Paraffin to Bulkamid™ and everything in between: 100 years of injectables for the treatment of stress urinary incontinence

Mistry K1, Ragab M1, Caygill P1, Davies M1
1Salisbury District Hospital, United Kingdom

Since restrictions were placed on the use of synthetic mesh in the United Kingdom there has been a steady increase in the use of injectable treatment for the management of stress urinary incontinence (SUI). We look at the inception of this practice and its development through time. A systematic search of the available urological literature was conducted to identify the key historical advances of injectable treatments in the management of females with SUI. The earliest reports of the use of urethral injections in the treatment of female SUI are from the 1900s. Gersuny, an Austrian surgeon, spurred by his previous successes with paraffin, experimented with its use to treat a woman with urinary incontinence. The procedure was adopted across Europe but its popularity soon waned following reports of serious complications such as pulmonary air emboli and urethral sloughing. In the latter part of the 20th Century, numerous materials were trialled with varying degrees of success, safety and durability such as Teflon, autologous fat, dextranomer microspheres (Zuidex™) and glutaraldehyde cross-linked bovine collagen (Contigen™). The currently available injectables; silicone microparticles (macroplastique™) and polyacrylamide hydrogel (Bulkamid™) were developed in the 1990s, with the later being the current favoured injectable owing to its low risk of complications. The current popularity of urethral bulking is a result of the void left by the pause on mesh use rather than its performance. The search for the ideal bulking agent that is easy to inject, volume stable, non – immunogenic and non-migratory will continue.