UROGYNECOLOGICAL SURGERY CURRENT APPROACHES AND TREATMENTS FOR INCONTINENCE

Urogynecological_Surgery_Kapak

INTRAMURAL URETHRAL BULKING AGENT INJECTIONS

Kevser Arkan

Diyarbakır Gazi Yaşargil Training and Research Hospital, Department of Gynecology and Obstetrics, Diyarbakır, Türkiye

Arkan K. Intramural Urethral Bulking Agent Injections. In: Balsak D, Çim N, Ege S editors. Urogynecological Surgery Current Approaches and Treatments for Incontinence. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.169-179.

ABSTRACT

Stress urinary incontinence (SUI), defined as the involuntary leakage of urine during activities that increase intra-abdominal pressure such as coughing, sneezing, or physical exertion, is among the most common pelvic floor disorders affecting women. Epidemiological studies report prevalence rates ranging from 20% to 40% in adult women, with significant negative consequences for daily functioning, psychosocial well-being, and overall quality of life. The underlying pathophysiology is multifactorial but generally explained by two main mechanisms: urethral hypermobility due to pelvic floor laxity and intrinsic sphincter deficiency (ISD), in which the urethral sphincter fails to generate adequate closure pressure.

Conservative treatments including lifestyle modification, pelvic floor muscle training, and pharmacotherapy remain first line options, but their efficacy is limited in moderate to severe cases or in patients with predominant ISD. Surgical procedures such as midurethral slings and colposuspension are effective but carry higher risks, longer recovery times, and may not be suitable for frail or elderly patients. Against this background, intramural urethral bulking agent injection has gained increasing attention as a minimally invasive therapeutic alternative.

This technique involves endoscopic or periurethral injection of biocompatible bulking materials into the submucosal layer, thereby increasing urethral coaptation and resistance to leakage. Multiple bulking agents have been investigated, including synthetic polymers, carbon-coated beads, and naturally derived hydrogels, each with distinct durability, safety profiles, and cost considerations. Injection techniques also vary, with transurethral and periurethral routes described. Clinical evidence demonstrates shortto mid-term success rates of 50-70%, with improvements in quality of life scores and patient satisfaction. The safety profile is favorable, with most complications being transient urinary tract infections, dysuria, or local discomfort; serious adverse events are rare.

Careful patient selection is essential, as bulking agents are most effective in women with ISD, those unfit for major surgery, or individuals seeking a less invasive approach. Limitations include variable long-term durability and the need for repeat injections in some patients. Future innovations focus on next-generation biomaterials with greater longevity, combination therapies with regenerative agents, and refined injection delivery systems.

Overall, intramural urethral bulking agent injection represents a valuable option in the minimally invasive management of female SUI, especially for patients unsuitable for traditional surgery, and ongoing advances are likely to expand its role in contemporary urogynecology.

Keywords: Stress urinary incontinence; Urethral bulking agent; Intrinsic sphincter deficiency; Minimally invasive treatment; Urogynecology

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