Search

Christopher Chapple,1 Roger Dmochowski2 1Department of Urology, Royal Hallamshire Hospital, Sheffield, UK; 2Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USACorrespondence: Christopher ChappleDepartment of Urology, Royal Hallamshire Hospital, Glossop Road, Sheffield S10 2JF, UKTel +44 114 271 3048Fax +44 114 279 7841Email c.r.chapple@shef.ac.ukAbstract: Stress urinary incontinence (SUI) has been treated surgically with the midurethral sling but in recent years, this option has come under scrutiny and the risk–benefit balance continues to be reviewed. The low-risk alternative for women with uncomplicated SUI is the bulking agent, which aims to achieve continence through coaptation of the urethra. Two classes of bulking agents can be identified: those made from solid microparticles in an absorbable liquid or gel carrier (particulate agents) and those comprising a homogenous gel (non-particulates) that resists absorption. Polydimethylsiloxane®, carbon-coated zirconium oxide®, calcium hydroxyapatite® and polyacrylate polyalcohol copolymer® are currently marketed particulate agents. With the exception of calcium hydroxyapatite, the particles are non-degradable. Each agent achieves its long-term bulking effect through reactive changes around the persisting particles while the carrier volume is lost. Bulkamid® is a non-particulate agent with the bulking effect resulting from the volume of gel injected. The lasting network of fine fibers formed by the host tissue anchors the gel in situ. Foreign-body granulomas, erosion and migration/material extrusion and loss of bulk have been observed in connection with the particle-based products. Bulkamid may be mechanistically less liable to these events; however, there are minimal data directly comparing the two types of bulking agent. The question of durability is inevitable based on their differing modes of action.Keywords: stress urinary incontinence, bulking agents, safety, particulate, non-particulate

Background: Sir Felix Semon established the Semon Lecture series in 1913 to advance the specialty of laryngology. The annual lectures continue to the present day (there have been 95 to date). Objective: This review illustrates how instrumental these lectures have been in shaping otolaryngology. Method: The period 1913–1970 preceded subspecialisation, and so forms the background of laryngology (as well as rhinology and otology) as we know it today. This era forms the focus of the article. Results: Changes came about by a standardisation of practices and research, and in the treatment of conditions. The initial period was crucial. Conclusion: Many lectures highlight the specialty's growth. Now, another vital resource, a dedicated website (semonlectures.org), has made this information more accessible to the wider public. [ABSTRACT FROM AUTHOR]