Leone Roberti Maggiore Umberto, Bogani Giorgio, Meschia Michele, Sorice Paola, Braga Andrea, Salvatore Stefano, Ghezzi Fabio, Serati Maurizio
Obstetrics and Gynaecology Unit, Vita-salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy.
Department of Obstetrics and Gynaecology, University of Insubria, Varese, Italy.
Eur J Obstet Gynecol Reprod Biol. 2015 Jun;189:48-54. doi: 10.1016/j.ejogrb.2015.03.025. Epub 2015 Mar 28.
Bulking agents provide an alternative option in the management of women with stress urinary incontinence and they seem to have an important role in the management flow chart of SUI. However, evidence on this issue is scanty. The most important aspect is to understand whether bulking agents are comparable with the other first-line anti-incontinence surgical procedure (MUS, Burch colposuspension and pubovaginal slings). Hence, the primary aim of the current review was to assess the objective and subjective outcomes of bulking agents in comparison with the other surgical procedures for the treatment of SUI. PubMed and Medline were systematically searched and we included studies evaluating the use of bulking agents in comparison with other surgical approaches for either primary or recurrent treatment of female SUI. Three studies meeting the inclusion criteria were identified. Two of these studies were RCTs evaluating the use of bulking agents versus other surgical procedures for the treatment of primary female SUI; the remnant article was a retrospective cohort study that compared the effectiveness and safety of repeat midurethral sling with urethral bulking after failed midurethral sling. The combined results of all analyses showed that the objective recurrence rate of peri- or trans-urethral injections is significantly higher in comparison with the other surgical procedures. Similar findings were observed when considering separately the treatment for primary or recurrent SUI. Furthermore, lower subjective recurrence rate was observed among patients undergoing other surgical treatment in comparison with those undergoing bulking agents; however, this trend was not statistically significant. Moreover, patients undergoing injection of bulking agents experienced a lower rate of voiding dysfunctions in comparison to the control group. According to current evidence, bulking agents should not be proposed as first-line treatment in those women seeking permanent cure for both primary and recurrent SUI. However, the effectiveness of a procedure should be balanced with its invasiveness and patients' expectations. Bulking agents are a minimally invasive approach to treat SUI and their use should be considered as an alternative strategy particularly in special conditions: patients who are fragile, in those who do not wish to have surgery, or in whom surgical options are restricted (postoperatively, after irradiation).
填充剂为压力性尿失禁女性的治疗提供了另一种选择，并且它们似乎在压力性尿失禁的治疗流程图中发挥着重要作用。然而，关于这个问题的证据很少。最重要的方面是了解填充剂是否与其他一线抗尿失禁手术方法（无张力尿道中段吊带术、Burch阴道悬吊术和耻骨后尿道悬吊术）相当。因此，本综述的主要目的是评估填充剂与其他治疗压力性尿失禁的手术方法相比的客观和主观疗效。我们系统检索了PubMed和Medline，并纳入了评估填充剂与其他手术方法用于女性压力性尿失禁的初次或复发治疗效果比较的研究。共确定了3项符合纳入标准的研究。其中2项研究为随机对照试验，评估填充剂与其他手术方法治疗女性原发性压力性尿失禁的效果；剩余1篇文章为回顾性队列研究，比较了初次无张力尿道中段吊带术失败后重复无张力尿道中段吊带术与尿道填充剂的有效性和安全性。所有分析的综合结果显示，与其他手术方法相比，经尿道或尿道周围注射填充剂后的客观复发率显著更高。在分别考虑原发性或复发性压力性尿失禁的治疗时也观察到了类似的结果。此外，与接受填充剂治疗的患者相比，接受其他手术治疗的患者主观复发率较低；然而，这种趋势没有统计学意义。此外，与对照组相比，接受填充剂注射的患者排尿功能障碍发生率较低。根据目前的证据，对于寻求原发性和复发性压力性尿失禁永久治愈的女性，不应将填充剂作为一线治疗方法。然而，一种治疗方法的有效性应与其侵入性和患者期望相平衡。填充剂是一种治疗压力性尿失禁的微创方法，其应用应被视为一种替代策略，特别是在特殊情况下：身体虚弱的患者、不愿接受手术的患者或手术选择受限的患者（术后、放疗后）。
