A Promising and Challenging Non-Invasive Solution to the Troubling Stress Urinary Incontinence: Bladder Neck Injection with Bulking Agents Volume 2 - Issue 3

Ayse Veyhurda Dikmen*

• MD, Consultant Urologist, Ankara, Turkey

Received: November 22, 2019;  Published: December 11, 2019

Corresponding author: Ayse Veyhurda Dikmen, MD, Consultant Urologist, Ankara, Turkey

DOI: 10.32474/GJAPM.2019.02.000138

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Abstract

Introduction & Objective: Stress urinary incontinence is a psychologically devastating disturbance, affecting the incontinent population mainly of elderly women. we aimed to identify retrospectively the response rate of the patients to minimal invasive treatment via bladder neck injection with bulking agents for primary bladder neck insufficiency through a new look. we aimed to make urologists remember this non-invasive method for stress urinary incontinence since it is a devastating problem, which can even stop sexual life completely for the elderly female population.

Methods: 4200 female patients attended our urology clinic with symptoms of stress urinary incontinence between January 2014 and April 2019 and underwent urologic evaluation and diary for daily-used pad number. 81 of 4200 patients were excluded during the period of collecting the data due to urologic and gynecologic co-morbidities and so 4119 patients were evaluated. 2091 (50.7%) patients had only one pad/day while 1810 (%43.9) women had two pads/day due to stress urinary incontinence. 218 (%5.3) patients had more than 2 pads/day. 610 of 4119 patients, having used duloksetine 20mg/d and 1290 patients underwent cystoscopy. 495 of them, 235 of whom with two pads/day stress urinary incontinence and 260 with one pad/day, aged between 42 and 88, were diagnosed to have primary bladder neck insufficiency causing stress urinary incontinence. 495 patients with primary bladder neck insufficiency underwent bladder neck injection with a bulking agent consisting of a suspension of dextranomer-based micro-particles and cross-linked hyaluronic acids of a non-animal-origin, at 4 through 8 o’clock via a 3.5-inch cystoscopic injection needle through a 30º telescope under local anesthesia.

Results: All were followed at least six months and only 20 of 495 injected patients had to continue their former medication. 475 (95.9% of the injected population) patients have completely left the medical treatment for their stress urinary incontinence. All were pleased after at least sixth month of the intervention. 404 (%81.6 of the intervention population) patients had no need for pad usage while 71 (14.3%) had to use only one pad/day.

Conclusion: Bladder neck injection with bulking agents for stress incontinence is a reliable and minimally invasive method for female patients owing to being able to be easily applied in the office setting. Being applicable under local anesthesia in office setting, it is so practical and promising and increases quality of life of patients.

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