Injectable agents in the treatment of stress urinary incontinence in women: Where are we now?

Periurethral bulking agents have been used for decades. The only currently available agents (in the United States) include glutaraldehyde cross-linked collagen, autologous fat, and carbon bead technology. Initial subjective c ure rates with collagen are acceptable, but with the majority of women requ iring reinjection. The risk of allergic phenomena complicates collagen use. Autologous fat injection is initially effective in >50% of women, but reso rption and fibrous replacement hamper the stability of the transplanted gra ft. Polytetrafluoroethylene and silicone are not currently approved by the US Food and Drug Administration because of particle migration. Materials in development include biologic agents such as allogeneic human collagen and autologous cartilage. Developmental synthetic agents include microballoon t echnology, hyaluronic acid with or without microsphere technology, hydroxyl apatite, and a variety of polymeric technologies. Patient selection and mat erial characteristics influence the optimal choice for injectable agent. UR OLOGY 56 (Suppl 6A): 32-40, 2000. (C) 2000, Elsevier Science Inc.