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Res Rep Urol. 2019 Nov 12;11:299-310. doi: 10.2147/RRU.S220216. eCollection 2019.

Particulate Versus Non-Particulate Bulking Agents In The Treatment Of Stress Urinary Incontinence.

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Department of Urology, Royal Hallamshire Hospital, Sheffield, UK.
Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA.


Stress urinary incontinence (SUI) has been treated surgically with the midurethral sling but in recent years, this option has come under scrutiny and the risk-benefit balance continues to be reviewed. The low-risk alternative for women with uncomplicated SUI is the bulking agent, which aims to achieve continence through coaptation of the urethra. Two classes of bulking agents can be identified: those made from solid microparticles in an absorbable liquid or gel carrier (particulate agents) and those comprising a homogenous gel (non-particulates) that resists absorption. Polydimethylsiloxane®, carbon-coated zirconium oxide®, calcium hydroxyapatite® and polyacrylate polyalcohol copolymer® are currently marketed particulate agents. With the exception of calcium hydroxyapatite, the particles are non-degradable. Each agent achieves its long-term bulking effect through reactive changes around the persisting particles while the carrier volume is lost. Bulkamid® is a non-particulate agent with the bulking effect resulting from the volume of gel injected. The lasting network of fine fibers formed by the host tissue anchors the gel in situ. Foreign-body granulomas, erosion and migration/material extrusion and loss of bulk have been observed in connection with the particle-based products. Bulkamid may be mechanistically less liable to these events; however, there are minimal data directly comparing the two types of bulking agent. The question of durability is inevitable based on their differing modes of action.


bulking agents; non-particulate; particulate; safety; stress urinary incontinence

Conflict of interest statement

C Chapple has acted as a consultant/advisor for Ferring, Contura, Astellas Pharma, Bayer Schering Parma AG, Galvani Bioelectronics (GSK), Pierre Fabre, Symimetics, Taris Biomedical, and Urovant Sciences. He has acted as an author for Allergan publications and as a researcher in scientific studies for Ipsen and as a speaker for Pfizer. He has also received a grant from Astellas Pharma and personal fees from Astellas Pharma, Bayer Schering Parma AG, Pierre Fabre, Pfizer, Ferring, Galvani Bioelectronics (GSK), Taris Biomedical, and Urovant Sciences. R Dmochowski has acted as a consultant for Axonicx, Blue Wind, Contura and Viveve. The authors report no other conflicts of interest in this work.

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