Submucosal Bladder Neck Injections for Management of Stress Urinary Incontinence

Submucosal deposition of bulking agents is increasingly used for the treatment of intrinsic stress urinary incontinence both in male and female patients. Bulking agents should ideally be nonimmunogenic, biocompatible, non-migratory, injectable, cause a minimal inflammatory reaction, retain the submucosal bulging effect, and reasonably cheap. None of the agents available to date fully meets these criteria. The rationale and clinical results of artificial, heterologous and autologous agents currently used for treatment are analyzed and the technique of transurethral submucosal injection applied by the authors is described. Perioperative imaging using transrectal or transvaginal ultrasonography is important for the exact placement of the injected material, and is one of the key factors for a satisfactory result. Depending on length of follow-up, the route of application (transurethral, antegrade transvesical, periurethral), the etiology of the patients, the amount of injected material, the number of procedures and the bulking agent used continence and improvement rates vary from 21-83% and 40-100%, respectively. A future outlook describes new agents and techniques that may be promising for broad clinical use.