Which treatment is best for stress incontinence, surgery or bulking agents?

This study compared the use of bulking agents versus surgery for the treatment of stress urinary incontinence (SUI). It found that bulking agents were less effective for SUI compared to surgical treatment.

Stress urinary incontinence (SUI) is a condition that is common in women. It leads to leaking of urine during exertion such as sneezing, coughing, or lifting weights. It is usually caused by weakness of the pelvic muscles from childbirth or older age.  

SUI can be treated in different ways. One treatment involves injecting a bulking agent into the urethra (the tube the drains the bladder). The bulking agent thickens the walls of the urethra, narrowing the opening of the tube and reducing urine leakage. Another treatment involves surgery to reduce urine leakage. There are different types of surgery but they usually involve lifting and supporting the neck of the urethra. When the urethra is raised urine is less likely to leak out due to gravity.

It is not clear whether surgery or bulking agent treatment is more effective in women with SUI.

This study reviewed 6 previous studies involving a total of 710 patients with SUI. 288 patients were treated with bulking agents. 317 patients were treated with surgery. The effectiveness of the treatment was assessed using patient self-assessment and questionnaires.

Patients treated with bulking agents were 30% less likely to notice an improvement in their symptoms compared to patients treated with surgery. There was no significant difference in the risk of complications between the two treatments.

This study showed that surgical treatment is more likely to lead to improved symptoms of SUI than urethral bulking agents. 

The studies included in this study all used different methods of measuring the outcomes. Further studies are needed to confirm these findings.