Professional Statements and Societal Positions Guidelines
Society of Obstetricians and Gynecologists of Canada – 2010
In 2010, the Society of Obstetricians and Gynecologists of Canada Urogynaecology Committee published a guideline on the evaluation and treatment of recurrent urinary incontinence after pelvic floor surgery. The guideline recommends that conservative management be used as first-line therapy. It also stated that individuals with significantly decreased urethral mobility may be managed with periurethral bulking agents as one of several treatment options.
National Institute for Health and Care Excellence – 2015
In 2013, the National Institute for Health and Care Excellence (NICE) amended its 2006 clinical guideline on urinary incontinence in women. The guideline now recommends considering intramural bulking agents (silicone, carbon-coated zirconium beads or hyaluronic acid/dextran copolymer) for the management of SUI if conservative management has failed. Women should be made aware that repeat injections may be needed to achieve efficacy and that efficacy diminishes with time and is inferior to that of synthetic tapes or autologous rectus fascial slings.
American College of Obstetricians and Gynecologists – 2016
In 2016, the American College of Obstetricians and Gynecologists updated its practice bulletin on urinary incontinence in women. The practice bulletin stated that urethral bulking injections are a relatively noninvasive treatment for stress urinary incontinence that may be appropriate if surgery has failed to achieve adequate symptom reduction, if symptoms recur after surgery, in women with symptoms who do not have urethral mobility, or in older women with comorbidities who cannot tolerate anesthesia or more invasive surgery. However, urethral bulking agents are less effective than surgical procedures such as sling placement and are rarely used as primary treatment for stress urinary incontinence. There was insufficient evidence to recommend any specific bulking agent.
American Urological Association et al – 2017
The 2017 joint guidelines on surgical treatment of female stress urinary incontinence from the American Urological Association and Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction stated that bulking agents are an option for individuals considering surgery for stress urinary incontinence (SUI). The guidelines also stated that there are few long-term data on the efficacy of bulking agents and that retreatment is common.
In 2017, the American Urological Association reviewed their guidelines and confirmed that endoscopic injection therapy for VUR is an option in the treatment of VUR. Success rates for open surgery are 98%, with few complications, compared to rates of 83% for endoscopic surgery; however, the higher success rates for open surgery are offset by the greater expense and the need for in-patient hospitalization. Postoperative urinary tract infections (UTIs) can occur with either treatment but are more likely to occur in individuals with a prior history of frequent UTIs. Following surgery, an ultrasound to confirm absence of obstruction is a standard of care. While an infrequent occurrence, urinary obstruction may be “clinically silent” and have severe consequences that could be readily corrected. Cystography is a recommendation after endoscopic surgery and an option after open surgery. Following reflux resolution (surgically or spontaneously) it is recommended that a planned follow-up, including assessment for infection, renal abnormalities, and overall health, be continued through adolescence.
Infants under one (1) year of age may not show clinical evidence of pyelonephritis as clearly as older children and they may have a greater risk of infection-related morbidity. It is therefore recommended that continuous antibiotic prophylaxis (CAP) be used in these children until more definitive studies suggest otherwise. Reflux resolution occurs in about 50% of these children within 24 months.