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Urethral bulking agents

Nature Clinical Practice Urology volume 3, pages 234–235 (2006)Cite this article

Before 1970, attempts had been made at injecting materials into the urethral wall to relieve incontinence, generally with poor results. Then, in the early 1970s, Solomon Berg reported on the use of polytetrafluoroethelene paste to treat stress urinary incontinence in women. The material he injected into the submucosa was a formulation used by ear, nose and throat surgeons to bulk paretic vocal cords and improve phonation. His results were promising in an era when the standard procedure for stress incontinence was anterior repair—a procedure with a very high failure rate.

Politano and coworkers subsequently used polytetrafluoroethelene to treat urethral-related incontinence in men and women.1,2,3 A specialized instrument, linked with an endoscope, was required for injection. Short-term continence was achieved in 73% of women with stress incontinence, with minimal complications. Of 720 men with postprostatectomy incontinence, 88% showed improved symptoms after two or more injections. Despite evidence from primate and dog models that polytetrafluoroethelene particles migrated to regional nodes and to the lung and brain, Politano noted that adverse events were rare, and that in his 20-year experience none had been linked to migration.2,4 Nonetheless, the data on particle migration, a lack of FDA approval and a difficult injection process deterred widespread use.

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  1. Professor of Urology at the University of Michigan, Ann Arbor, MI, USA

    Edward J McGuire

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  1. Edward J McGuire
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Correspondence to Edward J McGuire.

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The author declares no competing financial interests.

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McGuire, E. Urethral bulking agents. Nat Rev Urol 3, 234–235 (2006). https://doi.org/10.1038/ncpuro0478

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