Stress Urinary Incontinence Treatments

Bulking agents

Macroplastique

  1. Find lateral portion of urethra, position needle out and insert into midurethra at 45 degrees
  2. Inject and visualize submucosal wheal, should not see extravasation, should see good coaptation
  3. Repeat on contralateral side
  4. Test of success: red rubber catheter placed in urethra does not fall out spontaneously

Bulkamid

  1. Place bulkamid cystoscope into bladder and exam urethra
  2. Identify point of urethra where needle can be inserted to black line without buttonholing urethra into bladder
  3. Pick a clock point (130, 430, 730, or 1030) and move entire cystoscope to insert needle - move as a unit to keep needle at same submucosal level, torquing scope will drive needle deeper into tissue (not desired)
  4. Inject bulkamid agent, should see coaptation of mucosa
  5. Repeat up to 4x total, should see coaptation completely
  6. Tip: do not place catheter as this will mold the Bulkamid (undesired)