Urethral Bulking with Bulkamid
Stress urinary incontinence, leakage of urine with laughing, coughing, sneezing, and exercise, affects approximately one in four adult females and can cause considerable interruptions in daily life. There are a number of treatment options available for female stress urinary incontinence. One of these us the use of so called bulking agents in the urethra.
What is Urethral Bulking Injection?
A urethral bulking injection is a treatment for stress urinary incontinence (SUI), a condition causing unwanted bladder leaks that occur during normal activities. The likelihood of stress incontinence increases with age and symptoms are more common in women who have had one or more vaginal deliveries.
Leaks are a result of weakened muscles and supportive tissues surrounding the tube that carries urine from the bladder (aka urethra). Leaks can occur when you cough, sneeze, laugh, exercise or even through less vigorous activities like standing up and bending over. Unfortunately, many patients begin avoiding certain activities they enjoy for fear of leaking. But while SUI may be common, it is not normal. Several good options exist for the management of female stress incontinence.
One such option is the urethral bulking agent. Urethral bulking agents are injected around the urethra to “bulk up” the walls surrounding it. The bulking procedure effectively makes the urethra smaller at rest so that small changes in abdominal pressure cannot push urine out as easily. This is an outpatient treatment is very well tolerated and has virtually no recovery period.
Non-Mesh Treatment for Female Stress Urinary Incontinence in Women
Surgical treatment for stress urinary incontinence
Stress incontinence surgery aims to improve the weakened supports surrounding the urethra. Various procedures exist, and they typically have a very high success rate and low risk. However, some factors preclude women from being good candidates for surgery, such as medical problems which make anesthesia risky or even a desire for future pregnancy. It’s essential to speak to your doctor about the options best suited to your needs.
Urethral bulking
The earliest urethral bulking agents were collagen based. Today, urethral bulking involves injecting a synthetic material around the urethra. This bulking agent helps to build up the thickness of the wall of the urethra to tighten its seal against leakage.
Injection of the bulking agent is done by placing a camera in the urethra. This camera, called a cystoscope, helps to guide the placement of bulking agents.
Burch procedure
The Burch procedure suspends and stabilizes the urethra using permanent sutures to connect the tissues surrounding the urethra to a strong ligament attached to the pubic bone. This can be done through an open incision, laparoscopically or with robotic assistance. While the Burch does not use a synthetic mesh, it is not risk free and can lead to urgency of urination, restricted urine flow, and even recurrent bladder infection.
Autologous fascial bladder neck sling
An autologous fascial sling operation is a surgical procedure that creates a sling underneath the urethra using a strip of the patient’s own tissue, usually taken from the wall of the abdomen. The incision is similar to that of a C-section, with an additional small cut in the vaginal wall. This procedure requires general anesthesia and has the longest recovery period of the surgical options.
Xenograft bladder neck sling
A xenograft refers to the transplant of an organ, tissue, or cells to an individual of another species. A xenograft bladder neck sling is the same procedure as the autologous fascial surgery, but the tissue used to create the sling is from an animal, typically porcine.
Non-surgical treatments
Pessary
A vaginal pessary is a silicone device similar to a diaphragm that is inserted into the vagina to support the urethra. It can be used only when performing high-stress activities, or left in at all times. The pessary is a great option for women who want to avoid or postpone surgical management of female stress urinary incontinence.
Physical therapy
Pelvic floor physiotherapy is considered a first line treatment for stress incontinence in women according to the American Urological Association. Many women find that pelvic floor muscle exercises like Kegels help improve symptoms of SUI. Working with a specialized physical therapist can increase the success rate of these exercises. Physical therapy should be the first choice for patients who want to delay or avoid surgery.
Frequently Asked Questions about Urethral Bulking
Does Bulkamid work for other types of urinary incontinence?
No. Bulking injection procedures such as Bulkamid are only for the management of stress urinary incontinence.
What is a Bulkamid procedure?
The procedure is a series of 2-4 small injections that takes around 10-15 minutes.. The aim is to add additional volume to the wall of the urethra, which helps prevent urine from leaking out of the bladder during normal daily activities. While relatively new to the United States, Bulkamid has been used in Europe to treat SUI in women since 2006.
How well does urethral bulking work?
The success rate of Bulkamid is between 77% and 92%. This puts it at a similar rate as other more invasive procedures. It is also incredibly long lasting compared to other urethral bulking materials. It is important to know that the definition of “success” varies from patient to patient, so talk to your doctor about your short and long term goals for SUI.
How long does a Bulkamid injection last?
Clinical trials for Bulkamid suggest it is durable and effective for up to seven years. Compared to other urethral bulking material, this is a much longer time period.
What is Bulkamid made of?
The substance is a smooth, water-based gel which is able to remain stable in the body over time without causing reactions. Bulkamid is unique to other agents because the gel maintains its volume over time, meaning that most women see durable, long-lasting results rather than a decreased efficacy.
How long does urethral bulking last?
The efficacy of other urethral bulking agents reduces over time significantly faster than Bulkamid, meaning many patients require a second injection in as little as three to nine months.
How long does it take for Bulkamid to work?
Bulkamid has a recovery period of less than 24 hours, and begins to work immediately.
What are the side effects of Bulkamid?
The side effects of Bulkamid are the same as with any surgical implantation procedure or use of general anesthesia. The risks are detailed below, and should be noted do not occur in the vast majority of patients.
Is Bulkamid an implant?
Yes, while Bulkamid Hydrogel utilizes a gel liquid, it is a form of surgical implantation and should be considered such when weighing the risks and benefits.
Is urethral bulking safe? What are the risks?
Many women opt for urethral bulking as a treatment for their SUI over invasive surgery because comparatively, the procedure is minimally invasive and can be done under local anesthetic, and it comes with less risk of serious complications. It is considered a safe procedure, but as with any medical intervention there are risks associated. These vary from among patients and most are extremely rare. These include:
- Dysuria
- Stranguria
- Haematuria
- Urinary tract infection (UTI)
- Acute retention may occur.
- Scratching of the urethral mucosal
- Non-acute retention
- Abscess formation
- Fibrosis (tissue hardening)
- De novo urgency
- Necrosis
As with any surgery, you should talk to your doctor about the adverse events that are most likely for you and your specific medical history.