Stress urinary incontinence: improved periurethral bulking options on horizon.(Gynecology)

UNIVERSAL CITY, CALIF. -- Transvaginal tension-free tape procedures have become so popular for treating stress urinary incontinence that some physicians have forgotten about a nonsurgical alternative, periurethral bulking, that works "extremely well" for properly selected patients, Dr. Alfred E. Bent said at a meeting of the Obstetrical and Gynecological Assembly of Southern California.

"Some people think we should do tension-free vaginal tape [TVT] for everyone, and it's very easy to get sucked into that mentality," he said.

But for patients who want to avoid surgery or who have residual incontinence following surgery, periurethral bulking is a good alternative that's about to get better, according to Dr. Bent, who chairs the department of gynecology at the Greater Baltimore Medical Center.

No fewer than 11 companies are marketing or will soon introduce injectable materials designed to add bulk to the submucosal tissue at the bladder neck, creating, in effect, an artifical prostate that restricts urine flow in women with urethral hypermobility and intrinsic sphincter deficiency.

Proper patient selection and precise placement of bovine collagen or other materials lead to significant patient satisfaction with the procedure, although it does require repeated injections under local anesthesia, Dr. Bent said.

Indeed, the procedure's success is highly variable, with cure rates of 40%-50% and another 30% of patients reporting improvement in one study (J. Urol. 159[1]:106-08, 1998).

The same report indicated the need for follow-up injections ...