Incontinence poses a substantial economic burden on the UK’s NHS, estimated at £536 million in 1999/2000, equivalent to approximately 1.1% of the total NHS spend, for both men and women. Over two decades later, this cost is expected to have increased significantly due to factors like the ageing population, rising obesity rates, and inflation. Additionally, a 2004 study found that over a third of individuals aged 40 or older in the UK require healthcare for urinary incontinence symptoms, such as frequency, urgency, and nocturia, further highlighting the prevalence and impact of this condition. Treatment options for stress urinary incontinence (SUI) include conservative measures like physiotherapy, weight loss, and smoking cessation, as well as surgical interventions such as colposuspension, slings, and bulking agents. While pelvic floor exercises have shown effectiveness in some cases (50–69%), not all patients respond well to them. Bulking agents, materials injected into the submucosal space to elevate urethral mucosa or bladder neck, have gained attention as a minimally invasive treatment option. Various bulking agents, including Macroplastique®, Bulkamid®, Durasphere®, Zuidex™, and Coaptite™, have been used, each with different properties and outcomes. Short-term complications are well-documented, but long-term data are limited. For instance, a study on Macroplastique with a minimum three-year follow-up found limited long-term data on bulking agents. Similarly, Bulkamid studies reported short-term complications, with some patients requiring a second injection for desired symptomatic control. Concerns over the long-term complications of bulking agents have led to renewed interest in their efficacy and safety. Reports suggest that bulking agent therapy may be more cost-effective and less invasive than certain surgical procedures, driving its continued use despite evolving concerns. However, there is a lack of comprehensive data on long-term complications, highlighting the need for further research and accurate patient counselling regarding the risks associated with these treatments. A survey of British urologists found that over half had treated long-term complications related to bulking agents, underscoring the importance of considering these risks when discussing treatment options with patients. The study emphasises the need for informed consent processes that accurately reflect the potential long-term complications associated with bulking agent therapy. Overall, while bulking agents offer a minimally invasive option for stress UI treatment, their long-term safety profile warrants careful consideration and ongoing evaluation.
