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Urinary incontinence - injectable implant

Intrinsic sphincter deficiency repair; ISD repair; Injectable bulking agents for stress urinary incontinence

Injectable implants are injections of material into the urethra to help control urine leakage (urinary incontinence) caused by a weak urinary sphincter. The sphincter is a muscle that allows your body to hold urine in the bladder. If your sphincter muscle stops working well, you will have urine leakage.

Description

The material that is injected is permanent. Coaptite and Macroplastique are examples of two brands.

The doctor injects material through a needle into the wall of your urethra. This is the tube that carries urine from your bladder out of your body. The material bulks up the urethral tissue, causing it to tighten. This stops urine from leaking out of your bladder.

You may receive one of the following types of anesthesia (pain relief) for this procedure:

  • Local anesthesia (only the area being worked on will be numb)
  • Spinal anesthesia (you will be numb from the waist down)
  • General anesthesia (you will be asleep and not able to feel pain)

After you are numb or asleep from anesthesia, the doctor puts a medical device called a cystoscope into your urethra. The cystoscope allows your doctor to see the area.

Then the doctor passes a needle through the cystoscope into your urethra. Material is injected into the wall of the urethra or bladder neck through this needle. The doctor can also inject material into the tissue next to the sphincter.

The implant procedure is usually done in the hospital. Or, it is done in your doctor's office. The procedure takes about 20 to 30 minutes.

Why the Procedure Is Performed

Implants can help both men and women.

Men who have urine leakage after prostate surgery may choose to have implants.

Women who have urine leakage and want a simple procedure to control the problem may choose to have an implant procedure. These women may not want to have surgery that requires general anesthesia or a long recovery after surgery.

Risks

Risks for this procedure are:

  • Damage to the urethra or bladder
  • Urine leakage that gets worse
  • Pain where the injection was done
  • Allergic reaction to the material
  • Implant material that moves (migrates) to another area of the body
  • Trouble urinating after the procedure
  • Urinary tract infection
  • Blood in the urine

Before the Procedure

Tell your health care provider what medicines you are taking. This includes medicines, supplements, or herbs you bought without a prescription.

You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), vitamin E, warfarin (Coumadin), and any other medicines that make it hard for your blood to clot (blood thinners).

On the day of your procedure:

  • You may be asked not to drink or eat anything for 6 to 12 hours before the procedure. This will depend on what type of anesthesia you will have.
  • Take the medicines your provider told you to take with a small sip of water.
  • You will be told when to arrive at the hospital or clinic. Be sure to arrive on time.

After the Procedure

Most people can go home soon after the procedure. It may take up to a month before the injection fully works.

It may become harder to empty your bladder. You may need to use a catheter for a few days. This and any other urinary problems usually go away.

Outlook (Prognosis)

You may need 2 or 3 more injections to get good results. If the material moves away from the spot where it was injected, you may need more treatments in the future.

Implants can help most men who have had transurethral resection of the prostate (TURP). Implants help about one half of men who have had their prostate gland removed to treat prostate cancer.

References

Boone TB, Stewart JN, Martinez LM. Additional therapies for storage and emptying failure. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 127.

Kobashi KC, Albo ME, Dmochowski RR, et al. Surgical treatment of female stress urinary Incontinence: AUA/SUFU Guideline. J Urol. 2017;198(4):875-883. PMID: 28625508 pubmed.ncbi.nlm.nih.gov/28625508/.

Lentz GM, Miller JL. Lower urinary tract function and disorders: physiology of micturition, voiding dysfunction, urinary incontinence, urinary tract infections, and painful bladder syndrome. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 21.

