Department of Urology, Western Health, St Albans, Victoria, Australia.
Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.
Neurourol Urodyn. 2021 Aug;40(6):1349-1388. doi: 10.1002/nau.24696. Epub 2021 May 20.
To perform a systematic review to assess and compare the efficacy and safety of all urethral bulking agents (UBAs) available for the treatment of stress urinary incontinence (SUI) in women.
This systematic review was conducted in accordance with the PRISMA guideline. A systematic search was conducted using the Ovid Medline, Embase and PubMed databases. Studies were included if they involved women who underwent either Bulkamid®, Macroplastique®, Durasphere®, Coaptite®, or Urolastic® injections for the treatment of SUI. A total of 583 articles were screened with 56 articles included. A qualitative analysis was performed.
The newer synthetic UBAs are not inferior to Contigen®, with variable mean success rates of 30%-80% in the short-term. Better long-term success rates were found with Bulkamid® (42%-70%), Coaptite® (60%-75%), and Macroplastique® (21%-80%) on qualitative review. Urinary tract infection rates were similar between bulking agents (4%-10.6%) although temporary acute urinary retention was more commonly associated with Coaptite® (mean: 34.2%), and de novo urgency in Durasphere® (mean: 24.7%). Significant complications such as migration into lymph nodes was reported with Durasphere®. Erosion was reported with Macroplastique®, Coaptite®, and Urolastic®, with a rate as high as 24.6% in one study of Urolastic®.
Available data support the use of Bulkamid® and Macroplastique®, which has shown a short-term efficacy of 30%-90% and 40%-85% respectively, and long-term efficacy of 42%-70%, and 21%-80%, respectively. Bulkamid® appears to have a more favorable safety profile, with no cases of erosion or migration of product associated with its use. Direct comparisons of UBAs have not been performed.
进行系统评价，评估和比较所有可用的尿道填充剂（UBA）治疗女性压力性尿失禁（SUI）的疗效和安全性。
本系统评价按照 PRISMA 指南进行。使用 Ovid Medline、Embase 和 PubMed 数据库进行系统搜索。如果研究涉及接受 Bulkamid®、Macroplastique®、Durasphere®、Coaptite®或 Urolastic®注射治疗 SUI 的女性，则纳入研究。共筛选了 583 篇文章，其中 56 篇文章入选。进行定性分析。
新型合成 UBA 并不逊于 Contigen®，短期平均成功率为 30%-80%。Bulkamid®（42%-70%）、Coaptite®（60%-75%）和 Macroplastique®（21%-80%）的长期成功率较高。定性评价显示，尿路感染率在填充剂之间相似（4%-10.6%），但 Coaptite®（平均：34.2%）更常发生急性尿潴留，Durasphere®（平均：24.7%）新发尿急。有报道称 Durasphere®出现填充剂迁移至淋巴结等严重并发症。Macroplastique®、Coaptite®和 Urolastic®均有报道出现侵蚀，一项 Urolastic®研究中侵蚀发生率高达 24.6%。
现有数据支持使用 Bulkamid®和 Macroplastique®，它们的短期疗效分别为 30%-90%和 40%-85%，长期疗效分别为 42%-70%和 21%-80%。Bulkamid®似乎具有更好的安全性，其使用与产品侵蚀或迁移无关。尚未进行 UBA 的直接比较。
