This week, I would like to share with you how you can end your SUI more efficiently.

Because SUI mostly occurs due to injury in the support system of the urethra, the tube that drains the bladder to outside world, interventions usually target rebuilding the support system.

For example, urethral bulking agents are fillers similar to face fillers that buff up the urethra. They create resistance and prevent urine from leaking out when there is increase in abdominal pressure (like coughing, sneezing, jumping, or lifting anything heavy). During the procedure, the bulking agent, which can be made out of calcium or gel, is injected into the urethra under the direct visualization of a small camera. This procedure can be done either in the office or in the operating room, depending on your pain tolerance. Because the procedure takes literally two minutes, the majority of women do not have any problem having this procedure done in the office with some Valium and topical numbing. The bulking agent is an excellent choice for women who have mild to moderate urinary incontinence and those who desire to avoid/or cannot tolerate a surgical procedure due to their overall health.

Does urethral bulking last forever? Unfortunately, it doesn’t. The material that bulking agents are made of usually are either expelled from the urethral lining or becomes resorbed. So with time, women will either need a repeat injection or move on to other more durable options.

What is normal after you had a urethral bulking agent injected?

– You might have some blood in your urine, or your urine might look pink.

– You might see pieces of crystal or material in your urine when you pee. This is normal and does not mean that ALL the injected material is coming out.

– You urinary stream might change or spray. Even though it might cause some inconvenience, it is not harmful, and it can be partially corrected with adjusting your position on the toilet.

– If you have imaging studies done like a CT scan, MRI or X-ray, material from the fillers will show up. Often, doctors who read your image might not realize that the “calcifications” or “masses” that they see are actually your fillers. Make sure to let your doctors know because it will save you from additional unnecessary testing.

What if you try fillers, and they help for some time, and then your leakage returns?

Or what if you just want the most durable and long-lasting treatment to get back to the things you enjoy doing the most?

The most durable procedure for treatment of SUI is a urethral sling.

A urethral sling is a piece of a material that is placed vaginally and designed to support the urethra like a hammock to prevent leakage. Different materials are used for slings: your own fascia, cadaveric fascia, and synthetic mesh. Synthetic mesh is considered the gold standard for treatment of SUI. During this procedure, a small incision is made inside of your vagina and the sling is inserted. The procedure takes about 30 to 60 minutes, but it’s done in the operating room because of the need for anesthesia. Recovery is pretty quick because no big incisions are required.

Do you need to have a catheter after surgery?

Usually not. However, sometimes due to the tissue swelling surrounding the urethra, patients can’t void right away. In that case, a catheter will be placed with the goal to drain urine until swelling goes down—usually a day or two. Even though having a catheter can be uncomfortable, it’s important to remember that it’s temporary and to focus on the big picture of getting rid of incontinence and getting one step closer to having your life back with all the activities you enjoy.

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