 patients were available for assessment longterm. Only 2 of these patients showed long term SUI cure. However, the improvement to quality of life was significant long term. 

This study concluded that bulking agents could improve SUI symptoms long term in women who had unsuccessful surgical treatment. 

The authors note that there was a large drop out rate of patients in the study. They also note that collagen injections are no longer available in the USA. These factors may affect the study's results. 

If you are interested in learning more about bulking agents being used to treat SUI symptoms, contact your doctor.