Abstract
Urethral bulking is an office procedure for treatment of stress urinary incontinence that has increased in popularity in recent years. Numerous types of urethral bulking agents (UBAs) have been used since its first introduction in the 1930s.
Ultrasound imaging has made it possible to clearly visualize the implanted UBAs and anatomic location of those agents. Typically, these agents are imaged using specialty 3D 360° field-of-view transducers. Urethral bulking can be readily imaged with transducers commonly found in most ultrasound departments. However, a sonographer, during a pelvic or renal examination, may inadvertently find and image an echogenic structure near the urethrovesical junction in patients with a history of urethral bulking. Familiarizing oneself with the sonographic appearance of UBAs and optimizing techniques to obtain improved images of these agents may eliminate the need for additional imaging for the patient.
In this chapter, we will focus on the sonographic characteristics of UBAs and on knowing when and how to use appropriate probes to image the urethra. We will also describe the use of 2D/3D perineal and 3D endovaginal ultrasound imaging in the assessment of urethral bulking. Normal anatomy, ultrasound techniques, and equipment will be briefly reviewed. The use of 3D endovaginal imaging to identify and describe the location and distribution of UBAs following uncomplicated transurethral injection will be covered as well.
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References
Hegde A, Smith AL, Aguilar VC, Davila GW. Three-dimensional endovaginal ultrasound examination following injection of macroplastique for stress urinary incontinence: outcomes based on location and periurethral distribution of the bulking agent. Int Urogynecol J. 2013;24(7):1151–9.
Kerr LA. Bulking agents in the treatment of stress urinary incontinence: history, outcomes, patient populations, and reimbursement profile. Rev Urol. 2005;7(S1):S3–S11.
Lee HN, Lee YS, Han JY, Jeong JY, Choo MS, Lee KS. Transurethral injection of bulking agent for treatment of failed mid-urethral sling procedures. Int Urogynecol J Pelvic Floor Dysfunct. 2010;21(12):1479–83.
Quackels R. Two cases of incontinence after adenomectomy cured by paraffine injection into the perineum. Acta Urol Belg. 1955;23(3):259–62.
Mayer RD, Dmochowski RR, Appell RA, Sand PK, Klimberg IW, Jacoby K, Graham CW, Snyder JA, Nitti VW, Winters JC. Multicenter prospective randomized 52-week trial of calcium hydroxylapatite versus bovine dermal collagen for treatment of stress urinary incontinence. Urology. 2007;69(5):876–80.
Ghoniem G, Corcos J, Comiter C, Bernhard P, Westney OL, Herschorn S. Cross-linked polydimethylsiloxane injection for female stress urinary incontinence: results of a multicenter, randomized, controlled, single-blind study. J Urol. 2009;181(1):204–10.
Davila W. Nonsurgical outpatient therapies for the management of female stress urinary incontinence: long-term effectiveness and durability (review). Adv Urol. 2011;2011:176498.
Wieczorek AP, Wozniak MM, Stankiewicz A, Santoro GA, Bogusiewicz M, Rechberger T. 3-D high-frequency endovaginal ultrasound of female urethral complex and assessment of inter-observer reliability. Eur J Radiol. 2012;81(1):e7–e12.
Hegde A, Willy Davila G. Endovaginal imaging of vaginal implants. In: Shobeiri SA, editor. Practical pelvic ultrasonography: a multicompartmental approach to 2d/3d/4d ultrasonography of pelvic floor. 1st ed. New York: Springer; 2014.
Koelbl H, Saz V, Doerfler D, Haeusler G, Sam C, Hanzal E. Transurethral injection of silicone microimplants for intrinsic urethral sphincter deficiency. Obstet Gynecol. 1998;92(3):332–6.
Maher C, O’Reilly B, Dwyer P, Carey M, Cornish A. Schluter Pubovaginal sling versus transurethral Macroplastique for stress urinary incontinence and intrinsic sphincter deficiency: a prospective randomised controlled trial. BJOG. 2005;112(6):797–801.
Radley S, Chapple C, Mitsogiannis I, Glass K. Transurethral implantation of Macroplastique for the treatment of female stress urinary incontinence secondary to urethral sphincter deficiency. Eur Urol. 2001;39(4):383–9.
