What are bulking agents?
Bulking procedures are recommended for women with stress incontinence. They can also be used in more complex cases, such as for women who have had previous continence operations or elderly women who are not fit for more invasive treatments.
Injections of bulking agents around the urethra have a lower success rate than some other operations available and therefore they are not commonly offered as a first choice. The bulking agent stays inside the body permanently. However, it does not require any incisions and has a very low complication rate. It can be performed under local anaesthetic.
What does the operation involve?
A fine needle is inserted into the bladder neck through a cystoscope (telescope), and a bulking agent (such as Bulkamid) is injected into the urethral walls, around the bladder neck. This increases the size of the urethral walls and allows a better seal closure of the urethra. The bladder-neck bulking injections can be given under a local, spinal (like epidural) or short general anaesthetic. The procedure takes approximately 10–15 minutes and is a day-case procedure. Women can typically go home the same day.
What specific complications can occur?
Pain on passing urine: You may notice some initial burning or stinging on passing urine. This will usually settle within 24–48 hours. If you develop urinary frequency, offensive- or unusual-smelling urine and pain on urination you may have a bladder infection in which case you may need a course of antibiotics.
Difficulty emptying the bladder: Fewer than 10% of women have temporary difficulty emptying the bladder completely, requiring a catheter. There are no known long-term risks of such a problem.
Need for a repeat bulking procedure: A top-up of the bulking agent is sometimes needed to optimally control SUI symptoms. The effect of the bulking agent can also sometimes reduce with time, requiring a second injection.
Additional risks can include movement of the bulking material from where it was injected, hypersensitivity/allergy, abscess formation (local infection), or granuloma (a small cyst-like structure where the bulking material was injected). These risks are uncommon, and are related to certain types of agents.
What is the recovery following the surgery?
The operation is performed as a day-case. Therefore, the patient goes home the same day. Some women may experience some discomfort when passing urine for 24–48 hours following the operation and may find traces of blood in the urine. A small number of patients (1 in 100) will develop a urinary tract infection, which can be treated with a course of antibiotics. Drinking plenty of fluid after the operation should prevent these problems. If urinary retention develops, short- term Clean Intermittent Self-Catheterisation (CISC) may be required.
How successful is the operation?
This operation does not have the same success rate or long-lasting effects as a mid-urethral tape or colposuspension. 60–70% of women undergoing urethral bulking will notice a cure or improvement of their SUI symptoms.
Bulking agents may be absorbed over time, therefore the result may wear off, so repeated injections are often necessary. The length of time between injections varies with each patient. Some need to be re-injected after a few months and some after a few years.
