Bulking agents in the treatment of female urinary stress incontinence. Therapeutic approach to female stress incontinence

Urethral bulking agents are an attractive alternative for treating patients with intrinsic sphincter deficiency (ISD), i.e.,type III urinary stress in continence. These endoscopic techniques are minimally invasive and can be u sed in high-risk patients. As bulking agents, Teflon, autologous fat,collag en, silicone particles, and detachable microballoons have been the object o f considerable clinical research. Teflon forms granulomas in the surroundin g tissue and tends to migrate and is now considered obsolete. More recently , human collagen, autologous cartilage, Bioglass, and hyaluronic acid with dextranomer and polycarbon particles have come under clinical investigation , but long-term results are still lacking. The optimal bulking agent should be nondegradable and biologically inert an d should not migrate or change its bulking capability. To date, there is no consensus on the best agent fulfilling these requirements, but encapsulate d substances appear most promising.