From the White Plains Hospital/Montefiore System, White Plains, NY.
Northwell Health, Plainview, NY.
Urogynecology (Phila). 2024 Aug 1;30(8):667-682. doi: 10.1097/SPV.0000000000001548.
This Clinical Practice Statement aims to provide clinicians with evidence-based guidance for the use of urethral bulking agents (UBAs) in the treatment of stress urinary incontinence (SUI).
We conducted a structured search of the English literature published from January 1960 to November 2022. Search terms identified studies of both current and historic UBAs. Data extracted at the time of full-text review included type of study, research setting, number of participants, age group, bulking agent, primary outcome, secondary outcome, efficacy, and complications.
One thousand five hundred ninety-four nonduplicate articles were identified using the search criteria. After limiting the article types to randomized control led trials, prospective studies, guideline documents, reviews, meta-analyses, and case reports of complications, 395 studies were screened.
Based on our findings, we propose the following recommendations for clinicians when considering UBA: First, UBA is indicated in cases of demonstrable SUI. Intrinsic sphincter deficiency is not predictive of patient outcomes. Second, patients should be counseled on the risks, lack of long-term efficacy data, potential need for repeat injections, possible need for surgery for recurrent SUI, implications for future procedures, and pelvic imaging findings that may be observed after UBA. Third, UBA may be considered for initial management of SUI. Fourth, UBA is an option for patients with persistent or recurrent SUI after a sling procedure. Fifth, clinicians may prioritize UBA over surgery in specific patient populations. Sixth, polyacrylamide hydrogel demonstrates marginally improved safety and durability data over other available agents.
本临床实践声明旨在为临床医生提供使用尿道填充剂（UBA）治疗压力性尿失禁（SUI）的循证指导。
我们对 1960 年 1 月至 2022 年 11 月发表的英文文献进行了结构化搜索。搜索词确定了当前和历史 UBA 的研究。在全文审查时提取的数据包括研究类型、研究地点、参与者人数、年龄组、填充剂、主要结局、次要结局、疗效和并发症。
使用搜索标准确定了 1594 篇非重复文章。在将文章类型限制为随机对照试验、前瞻性研究、指南文件、综述、荟萃分析和并发症病例报告后，筛选了 395 篇研究。
根据我们的发现，当考虑 UBA 时，我们向临床医生提出以下建议：首先，UBA 适用于有明显 SUI 的病例。固有括约肌缺陷不能预测患者结局。其次，应向患者告知风险、缺乏长期疗效数据、可能需要重复注射、可能需要手术治疗复发性 SUI、对未来程序的影响以及 UBA 后可能观察到的盆腔影像学发现。第三，UBA 可考虑用于 SUI 的初始管理。第四，UBA 是吊带手术后持续或复发性 SUI 的患者的选择。第五，在特定患者人群中，临床医生可能会优先选择 UBA 而不是手术。第六，聚丙烯酰胺水凝胶在安全性和耐用性数据方面优于其他可用药物。
