What To Expect During A Urethral Bulking Injection
A urethral bulking injection is typically performed in a hospital under:
- Local anesthesia, where the bladder and urethra will be numbed
- Regional, where the body below the waist is numbed
- General anesthesia, where you are put to sleep
During the procedure, your doctor will insert a cystoscope into the urethra to see the inside of the urethra. Your doctor will then insert a needle into the sphincter and inject a bulking agent through the needle into the urethra wall. The bulking agent should make the urethra wall thicker, close and stop the flow of urine out of the bladder. When you need to urinate, the wall will allow the urine to flow normally out of the urethra.
How Long Will It Take Me To Get Back To My Daily Activities
If you are unable to urinate without any problems and there is not much residual urine in the bladder, you will be discharged from the clinic.
For 3-4 weeks your doctor may recommend to:
- Consume enough liquid, especially water, to provide at least 2 litres of urine output
- Not lift anything heavier than 5 kilograms
- Not do any heavy exercise
- Take showers instead of baths
- Avoid thermal baths, or going to the sauna
- Prevent constipation by adapting your diet
- Avoid sexual activity
- Avoid activities which can traumatise the operation such as cycling and horseback riding.
- Have a fever
What Are The Advantages Of Bulkamid Injections
- This is the least invasive surgical procedure to treat stress urinary incontinence.
- It can be performed under local anaesthesia or general anaesthesia/ sedation if preferred.
- The side-effects and complication rate from Bulkamid® injections are minimal.
- This procedure may be more acceptable to women who wish to avoid the potential complications associated with more invasive surgery or a general anaesthetic.
- Having a Bulkamid® injection does not prevent an individual from having more invasive surgery such as a sling procedure in the future.
It may suit:
- Some women who have only a mild degree of incontinence even after performing pelvic floor physiotherapy.
- Women who already have difficulty emptying their bladder and who are therefore at risk of emptying their bladder poorly after stress incontinence surgery, as Bulkamid® injections have an extremely low rate of problems with long-term urinary retention.
- Women who want a procedure that allows them to return rapidly to work and their normal level of activity.
- Women who are willing to accept the lower cure or significant improvement rate in stress urinary incontinence after treatment with Bulkamid® compared to sling surgery success rates.
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Urethral Bulking For Stress Urinary Incontinence
In this Health Topic
SUI is a common problem affecting women which is caused by a weakness of the pelvic floor muscles , the urethra , or the ligaments that support the urethra. This leads to leaking urine with coughing, sneezing, exertion, laughing and other activities which raise the pressure in the abdomen.
Several risk factors are associated with SUI, such as childbirth , obesity, menopause, chronic cough, chronic constipation, or heavy lifting.
Urethral bulking involves injecting a bulking agent around the urethra. This narrows the urethra, so leakage is less likely to occur. Common bulking agents include collagen and water-based gels containing various agents.
- Women who are not fit enough for surgery and anesthesia
- Women who havent completed their family
- Women who do not wish to undergo surgery for stress incontinence or for whom conventional surgery has not been fully effective
- Women whose stress incontinence is due mainly to a deficiency in the sphincter muscle surrounding the urethra
Before scheduling you for urethral bulking, your doctor may recommend a urodynamics test. This is an investigation of bladder function, which will confirm your diagnosis and help rule out any other problems with the bladder.
Other options for the treatment of stress incontinence include pelvic floor physiotherapy, or surgical options such as mid-urethral slings , colposuspension , or an artificial urinary sphincter .
What Are The Features To Look Out For
You should contact your doctor or the hospital if you notice increased temperature, discomfort when passing urine or offensive smell of urine. A specimen of urine will be taken and sent to the laboratory for confirmation of infection. You may be provided with an antibiotic prescription.
If you are passing small volumes of urine repeatedly or not passing enough urine you should contact the hospital. You will have a scan to check if your bladder is full and may have it emptied with a catheter. If this persists, a nurse will teach you how to perform clean intermittent self catheterisation, this is usually for a short duration.
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Injections Of Bulking Agents For Urinary Incontinence In Women
Stress incontinence is losing urine when coughing, laughing, sneezing or exercising. A significant amount of a woman’s and their family’s income can be spent on managing the symptoms. Usually muscles and tissue form a cushion supporting the base of the bladder and closing the urethra . If they do not, artificial cushioning can be created by injecting bulking agents into the area around the urethra. The review of 14 trials, which included 2004 women, found some limited evidence that this can relieve stress incontinence in women. Other treatments such as surgery might be better. Using the women’s own fat tissue as the agent injected can cause serious complications. In terms of costs, a brief review of economic studies suggested that collagen injection was less costly than surgery when used as first treatment or after initial surgery failure.
Urinary incontinence imposes a significant health and economic burden to society. Periurethral or transurethral injection of bulking agents is a minimally invasive surgical procedure used as one the surgical treatments of stress urinary incontinence in adult women.
To assess the effects of periurethral or transurethral injection therapy on the cure or improvement of urinary incontinence in women.
We searched the Cochrane Incontinence Group Specialised Trials Register and the reference lists of relevant articles.
