The use of urethral bulking agents in the treatment of stress urinary incontinence

Key content Treatment options for stress urinary incontinence (SUI) include physical therapies and a range of surgical options. Urethral bulking agents may be used as a surgical treatment for SUI. There are different types of bulking agents, with varying complications and outcomes. We discuss the impact of the current UK pause for vigilance and restriction on the use of mesh in the treatment of SUI. Learning objectives To gain an overview of the history of bulking agents. To understand the properties of commonly used bulking agents. To understand the clinical indications and evidence on efficacy and complications of urethral bulking agents. Ethical considerations Should urethral bulking agents be used as a first-line treatment for SUI? Should the introduction of new urethral bulking agents be undertaken within a clinical research trial in light of lessons learned from the introduction of vaginal mesh implants? Women with SUI should be counselled on both surgical and nonsurgical options. There is an absence of long-term safety and outcome data for newer bulking agents.