Effectiveness and safety of bulking agents versus surgical methods in women with stress urinary incontinence: a systematic review and meta-analysis

• Published in: International Urogynecology Journal 2022-04, Vol.33 (4), p.777-787
• Main Authors: Pivazyan, Laura, Kasyan, George, Grigoryan, Bagrat, Pushkar, Dmitry
• Format: Article
• Language: English
• Subjects: Bias; Clinical trials; Female; Gynecology; Humans; Medicine; Medicine & Public Health; Meta-analysis; Patients; Quality of life; Questionnaires; Review Article; Suburethral Slings; Systematic review; Treatment Outcome; Urethra - surgery; Urinary incontinence; Urinary Incontinence - surgery; Urinary Incontinence, Stress - surgery; Urologic Surgical Procedures - methods; Urological surgery; Urology
• ISSN: 0937-3462; 1433-3023; 1433-3023
• DOI: 10.1007/s00192-021-04937-1

Introduction and hypothesis The objective was to evaluate the efficacy and safety of bulking agents compared with surgical methods for female stress urinary incontinence. Methods Inclusion and exclusion criteria: women with stress urinary incontinence. Bulking agents versus any surgical treatment as a comparison. Patients with other types of incontinence and treatment were excluded. Electronic databases (PubMed, MEDLINE, and the Cochrane Library) were searched from 2000 until 2021 to identify articles evaluating the effectiveness and safety of urethral bulking agents versus surgical methods. Risk-of-bias assessment tools recommended by the Cochrane Society were used to evaluate the risk of bias in the studies included. Results Six studies were included in the quantitative synthesis for a total of 710 patients. Our systematic review and meta-analysis showed that bulking agents are less effective than surgical procedures according to subjective improvement after treatment (RR = 0.70, 95% CI: 0.53 to 0.92, p  = 0.01). There was no statistically significant difference between these two methods with regard to complications after the intervention (RR = 1.30, 95% CI: 0.30 to 5.66, p  = 0.73). Conclusion The main limitation of this systematic review and meta-analysis was the absence of a common objective outcome measure to evaluate effectiveness. However, it shows that bulking agents are less effective than surgical procedures in subjective improvement. Safety analysis showed no significant difference between these methods. Hence, we believe that the first and final surgery is considered to be the best.