Periurethral injection therapy is used to treat stress urinary incontinence caused by intrinsic sphincteric deficiency (ISD). It may also be utilized to “touch up” the urethral resistance in patients with residual leakage after a bladder sling procedure. These injections are performed under cystoscopic guidance. A bulking agent is strategically injected into the sub-mucosal layer of the proximal urethra. By bulking the mucosa in the proximal urethra, there is increased resistance to outflow of urine, therefore preventing involuntary bladder neck opening.

Please refer to the “what is cystoscopy” section for details on preparing for the procedure, possible risks, and post-operative instructions.

The most common complication is urinary tract infection. Urinary retention may occur for a short period after the procedure and is usually managed by clean intermittent self-catheterization. Permanent voiding dysfunction is extremely rare. Other rare events include tissue necrosis at injection site, urethral prolapse, osteitis pubis, urethral diverticulum, urethral abscess, and vesicovaginal fistula.

Postoperative patients may be given prescriptions for pyridium (to alleviate   burning with urination) and antibiotics (to prevent infection). Rarely a small foley catheter will need to be placed post-procedure for 24-48 hours.

Success rates vary between patients. Some patients require more than one injection therapy to provide continence or significant improvement. Repeat injection intervals required to maintain the effect is patient- dependent.