Systematic review of injectable bulking agent as a treatment for faecal incontinence: OP18

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Aim:Perianal injection of bulking agents has been used to treat the symptoms of faecal incontinence. However, various different agents have been tried without a standardised technique and the supposed benefit of the treatment is largelypragmatic.Method:We searched the Cochrane Incontinence Group Specialised Register of trials, ZETOC, clinical trials registries and the reference lists of relevant articles. All randomised or quasi-randomised controlled trials comparing use of injectable bulking agents for faecal incontinence with any alternative treatments or placebo were reviewed. Case-control and cohort studies were also reviewed to assess risks and complications associated with the treatment.Results:Four eligible randomised studies were identified with a total of 176 patients. PTQTM (Uroplasty Ltd, Geleen, the Netherlands), a silicone biomaterial, was shown toprovide someimprovement and have less adverse events in treating faecal incontinence than Durasphere (Carbon Medical Technology St Paul, MN, USA), (carbon-coated beads). However, PTQTM did not demonstrate obvious clinical benefit compared to control injection of normal saline. The number of reported complications, including case series evidence, was 53 out of 402 patients (13.2%) who underwent injection. Most complications were minor.Conclusion:Within the available data, we found no evidence for effectiveness of the treatment in improving faecal incontinence.

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