Beads for urethral bulking prove good 'quick fix'. (Less Invasive than Incontinence Surgery).

BALTIMORE -- Urethral bulking procedures remain a good treatment choice for incompetent urinary sphincter, and they yield similar results whether the injected material is collagen or microcarbon beads, Dr. Ananias Diokno said at a urogynecology meeting sponsored by Johns Hopkins University.

Urethral bulking is indicated for women with an intrinsic sphincter deficiency who are not good candidates for surgery, want minimally invasive therapy, or have had only a partial response to a suspension/sling procedure and want to further enhance that response, said Dr. Diokno, chief of urology at William Beaumont Hospital in Royal Oak, Mich.

Injectable Teflon was widely used as a urethral bulking agent in the 1950s and 1960s and was effective, but it has been largely abandoned because of fear that the Teflon would migrate to other tissues, as well as other safety issues. Similarly, silicone particles have been used in Europe but "will never be accepted here" for liability reasons, he said.

Injections of autologous fat, autologous chondrocytes harvested from the ear, or calcium hydroxylapatite also have shown promise but are still considered investigational. That leaves two materials--collagen and microcarbon beads--that have been approved by the Food and Drug Administration as urethral bulking agents.

Only one randomized, controlled trial to date has directly compared the two materials. In the recently published study, researchers at the Mayo Clinic in Rochester, Minn., found that at 12-month follow-up, the "dry rate" was 69% for collagen and 80% for microcarbon beads--a difference that was not statistically significant.

Subjects in both groups had similar grades of residual incontinence and degrees of urinary leakage based on the weight of absorbent pads. Similar numbers of subjects in both groups improved ...