Effectiveness of bulking agents in managing stress and mixed urinary incontinence: a systematic review and meta-analysis

Abstract

Stress urinary incontinence and stress-predominant mixed urinary incontinence are prevalent conditions that significantly impair quality of life, particularly among women. Urethral bulking agents have emerged as a non-surgical treatment option for patients who are hesitant to undergo surgical interventions. The aim of this systematic review and meta-analysis is to evaluate the efficacy and safety of various urethral bulking agents, specifically Bulkamid, Macroplastique, and Urolastic, in treating stress urinary incontinence and stress-predominant mixed urinary incontinence. The review encompasses 15 studies, including rando­mized controlled trials and cohort studies, with a total of 1,120 patients. The analysis focuses on cure and improvement rates, complications, and the risk of bias associated with the included studies. The fin­dings indicate that bulking agents demonstrate cure and improvement rates ranging from 70 to 80 %, with a pooled average of 75 %. Subgroup analyses reveal cure rates of 76 % for Bulkamid, 73 % for Urolastic, and 77 % for Macroplastique. Despite significant statistical heterogeneity, particularly for Bulkamid and Urolastic, the results suggest that these agents can serve as effective non-surgical options. The outcomes appear consistent across all continents included in this study, reinforcing their potential as reliable alternative glo­bally. Ho­wever, the review highlights the necessity for well-designed randomized controlled trials to further assess the long-term efficacy and safety of these treatments, ultimately aiming to optimize patient outcomes.