Understanding Periurethral Injections for Stress Urinary Incontinence

What is stress urinary incontinence?

Stress urinary incontinence (SUI) occurs when pressure inside the abdomen increases during physical activities - such as lifting, sneezing, or laughing - and leads to the unintentional release of urine. This is the most common form of incontinence and primarily affects women, particularly after childbirth. In men, SUI typically occurs following prostate or bladder surgery.

The issue stems from weakened pelvic floor muscles or a malfunctioning urinary sphincter, which fails to maintain bladder closure during effort. Other risk factors include menopause, obesity, chronic constipation, intensive physical labor, or certain medications.

How do periurethral injections work?

Periurethral injections involve injecting a bulking agent into the wall of the urethra to reduce its diameter. This improves the urethra’s ability to stay closed under pressure. The goal is to restore continence without invasive surgery.

The procedure is typically performed under local anesthesia on an outpatient basis and takes around 15 minutes. A local anesthetic gel is applied, and a cystoscope is used to visualize the urethra. The physician then injects the chosen material into the urethral wall to create a cushioning effect that helps prevent leakage.

After the procedure, the patient is monitored briefly. Once they successfully pass urine and a follow-up ultrasound shows no issues, they may go home. Prophylactic antibiotics are usually prescribed to reduce the risk of urinary tract infection.

What materials are used?

Various substances can be used, including:

• Hyaluronic acid (widely used and well tolerated)
• Collagen or autologous fat (natural, but may degrade over time)
• Synthetic compounds like silicone microspheres or polymer gels

Each option has its pros and cons. Natural substances are generally safer but less durable. Synthetic agents last longer but may pose a higher risk of side effects. Patients are advised to discuss the product used with their healthcare provider to fully understand the benefits and potential risks.

What results can be expected?

Many patients notice improvement within days of the procedure. However, results may fade over time if the material resorbs, and repeat injections might be necessary. To maximize the outcome, pelvic floor physiotherapy is often recommended alongside the treatment.

Possible side effects include mild bleeding, discomfort, or temporary urinary retention. These typically resolve within a few days or weeks. The procedure is generally well tolerated and requires minimal downtime.

Is this treatment covered by health insurance?

Currently, periurethral injections are not routinely reimbursed. The cost varies based on the product used - for example, a single dose of macroplastic material can exceed €1,000. Patients should consult their insurer or specialist to clarify what costs may be involved.

Who is a good candidate?

This treatment is suitable for individuals with moderate to severe stress urinary incontinence who are not ready or eligible for more invasive surgical interventions. It offers a safe and efficient alternative to regain bladder control and improve quality of life.