Botox Intravesical Injections And Bulking Agent Injections Have Been Shown To Help When Dealing With Overactive Bladder And Other Bladder Issues
Bladder issues such as overactive bladder syndrome, or OAB, cause many problems for patients such as urinary incontinence, frequency of urination, and constantly having to get up at night to urinate. Injections are normally performed in-office and have a short recovery time.
- Overall bladder issues affect many patients.
- Studies have shown that using bulking agents and Botox intravesical injections can be cost effective and have a longer lasting effect than other therapies.
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Why Do I Need A Urethral Bulking Agent Injection
Injections increase the bulk of the bladder neck. This will resists any increase in pressure on coughing and sneezing, to stop leakage of urine .
As with other forms of surgery, an injection is offered after failure of conservative measures, including pelvic floor muscle training. Injections are less effective than other procedures such as autologous sling and colposuspension. The effect may ware off with time, so the procedure may need repeating.
Urethral bulking agents may be more suitable for patients who can not have other forms of surgery, for example due to anaesthetic reasons.
What Are The Main Indications For Bulkamid Injections
This procedure is most suitable for people with stress urinary incontinence due to intrinsic sphincter deficiency where the urethral tissues close poorly and which is generally associated with more severe urine leakage with minimal exertion.
It might also be effective in patients with urethral hypermobility where excessive movement of the urethra predisposes to stress urinary incontinence.
Dr. McKertich will advise patients regarding suitability for Bulkamid® injection depending on the results of investigations including Urodynamic study.
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Bulking Agents To Restore Urinary Continence
Collagen is one of several bulking agents that may used to help restore continence.
Injections of one of several kinds of bulking agents is an outpatient procedure that may be used to restore urinary continence. In this procedure a bulking agent is injected into the neck of the bladder. This bulks the bladder neck and helps compress the urethra , and thus helps to prevent urinary leakage.
Many people like to try this treatment because it is less invasive than surgery. And many people have good success with this treatment. It is generally considered to be a low-risk procedure. However, this procedure is not without complications, and in only a small number of cases are there severe adverse reactions. Researchers continue to try to locate the best possible bulking agent, to reduce complications. Most complications are easily reversed with conservative measures.
Injections of a bulking agents is a short-term solution, so it may be ideal for treatment of incontinence from damage to the urethra after childbirth or after prostate surgery. But this means that if incontinence returns, the injections must be repeated by your professional healthcare provider anywhere from every couple of months to once a year, depending on the individual and the severity of the incontinence.
Who Can I Contact With Any Concerns Or Questions
This leaflet is intended for patients receiving care in Brighton & Hove or Haywards Heath.
This patient information leaflet was prepared by Dr. Sharif Ismail, Consultant Subspecialist Urogynaecologist.
This information leaflet has been approved at the Clinical Governance and Safety and Quality Meetings of the Department of Obstetrics and Gynaecology as well as Brighton and Sussex University Hospitals NHS Trust Carer and Patient Information Group .
Ratified April 2017 Womens Safety and Quality Committee.
If you have any problems or questions, please use the telephone numbers below to contact us.
Princess Royal Hospital, Horsted Keynes Ward: Extension 5686
Royal Sussex County Hospital, Level 11: Extension 4013
Urogynaecology Unit at Lewes Victoria Hospital: Extension 2178
Who Is A Candidate For A Urethral Bulking Injection
A urethral bulking injection is an option for women who have the following conditions:
- Stress urinary incontinence after a urethral sling
- Stress urinary incontinence in women who cannot have surgery due to other medical conditions
- Urinary sphincter dysfunction
- Difficulty emptying the bladder
- Have an obstruction in the urethra
If you are undergoing cancer treatments that have impacted the pelvic muscles, a urethral bulking injection may not be an appropriate option either.
Bulking Agents For Urinary Incontinence: What When And Where
Stress urinary incontinence is a major problem at the field of female urology and urogynecology. Symptomatically, this is a losing of the urine on physical efforts, coughing or sneezing. Incompetency of the urethral closing mechanisms are causing urine loss. Mid-urethral synthetic slings are the gold standard of the treatment of the stress urinary incontinence. At the same time, different urethral bulking injections are creating an artificial cushioning at the area around the urethra . Bulking agents may work by increasing the central filler volume and thereby increasing the power of sphincter. The timing of the procedures are rarely evidence approved, and mainly they are empirical, based on personal experience, availability of the injections and dedicated patients.
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What Is A Urethral Bulking Injection
A urethral bulking injection is a procedure that is used to treat urinary incontinence in women. During the procedure, bulking agents are injected into the walls of the urethra to help close the sphincter. The goal of a urethral bulking injection is to help patients gain control over their urine flow.
Risks Of A Urethral Bulking Injection
Complications associated with a urethral bulking injection are rare but may include:
- Worsening of a patients stress incontinence
- Bladder infection or urinary tract infection
- Discomfort at the injection site
- Urinary retention – difficulty urinating
- Allergic reactions to anesthesia or bulking agent used during the procedure
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Injection Of Bulking Agents
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Injection of bulking agents may offer short-term relief but does not cure stress urinary incontinence. Bulking agents can consist of synthetic materials or bovine collagen. The substance is injected into the urethral wall to aid urethral closure. The effect wears off over time. There is a risk that the injection will lead to temporary problems emptying the bladder.
