Bulking agents for the treatment of stress urinary incontinence: A scoping review of systematic reviews
Bibliographic record
Abstract
Objective: Stress urinary incontinence (SUI) is a common problem affecting up to 46% of women. Urethral bulking agents (UBAs) are a popular minimally invasive procedure, being used increasingly commonly to avoid complications of more invasive procedures. The purpose of this scoping review is to evaluate systematic reviews on UBAs for adult women. Methods: MEDLINE, Embase and CINAHL databases were electronically searched for relevant studies. We included systematic reviews reporting outcomes of currently available UBA for adult women with SUI published from 2017 to October 2022. Results: Overall, 243 studies were identified, and eight studies were eligible for inclusion. Objective cure rate for UBAs ranged from 25.4% to 93.3%. Subjective cure rates of UBAs were significantly lower compared to mid-urethral slings (MUSs) (28% vs. 77.6%, p < 0.01). UBAs showed quality of life benefit compared to pelvic physiotherapy at 3 months (mean difference (MD) = 0.54, 95% confidence interval (CI) = 0.16–0.92), but were inferior to MUS (59.2% vs. 91.0%, p = 0.01). Post-intervention complications were similar between UBAs and other surgical procedures (Relative Risk/RR = 1.30, 95% CI = 0.30–5.66). Urinary tract infection rate was similar among the different types of UBAs, with a pooled rate of 13.0%. Pooled rates of urinary retention for all bulking agents were 10.0% (95% CI = 6.0–14.0%). Outcome reporting was heterogeneous between studies, and some outcomes were quite poorly reported. Conclusion: Data from systematic reviews support the use of UBAs. However, success rate ranges were wide. MUS have higher success rates than UBAs. Long-term data using a standardized set of outcomes with direct comparisons between currently available bulking agents are needed. Level of evidence: Not applicable
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.016 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.015 | 0.005 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".