Introduction
Bulking agents are substances that are injected around the urethra to help prevent the leakage of urine. Bulking agents are placed by a minimally invasive surgical procedure and are a suitable alternative for those with stress urinary incontinence in whom pelvic floor exercises have not provided adequate relief of their leakage and in those who don’t want to undergo more invasive procedures.
Indications
Bulking agents are predominantly used in women with stress urinary incontinence who have failed conservative measures. They can occasionally be used in men with post prostatectomy incontinence however the success rates are variable.
Preoperative Instructions
A urine test will be performed to ensure the patient does not have an active urinary tract infection, as this will require treatment prior to the procedure. Certain medications that promote bleeding such as warfarin, clopidogrel, rivaroxaban and apixaban will need to be stopped for certain period prior to the procedure to reduce the risk of significant bleeding. This procedure can still be performed if the patient is taking aspirin.
Procedure
The procedure is performed with the patient asleep under a general anaesthetic. A cystoscopy is initially performed to inspect the urethra and the bladder. Following this, the bulking agent is then injected around the urethra under vision until the surgeon is satisfied that the urethral tissues have bulked up enough to reduce the amount of incontinence.
Postoperative Instructions
The patient will usually remain in hospital overnight to ensure they are able to empty their bladder with ease. If they have difficulty emptying their bladder, the nurse will insert a very fine catheter to assist with emptying. The patient can also be taught how to perform this catheterization themselves. Ongoing catheterisation is usually not required beyond 48 hours.
Risks
The risks of urethral bulking include:
- Mild pain around the urethra.
- Difficulty emptying the bladder.
- Urinary urgency.
- Urinary tract infection.
- Dysuria (burning or stinging when urinating).
Treatment Alternatives
The treatment alternatives to urethral bulking for stress urinary incontinence include:
- Pelvic floor physiotherapy.
- Sub urethral sling (mesh or non-mesh) – see Female sling.
- Long term catheterization (supra-pubic or urethral).