How Do Injectable Agents For Stress Urinary Incontinence Work
Urethral bulking agents such as Bulkamid®, Durasphere®, Macroplastique® are injected via a needle through a telescope into the water pipe to improve problems with stress urinary incontinence.
These agents work by a bulking effect in the tissues around the urethra that protects against incontinence by increasing the resistance to the outflow of urine and enabling the walls of the urethra to seal better to prevent leakage.
The best results occur when the patients incontinence is due to poor urethral function combined with good pelvic muscle support. Injectable agents can be used both in women and men with stress urinary incontinence .
Top Left = Cystoscope inserted into urethra Top Right = Bulking agent injected into urethra Bottom Left = Cross-section of urethra before bulking agent injection Bottom Right = Cross-section of urethra after bulking agent injection showing coaptation of urethral lining.
Copyright Dr Karen McKertich – Not for use without attribution.
What Does The Operation Involve
The operation is carried out through cystoscopy . There are no incisions or sutures. The operation can be done while you are awake, using local anaesthesia, or under general anaesthesia.
Local anaesthesia is introduced into the bladder through a catheter. You will be asked to lay on your front for 5 minutes, on each of side for 5 minutes and on you back for 5 minutes.
The area around the urethra will be cleaned and you will be covered with drapes. The camera is introduced and you will be able to see on the screen, if you wish. A special needle is used to inject the urethral bulking agent.
Are There Any Alternatives To Urethral Bulking Agents
Alternative forms of surgery include:
Autologus sling: this operation supports the urethra using a strip from the abdominal wall. This is a more invasive operation that requires stay in hospital for a day or two.
Colposuspension: this operation supports the bladder neck to the back of the bone in the lower abdomen. This is a more invasive operation that requires stay in hospital for a day or two.
All these operations are more effective and durable than urethral bulking agents. These can be discussed with your doctor.
The use of Tension free vaginal tape sling was paused in 2017, following safety concerns.
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What Are The Results Of Bulkamid In Treating Stress Urinary Incontinence In Women
The result of treatment with Bulkamid® is immediate. One of the advantages of treatment with Bulkamid is that there is no significant restriction in activity after the procedure as is required after sling procedures for stress urinary incontinence. The recovery time is very rapid.
Up to 2/3 of patients who are treated with Bulkamid® are either cured or have significant improvement in their stress urinary incontinence after 2 years.
As there is the potential for absorption or leakage of all injectable bulking agents such as Bulkamid® from the urethra with time, stress urinary incontinence can recur. If stress incontinence recurs, Bulkamid® can be reinjected into the urethra. Around 44% of women will request reinjection.
What Are The Disadvantages Of Bulkamid Injections
- Repeat injections are often required to maintain effectiveness as the Bulkamid® may be reabsorbed by the body. As a result the initial effectiveness of the Bulkamid® injection may decline over time.
- Please Note: Bulkamid® periurethral injections should not be regarded as a one-time or permanent treatment. Many patients need additional treatments with Bulkamid® to achieve and maintain improvement in incontinence.
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How The Procedure Is Done
Urethral bulking is usually performed in a doctors office. You do not need general anesthesia or an overnight hospital stay. You can eat and drink normally on the day of the procedure. The actual procedure takes about 20 minutes. However, the entire visit may require one to two hours.
When you arrive, youll need to give a urine sample. This sample will be checked for signs of UTI. If you have a UTI, the procedure will need to be rescheduled. If you have symptoms of a UTI at home, call the office right away.
Once you are numb, the doctor will begin the procedure. With the cystoscope in the urethra, the doctor injects the bulking agent using a needle. This can be painful briefly.
Before you go home, youll be asked to urinate. Sometimes the injections cause difficulty emptying the bladder. These symptoms occur in less than 10 percent of women. If you cannot urinate, the doctors assistant will teach you how to catheterize yourself. Typically, this is only needed for a couple of days.
What Can I Expect Before The Operation
At your pre op assessment and on your admission day the nurse will go through your hospital stay and explain your operation. Please do let us know about any concerns you have or if there is any information you think we should know about that will make your stay with us more comfortable.
You will need to make arrangements for your family, children or any other commitments that you have prior to coming in to hospital and to cover the length of your recovery.
You will see the doctor performing the surgery before you go to theatre. You will also see the anaesthetist, if you are having the operation under general or spinal anaesthesia. It is not unusual to feel anxious the nursing staff will gladly discuss how you are feeling and talk you through your emotions.
If you have not already signed the consent form on booking, the doctor will go through it with you before you go to theatre. You will be asked for permission to enter your data on the national database for continence and prolapse surgery. This is a quality control measure to compare the safety and effectiveness of such procedures at the hospital against other units in the country.
Completing a frequency volume chart and quality of life questionnaire at follow up will enable assessing the benefit of surgery for you.
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