The Efficacy of Urethral Bulking Agents for Incontinence Following Continent Urinary Reconstruction: A Narrative Review

BACKGROUND: Urinary incontinence following continent urinary reconstruction, including bladder neck reconstruction and Mitrofanoff channels, remains a complex and challenging clinical issue. Minimally invasive options, particularly bulking agents, have been explored as an alternative to major surgical interventions, although long-term effectiveness is debatable. METHOD: This systematic review was conducted in accordance with PRISMA guidelines. Searches were performed in PubMed, Medline, and Google Scholar to identify studies evaluating the use of bulking agents for urinary incontinence in patients undergoing continent urinary reconstruction. Studies assessing the use of bulking agents for incontinence arising from continent catheterisable channels or other forms of lower urinary tract reconstructive surgery were included. Owing to significant heterogeneity in study design, patient populations, interventions, and outcome reporting, a narrative review of the findings was performed. RESULTS: A total of 10 studies were included, encompassing both adult and pediatric populations. Success rates ranged widely, with some studies indicating initial improvements that declined over time. A higher success rate was reported in the pediatric population in comparison to the adult group; however, achieving long-term success often required multiple repeat procedures. Notably, neither population group experienced significant complications. DISCUSSION: The variability in bulking agent outcomes is influenced by factors such as patient age, type of reconstruction, and underlying pathology. The predominance of retrospective studies and inconsistent outcome definitions limit the strength of current evidence. Standardized outcome measures and collaborative prospective registry-based studies are needed to establish clearer guidance. CONCLUSION: Bulking agents provide a minimally invasive option for managing urinary incontinence post-lower urinary tract reconstructive surgery, although their success rate is highly variable. Clinicians should tailor treatment to individual patient characteristics, balancing the potential for short term relief with the likelihood of needing repeat interventions.