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Urethral bulking for urinary incontinence

Urethral bulking to treat urinary incontinence involves injecting material around the urethra. This may be done to:

    * Close a hole in the urethra through which urine leaks out.
    * Build up the thickness of the wall of the urethra so it seals tightly when you hold back urine.

Most bulking materials are injected around the urethra just outside the muscle of the urethra at the bladder outlet. Injecting the bulking material may be done through the skin, through the urethra or, in women, through the vagina. Needle placement is guided by the use of a cystoscope inserted into the urethra.

Materials used for urethral bulking include:

    * Polytetrafluoroethylene (PTFE).
    * Bovine collagen (glutaraldehyde cross-linked bovine collagen).
    * Durasphere.

Urethral bulking procedures are usually performed under local anesthesia in women, but men may require a general or regional anesthesia. A local anesthetic allows the person to stand up after an injection to determine whether continence has been achieved. If continence has not been restored, another injection may be done immediately.

The surgery is used mostly for women and occasionally for men.

What To Expect After Surgery

Most urethral bulking injections can be done in a doctor's office or surgery center. They rarely require hospitalization. You may need to take it easy for a few days afterward.

Why It Is Done

Urethral bulking may be done to treat:

    * Mild stress incontinence in women.
    * Sensory urge incontinence.
    * Mild stress incontinence in men that results from prostate surgery.

How Well It Works

Urethral bulking usually relieves symptoms for about 1 year, although 2 to 3 injections are likely to be needed.

Risks

The main risks related to urethral bulking are pain at the injection site, injury to the urethra, and migration of the bulking material. On rare occasions, it travels to the lungs.

What To Think About

This surgery is used mostly for women and occasionally for men.

Collagen used for bulking is obtained from cows and is used after being chemically modified. It may cause allergic reactions in some people, therefore a skin test is done to check for allergies before collagen is used. Collagen is absorbed slowly by the body, which makes it necessary to repeat the injections after several years. Collagen therapy is expensive.

Two materials under study for bulking use are silicone and fat taken from the person receiving the urethral bulking. The use of fat as a bulking material eliminates the possibility of allergic reactions. However, there are indications from animal studies that it may be reabsorbed quickly by the body, thereby losing its effectiveness.

This treatment method avoids the risks associated with abdominal surgery.

Before having urethral bulking treatment, ask your doctor about the following:

    * How much success has the doctor had in treating incontinence with surgery? The success of surgical procedures for urinary incontinence depends on the experience and skill of the surgeon.
    * Is there anything you can do to increase the likelihood of a successful surgery? Losing weight, quitting smoking, or doing pelvic floor (Kegel) exercises before surgery may increase the likelihood of regaining continence after surgery.