  • Urinary incontinence

    Animation

  •  

    Urinary incontinence - Animation

    When you enter a store or restaurant, are you often looking to find the establishments bathroom? If you're having trouble holding in your urine, or if you often leak urine, you probably have what's called urinary incontinence. Normally, the bladder begins to fill with urine from the kidneys. The bladder stretches to allow more and more urine. You should feel the first urge to urinate when there is about 200 mL, just under 1 cup of urine stored in your bladder. A healthy nervous system will respond to this stretching sensation by letting you know that you have to urinate. But, at the same time, the bladder should keep filling. But the system doesn't work correctly in people with urinary incontinence. Some people with urinary incontinence leak urine during activities like coughing, sneezing, laughing, or exercise. This is called stress incontinence. When you have a sudden, strong need to urinate, but can't make it to the bathroom before you do urinate, it's called urge incontinence. Other people have what's called overflow incontinence, when the bladder cannot empty and they dribble. Urinary incontinence can have many causes, and it's most common in older adults. Women are more likely than men to have it. For some people the bladder muscle is overactive. For others, the muscles holding the urine in are weak. And for others, the problem is sensing when the bladder is full. They might have brain or nerve problems, dementia or other health problems that make it hard to feel and respond to the urge to urinate, or problems with the urinary system itself. To treat urinary incontinence, your doctor can help you form a treatment plan. Most likely, exercises to strengthen the muscles of your pelvic floor will be part of that plan. Bladder training exercises can also be effective. And depending on the cause of incontinence, oral medications, or topical estrogen may be helpful. If you have overflow incontinence and cannot empty your bladder completely, you may need to use a catheter. Your doctor can recommend the best catheter for you. For urine leaks, you might wear absorbent pads or undergarments. Whatever else you try, lifestyle changes may help. Aim for an ideal weight. Losing excess weight and increasing exercise both often improve incontinence, especially in women. Also, some specific beverages and foods might increase leaking in some people. For instance, you might try eliminating alcohol, caffeine, carbonated beverages, even decaf coffee. Drink plenty of water, but do NOT drink anything 2 to 4 hours before going to bed. Be sure to empty your bladder before going to bed to help prevent urine leakage at night. Throughout the day, urinate at set times, even if you do not feel the urge. Schedule yourself every 3 to 4 hours. Urinary incontinence is very common, but many people never talk to their doctor about it. Don't let that be you. See your doctor and bring it up at your next doctor's visit.

  • Urinary incontinence

    Animation

  •  

    Urinary incontinence - Animation

    When you enter a store or restaurant, are you often looking to find the establishments bathroom? If you're having trouble holding in your urine, or if you often leak urine, you probably have what's called urinary incontinence. Normally, the bladder begins to fill with urine from the kidneys. The bladder stretches to allow more and more urine. You should feel the first urge to urinate when there is about 200 mL, just under 1 cup of urine stored in your bladder. A healthy nervous system will respond to this stretching sensation by letting you know that you have to urinate. But, at the same time, the bladder should keep filling. But the system doesn't work correctly in people with urinary incontinence. Some people with urinary incontinence leak urine during activities like coughing, sneezing, laughing, or exercise. This is called stress incontinence. When you have a sudden, strong need to urinate, but can't make it to the bathroom before you do urinate, it's called urge incontinence. Other people have what's called overflow incontinence, when the bladder cannot empty and they dribble. Urinary incontinence can have many causes, and it's most common in older adults. Women are more likely than men to have it. For some people the bladder muscle is overactive. For others, the muscles holding the urine in are weak. And for others, the problem is sensing when the bladder is full. They might have brain or nerve problems, dementia or other health problems that make it hard to feel and respond to the urge to urinate, or problems with the urinary system itself. To treat urinary incontinence, your doctor can help you form a treatment plan. Most likely, exercises to strengthen the muscles of your pelvic floor will be part of that plan. Bladder training exercises can also be effective. And depending on the cause of incontinence, oral medications, or topical estrogen may be helpful. If you have overflow incontinence and cannot empty your bladder completely, you may need to use a catheter. Your doctor can recommend the best catheter for you. For urine leaks, you might wear absorbent pads or undergarments. Whatever else you try, lifestyle changes may help. Aim for an ideal weight. Losing excess weight and increasing exercise both often improve incontinence, especially in women. Also, some specific beverages and foods might increase leaking in some people. For instance, you might try eliminating alcohol, caffeine, carbonated beverages, even decaf coffee. Drink plenty of water, but do NOT drink anything 2 to 4 hours before going to bed. Be sure to empty your bladder before going to bed to help prevent urine leakage at night. Throughout the day, urinate at set times, even if you do not feel the urge. Schedule yourself every 3 to 4 hours. Urinary incontinence is very common, but many people never talk to their doctor about it. Don't let that be you. See your doctor and bring it up at your next doctor's visit.


Review Date: 1/1/2023

Reviewed By: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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