Introduction
Urethral bulking (UB) is a medical procedure that is performed under LA (local anesthesia) by doctors (urologists) to manage or treat urinary incontinence (inability to control urinary flow) such as stress-induced urinary incontinence (SIU) among women, mostly and sometimes in men. It is usually performed by women who want to avoid the unnecessary risk of surgical procedures. However, urethral bulking is a temporary management procedure and is likely to go off with a period. Hence, the urethral bulking injection procedure needs to be repeated over time if stress incontinence is experienced again. The injected substances, often in the form of bulking agents, create a supportive barrier around the urethra, helping to reduce the leakage of urine. This article highlights the urethral bulking procedure, risk factors, side effects, indications, contraindications, and clinical outcomes.
What Is Stress Urinary Incontinence?
Stress urinary incontinence is a medical condition characterized by urine leakage during physical activities like laughing, sneezing, or exercising. It is most commonly seen among women as compared to men.
When Are Urethral Bulking Procedures Indicated?
The best candidates for urethral bulking procedures are:
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In individuals with stress urinary incontinence after a urethral sling.
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Women who do not want to undergo surgical procedures due to associated risks.
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Urethral hypermobility (excessive mobility of female urethra due to weak urogenital diaphragm).
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Urinary sphincter dysfunction (failure of sphincter to relax, resulting in obstruction of urinary outflow).
What Are Contraindications of the Urethral Bulking Procedure?
The urethral bulking procedure is not indicated in cases like:
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In individuals with active urinary tract infections.
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Difficulty in emptying the bladder.
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Presence of obstruction in the urethra.
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Individuals undergoing cancer treatment, which has also impacted pelvic muscles.
What Is Urethral Bulking Procedure?
The urethral bulking procedure is a procedure that involves injecting bulking agents in the urethral walls to aid in the closing of the urethral sphincter. Common bulking agents used in these procedures include synthetic materials, collagen, or autologous substances. The choice of bulking agent depends on factors such as the patient's medical history, the specific condition being treated, and the physician's preference. The main aim of this procedure is to achieve controlled urinary flow or bladder control.
Urethral bulking procedures are often considered a minimally invasive option compared to more extensive surgical interventions. They are typically performed on an outpatient basis, and recovery time is generally shorter than traditional surgical approaches.
How Is Urethral Bulking Procedure Performed?
The various steps involved during the procedure are:
Patient Selection: Urethral bulking procedures are often considered for women with mild to moderate stress urinary incontinence who have not responded well to conservative treatments or do not want to undergo extensive surgical procedures.
Surgical Procedure:
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The specialist doctor injects local anesthesia around the regions of the urethral walls where bulking agents need to be injected.
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The specialist usually uses cystoscopy (a thin tube with an attached camera to view the internal bladder) to view the complete urethra. An injection loaded with a bulking agent is then injected into the sphincter of the urethral wall, followed by injecting a complete bulking agent slowly under cystoscopy. The entire procedure usually takes around 20 minutes to complete.
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The bulking agent makes the urethra walls thicker after the injection, which closes and restricts the flow of urine out of the bladder.
Duration of the Effect of Urethral Bulking Procedures
The duration of the effect depends on the type of bulking agent used. Some may provide long-term relief, while others may require periodic re-treatment.
How Effective Is the Urethral Bulking Procedure?
Urethral bulking procedures are considered less invasive than traditional surgical options for SUI, such as a mid-urethral sling procedure. The effectiveness of urethral bulking agents can vary among individuals. Some may experience significant improvement in symptoms, while others may require additional treatments.
Recovery from Urethral Bulking Procedure
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Individuals are usually allowed to go home the same day of the treatment after the anesthetic effects wear off, and patients can urinate on their own.
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If the individual cannot urinate themselves, then a urinary catheter is inserted to aid in normal urination.
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Individuals usually take a few days to a week to recover completely from the procedure.
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The recovery period is quicker, with lower complication rates.
What Are the Risks Associated with the Urethral Bulking Injection Procedure?
A few risks associated with the urethral bulking injection procedure are:
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It may worsen the patient's condition for a while.
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Increased risk of urinary tract infection.
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Pain and discomfort at the injection site.
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Difficulty urinating initially.
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In some cases, individuals may develop hypersensitivity (allergic) reactions to the bulking agents used in the procedure.
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Burning sensation on urination.
What Are the Clinical Outcomes of the Urethral Bulking Procedure?
The urethral bulking injection procedure has shown promising results in most of the patients with stress urinary incontinence, based on clinical studies. The success rate of the procedure is around 50 to 70 percent. However, in thirty percent of cases, the urethral bulking injection procedures may need to be repeated after the effect of the previous procedure wears off. Based on the study, the procedure might need repetition after 6 to 24 months.
When to Call the Doctor?
In case any of the following symptoms are observed after the procedure, it is advised to inform the doctor (urologist) as soon as possible:
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Bleeding (blood in the urine).
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Difficulty with urination.
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Pain or burning sensation on urination.
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High fever.
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Frequent urge to urinate.
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Shivering and chills.
Conclusion
In conclusion, urethral bulking procedures represent a viable and effective option for addressing certain urological conditions. These minimally invasive interventions have shown promise for improving symptoms related to urinary incontinence and other urethral issues. It is advised that individuals with urinary incontinence discuss the risks and benefits associated with the urethral bulking procedure with the doctor beforehand. While further research is needed to establish long-term efficacy and safety, current evidence suggests that urethral bulking procedures can offer a valuable therapeutic approach with potential benefits for patients seeking minimally invasive solutions for their urological concerns.
