Urethral Bulking Injection
What is it?
When you lose urine with cough, laugh, sneeze, or exercise, this is called stress incontinence. This can happen because the supportive tissue around the urethra is weak (urethral hypermobility), as well because the inner sphincter muscle at the bladder neck is not tight enough (intrinsic sphincter deficiency). Usually women leak from a combination of both problems.
A urethral bulking agent injection is a minimally invasive office procedure that can be used to help the inner sphincter close more tightly. You need to have have a physical exam done by a urologist or urogynecologist prior to this procedure to see if you are a good candidate. It is also extremely important to recognize that this injection is done for stress incontinence, not for overactive bladder and urge incontinence.
How is it done?
In the office, you will receive an anesthetic suppository that we place in the urethra. After about 15-20 minutes a cystoscope is placed into the bladder. This is done to visualize the opening of the urethra close to the bladder neck. A needle is then inserted in 2-3 areas of the urethra, and a soft material is injected to plump up the tissue and augment the closure mechanism. You will feel a pinching or a slight burning sensation when the needle is inserted.
After the procedure, we will make sure you are able to urinate before you go home.
How effective is the procedure?
Data shows that for this procedure, about 70% of women will be improved or dry. About 1/3 achieve complete dryness. Some women need a repeat injection a few weeks after the first one if they feel the result is not strong enough. In women who have a good result, they typically need a repeat injection in about 12 months. There is another agent which lasts longer and has promising results, but it is not available in the US yet.
What if I cannot urinate after?
Occasionally, the bulking effect precludes you from being able to empty your bladder. If you are retaining a significant volume of urine, we will insert a very small catheter (tube) to drain the bladder in the office. The tube is simply removed once the bladder is empty. If you continue to have this problem, we will teach you how to do it yourself at home (intermittent catheterization). Typically, in the small percentage of women who have this problem after a bulking agent injection, it resolves after a few days.