[The injectables in urogynecology]

The purpose of this review is to summarize the results of reports of injectable agents for the treatment of female urinary stress incontinence. The real indication for injectables is intrinsic shincter deficiency (ISD) but urethral hypermobility is not a controindication. Six agents were reviewed: Teflon, autologous fat, collagen, silicone microparticles, silicone microballoons and pyrolytic carbon. Collagen was the most frequently reported agent and yielded 1 year cure/ improvement rate of 60-80%, but results de-creased significantly with longer term follow-up. Teflon has been used longer for the treatment of stress incontinence but both low long and short-term success rate and the reported complications such as particles migration have resulted in its lack of widespread acceptance. Autologous fat has been suggested as the natural injectable but yielded disappointing success rate. Injection of silicone microparticles was associated with a long-term success rate of about 70% in patients with ISD. Moreover, it is now injected without urethroscopy and this makes the procedure easier. Silicone microballoons and pyrolytic carbon have been recently introduced into clinical practice with a short-term success rate of about 70%. However, longer follow-up is needed. In conclusion, long-term durability, cost effectiveness and some safety issues still have to be addressed by further clinical trials.