TREAMENTS AND SURGERIES
Urethral bulking agent injection for stress incontinence | TREAMENTS AND SURGERIES
Injections of urethral bulking agents helps to reduce urine leakage in individuals with stress incontinence.
Intraurethral injections of bulking agents is generally proposed as a stress incontinence treatment for older women who cannot or do not want to undergo surgery. It’s also used in cases in which perineal rehabilitation has not been effective. Bulking agents can also be used to treat chronic urinary incontinence in younger women.
The intraurethral injections of bulking agents has the effect of swelling the urethral wall. This, in turn, provides resistance against urine leakage and facilitates closure of the striated sphincter.
While this treatment provides only short-term results, it can be repeated and has the advantage of being non-invasive. When tested in clinical trials, injections of bulking agents have had positive results, with 66% of patients self-reporting that their condition improved or was resolved after a year of treatment.
- Urinalysis and urine culture are required about 10 days before the injection. If the culture shows the presence of bacteria, antibiotic treatment will then be started. You will receive a notice from the secretary, along with a prescription.
- If you are taking anticoagulant medicines (medicines that thin the blood) you will be asked to stop taking them and in some cases, they will be replaced by other medicines before the injection. You can start taking your medicine again after the injection.
You need to take antibiotics to prevent infections
- Drink plenty of water for 24 hours after the injection, especially if the urine is reddish.
- You can resume your usual activities the day after the injection.
- You should make a follow-up appointment within four to eight weeks of the injection to see how well the treatment is working: a bladder flow measurement and ultrasound will be offered to assess bladder emptying.
How do transurethral injections of bulking agents work?
A bulking agent is a sterile, viscous gel containing a mixture of dextranomer microspheres. It’s non-absorbable and non-toxic. It’s injected transurethrally in the submucosa with the aid of a cystoscope (a small tube with a camera on the end). Direct visual surveillance of the injection from two or three angles allows the surgical team to precisely apply the product.
What does the procedure involve?
A urinary catheter is inserted into the bladder. To anesthetize the bladder wall, Lidocaine is administered by intravesical injection for a period of 15 minutes. The local anesthetic eliminates pain, but the patient may feel the sensation of the needle making contact with tissues, which can be unpleasant.
Patients are placed in the lithotomy position. An adapted cystoscope is inserted through the urinary tract and the urethra is examined. The bulking agent is injected into the submucosa using a needle, with the cystoscope providing visual aid.
Three injections ranging from 0.2 ml to 0.8 ml are made 0.5 cm to 1 cm down the bladder neck. The needle is reinserted if the injection is too shallow or too deep. When the resulting occlusion (a small bulge preventing the backflow of urine) has been visually examined and deemed satisfactory, the procedure is concluded. The bladder is then emptied with the help of the cystoscope.
After the injection of the bulking agent, our nursing staff will monitor the patient. The patient can leave the office after urinating and an ultrasound confirms that all is well.
Patients are placed in the lithotomy position. An adapted cystoscope is inserted through the urinary tract and the urethra is examined. The bulking agent is injected into the submucosa using a needle, with the cystoscope providing visual aid.
Three injections ranging from 0.2 ml to 0.8 ml are made 0.5 cm to 1 cm down the bladder neck. The needle is reinserted if the injection is too shallow or too deep. When the resulting occlusion (a small bulge preventing the backflow of urine) has been visually examined and deemed satisfactory, the procedure is concluded. The bladder is then emptied with the help of the cystoscope.
After the injection of the bulking agent, our nursing staff will monitor the patient. The patient can leave the office after urinating and an ultrasound confirms that all is well.
What are the risks and complications of receiving bulking agent injections?
In rare cases, patients may experience one or more of the following complications as a result of the cystoscopy and/or injections to the bladder wall:
- Pain or discomfort while the cystoscope is passed through the ureter or when the injections are administered
- Bleeding in the bladder for more than 12 hours
- Urinary retention (this is the most common side effect; however, it’s temporary, lasting no more than a few weeks)
- Urinary infection (despite the use of prophylactic antibiotics)
- No signs of improvement, necessitating a second injection