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Macroplastique — Polydimethylsiloxane (PDMS)

Macroplastique is a polydimethylsiloxane (PDMS) elastomer microparticle bulking agent for female (and occasionally male) stress urinary incontinence. The microparticles are suspended in a biologic carrier that is absorbed after injection, leaving the PDMS microparticles to form local tissue coaptation.

Composition​

  • PDMS microparticles (~100–600 μm) — large enough to avoid systemic migration
  • Suspended in a hydrogel carrier that is absorbed after injection
  • Microparticles induce a localized fibrotic response that maintains bulking effect

Injection​

  • Transurethral cystoscopic injection at the mid-urethra
  • Dedicated Macroplastique Implantation System (MIS) delivery device
  • Typical volume: 2.5 mL delivered in 3 sites

Evidence​

  • Long-term efficacy 21–80% depending on series and outcome definition[1][2]
  • Among the most extensive evidence bases in bulking
  • Durable through multi-year follow-up in several series

Key Considerations​

  • Particle size (>100 μm) prevents lymph-node migration seen with smaller-particle agents (Durasphere)
  • Higher de novo urgency than Bulkamid in some comparisons
  • Local granuloma formation reported in a minority

References​

1. Hoe V, Haller B, Yao HH, O'Connell HE. Urethral Bulking Agents for the Treatment of Stress Urinary Incontinence in Women: A Systematic Review. Neurourology and Urodynamics. 2021;40(6):1349–1388. doi:10.1002/nau.24696

2. Hussain SM, Bray R. Urethral Bulking Agents for Female Stress Urinary Incontinence. Neurourology and Urodynamics. 2019;38(3):887–892. doi:10.1002/nau.23924

See also: Bulkamid, Durasphere.