Bulking Agents for Bladder Leakage

By Barbara C. Bourassa

You’ve been diagnosed with stress incontinence, but the treatments your doctor suggested for those tiny leaks when you cough, laugh, or sneeze, such as Kegels or physical therapy, haven’t worked. Now you’re wondering if it’s time to consider a surgical procedure. Where do you go from here?

First, take comfort in knowing that you’re not alone—one in 25 women in the U.S. (and one in 12 over the age of 60) has had a surgical procedure of one kind or another to help alleviate the symptoms of stress incontinence, according to an article published in the January 2008 issue of Harvard Women’s Health Watch. The type of surgery that one is best suited for depends, in part, on the underlying cause of the stress incontinence—and only a doctor can determine which procedure is most appropriate.

That said, the surgical options for treating SUI fall roughly into one of two categories: inpatient (those requiring general anesthesia and the use of an operating room) and outpatient (procedures that can be performed in a doctor’s office using local anesthesia.) Inpatient treatments include such procedures as the sling, in which the surgeon uses sutures, the patient’s own tissue, or synthetic material to support the urethra and bladder neck. Outpatient treatments involve the use of bulking agents such as collagen, which the doctor injects into the tissue surrounding the urethra in order to give it rigidity or make it narrower. The concept is similar to “the way in which a washer prevents leakage in a hose,” explains Raymond Rackley, MD, a specialist in female urology at the Cleveland Clinic

Although the sling is viewed by many bladder experts as the preferred surgery for stress incontinence, not all patients require it or can even tolerate it. “Bulking agents are often best suited for a certain subset of stress incontinence patients,” says Neeraj Kohli, M.D., a urogynecologist at Brigham & Women’s Hospital in Boston. “This includes older patients, who may be medically compromised (meaning they can’t tolerate general anesthesia) or women suffering from mild bladder leakage who don’t require the full-blown sling procedure.” Women who plan on future pregnancies are also better candidates for bulking agents, he notes, because “the sling is more of an anatomical structure. After a patient has a sling, we typically suggest a C-section.” Another small group of women—patients who have undergone some type of incontinence treatment but who still have residual leaking—may also be good candidates as well, he adds.

The procedure is fairly simple and takes just about a half hour, which is why it’s usually performed in the doctor’s office. The material, such as collagen, is implanted in the tissue much in the same way that a plastic surgeon uses collagen to augment a patient’s lips. Because collagen is derived from cattle, a small percentage of women are allergic to it—but this is determined ahead of time with a simple skin test. Another agent, called Coaptite, is also being used by certain doctors with fairly good success rates."All of these procedures are safe and effective, assuming you have a qualified professional performing the procedure,” Kohli says. If you are considering this (or any other surgery), Kohli and experts at Brigham & Women’s Hospital suggest talking with your doctor and/or specialist. Before you make your decision ask them the following questions:

1. How many of these procedures have you performed in the last six months?
2. What are your own personal results in terms of success rates with this surgery?
3. What are the possible complications?
4. If I experience complications, would you treat me yourself or send me to someone else (and should I consider selecting this second person to do the surgery?)
5. Do you have specialized training or experience in this procedure?