Bulking Agents Buy Time For Incontinence Patients


Expert Analysis from an International Pelvic Reconstructive and Vaginal Surgery Conference

ST. LOUIS — It's bulking-agent season.

This is the time of year when many women will present with stress urinary incontinence, looking for a no-downtime solution for their symptoms. For these women, bulking agents may be the answer, Dr. Peter M. Lotze said at the conference, which was sponsored by the Society of Pelvic Reconstructive Surgeons.

In August and September, teachers will often come to the office saying that they need treatment because they are leaking urine, but adding that they need to be ready for work in a week, said Dr. Lotze of the department of ob.gyn. at the University of Texas, Houston, who is a practicing urogynecologist.

The upcoming winter holiday season presents another occasion for which women desire a solution that doesn't involve the downtime and restrictions associated with a more involved surgical procedure, he said.

Granted, most patients will do better in the long term with a midurethral sling, as long as they have some mobility of the urethra, but some patients simply need (or prefer) a quick fix, said Dr. Ginger Cathey of the department of ob.gyn. at Baylor College of Medicine, Houston, who is also a practicing urogynecologist.

Although most of her patients choose the sling once they've been counseled about the higher cure rates compared with bulking agents, Dr. Cathey does sometimes use C.R. Bard Inc.'s Contigen, an injectable collagen implant, in those who do not choose sling surgery.

BioForm Medical Inc.'s Coaptite injectable implant is another option.

“If I do [use bulking agents], I use Coaptite,” Dr. Lotze said, noting that just one or two injections of the gel-like implant can temper incontinence in some patients, with no restrictions, and two to five injections can “get you where you want to be” in terms of alleviating symptoms and buying the patient time.

Injection of Coaptite is not layer dependent; you don't have to be in a specific muscle layer right underneath the epithelium of the urethra, which makes for a simpler procedure, he said.

“You can get it in the tissue of the urethra, and it doesn't matter – you're in the right spot,” he said.

Do you have patients who are miserable due to their leakage, but who don't have time for surgery?

“Really think about this as part of what to do this time of year,” he said.

Dr. Lotze disclosed that he is a speaker and researcher for Boston Scientific Corp., which is the distributor of Coaptite. Dr. Cathey is a consultant for C.R. Bard Inc.

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