Bulking Agents

Raymond R. Rackley and Ahmed Elazab

For the past several decades, injectable bulking agents have been used for a growing number of people with varying degrees of stress urinary incontinence (SUI). The goal of this therapy for incontinence is to create coaptation and a better mucosal seal for the incompetent urethra. These agents improve intrinsic sphincter function as evidenced by an increase in posttreatment abdominal leak pressure measurements.

Although first introduced in 1938, this conceptual form of therapy has received renewed interest since 1988, with the introductory use of bovine glutaraldehyde crosslinked (GAX) collagen for the treatment of intrinsic sphincteric deficiency (ISD). In the United States (US), most physicians' experiences with injectable bulking agents have been limited to GAX collagen (Contigen; Bard Urological, Cov-ington, GA), autologous fat, and carbon-coated beads (Durasphere; Boston Scientific Corp., Boston, MA) whereas non-US physicians have used such agents as silicon, polytetrafluoroethylene paste, calcium hydroxylapatite, hyaluronic acid, and injectable microballoons. New and revised bulking agents are currently under investigation in the US, as properties of the ideal bulking agent make this form of therapy a highly competitive field for innovations in technology.

Contemporary application of bulking agents has become increasingly popular by both patients and physicians, because the therapy entails a minimally invasive procedure performed under a local anesthesia in an outpatient setting. Although this choice of therapy is largely patient driven, selection remains important to the ultimate success of injection therapy, because the ideal candidates are usually those who have SUI with good anatomic support and healthy tissue.

Despite a tremendous growth in contemporary interest in injectable bulking agents, there have been only a few prospective randomized trials comparing different bulking agents or even injectable therapy to other forms of treatment for SUI. This chapter will summarize the properties, technical approaches, published results, and complications of the various agents available in the US, as well as explore some of the controversies surrounding these issues that have promoted or limited the application of this therapy.

Herbal Remedies For Acid Reflux

Herbal Remedies For Acid Reflux

Gastroesophageal reflux disease is the medical term for what we know as acid reflux. Acid reflux occurs when the stomach releases its liquid back into the esophagus, causing inflammation and damage to the esophageal lining. The regurgitated acid most often consists of a few compoundsbr acid, bile, and pepsin.

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