Periurethral injections for stress incontinence
Periurethral injections are used for stress urinary incontinence (leakage of urine caused by physical exertion, coughing, sneezing etc.) The procedure is usually performed under general anaesthetic but can sometimes be done with local anaesthetic. A cystoscope is inserted through the urethra (water-pipe) and used to inject a gel-like substance in 3 positions around the bladder opening causing mild compression and preventing urine leakage. The procedure is relatively straightforward with little or no recovery time in most cases. Major complications are rare.
There can be a temporary difficulty passing urine immediately afterwards but this is usually short-lived. The immediate success rate of this procedure is about 70% but in the long-term the success rate is probably less than with other surgical procedures eg vaginal tape operations (TVT, TOT). About 30% of women require a second injection procedure to optimise their response.
The common reasons for choosing periurethral bulking injections are:
- Patients who don’t wish to have a mesh tape procedure
- Patients wishing to avoid bigger operations
- Patients wishing to return to physical activities immediately (other treatments usually require 6 weeks of reduced activities)
- Patients whose family is not complete and may wish to have more children
- Medical problems which may make other treatments more difficult (eg previous radiotherapy/operations)
- Failure of other treatments
In Nottingham, we use Bulkamid injections. This is one of the more modern bulking injections and allows a more accurate placement of the injection around the water-pipe (urethra). The success rate appears to be better than with other bulking injections and there are few side effects.
We have found that about 50% of patients are able to get a useful and lasting improvement in their incontinence. Having this treatment does not appear to compromise our ability to perform other operations later if required.
Please follow this link for the BAUS Patient Information Leaflet on Bulking Injections.