Tamanini J, D’Ancona C, Tadini V, Netto N. Macroplastique implantation system for the treatment of female stress urinary incontinence. J Urol. 2003;169(6):2229–33.
Tamanini J, D’Ancona C, Netto N. Macroplastique implantation system for female stress urinary incontinence: long-term follow-up. J Endourol. 2006;20(12):1082–6.
ter Meulen PH, Berghmans LC, Nieman FH, van Kerrebroeck PE. Effects of macroplastique implantation system for stress urinary incontinence and urethral hypermobility in women. Int Urogynecol J Pelvic Floor Dysfunc. 2009;20(2):177–83.
Zullo M, Plotti F, Bellati F, Muzii L, Angioli R, Panici P. Transurethral polydimethylsiloxane implantation: a valid option for the treatment of stress urinary incontinence due to intrinsic sphincter deficiency without urethral hypermobility. J Urol. 2005;173(3):898–902.
Rovner E, Goudelocke C. Which injectable to use in the treatment of intrinsic sphincter deficiency? Curr Opin Urol. 2010;20(4):296–301.
Smith T, Chang D, Dmochowski R, Hilton P, Nilsson CG, Reid FM, Rovner E. (2005) Surgery for urinary incontinence in women. In: Abrams P, Cardozo L, Khoury S, Wein, editors. Incontinence: 4th International Consultation on Incontinence, Paris July 5–8, 2008. Plymouth UK: Health Publications; 2009. P. 1121–90
Chapple C, Wein AJ, Brubaker L, Dmochowski R, Espuna PM, Haab F, Simon H. Stress incontinence injection therapy: what is best for our patients? Eur Urol. 2005;48(4):552–65.
Lightner D, Rovner E, Corcos J, Payne C, Brubaker L, Drutz H, Steinhoff G, Zuidex Study Group. Randomized controlled multisite trial of injected bulking agents for women with intrinsic sphincter deficiency: mid-urethral injection of Zuidex via the implacer versus proximal urethral injection of contigen cystoscopically. Urology. 2009;74(4):771–5.
DeFreitas G, Wilson T, Zimmern P, Forte T. Three dimensional ultrasonography: an objective outcome tool to assess collagen distribution in women with stress urinary incontinence. Urology. 2003;62(2):232–6.
Poon CI, Zimmern PE. Role of three-dimensional ultrasound in assessment of women undergoing urethral bulking agent therapy. Curr Opin Obstet Gynecol. 2004;16(5):411–7.
Santoro GA, Wieczorek AP, Dietz HP, Melligren A, Sultan AH, Shobeiri SA, et al. State of the art: an integrated approach to pelvic floor ultrasonography. Ultrasound Obstet Gynecol. 2011;37(4):381–96.
Denson L, Shobeiri SA. Imaging of urethral bulking agents: a sonographer’s perspective. J Diagn Med Sonogrphy. 2013;29(6):255–9.
Benshushan A, Brzezinski A, Shoshani O, Rojansky N. Periurethral injection for the treatment of urinary incontinence. Obstet Gynecol Surv. 1998;53(6):383–8.
Khullar V, Cardozo LD, Abbott D, Hillard T, Norman S, Bourne T. The mechanism of continence achieved with GAX collagen as determined by ultrasound (abstract). Neurourol Urodyn. 1993;12(4):439–40.
Monga AK, Stanton SL. Urodynamics: prediction, outcome and analysis of mechanism for cure of stress incontinence by periurethral collagen. Br J Obstet Gynaecol. 1997;104(2):158–62.
Elia G, Bergman A. Periurethral collagen implant: ultrasound assessment and prediction of outcome. Int Urogynecol J Pelvic Floor Dysfunct. 1996;7(6):335–8.
Poon CI, Zimmern PE, Wilson TS, Defreitas GA, Foreman MR. Three-dimensional ultrasonography to assess long-term durability of periurethral collagen in women with stress urinary incontinence due to intrinsic sphincter deficiency. Urology. 2005;65(1):60–4.
Shobeiri, SA, Yune JJ, Quiroz L, Siddighi S, Nihira MA. Transurethral bulking agent location and distribution: A 3D ultrasound analysis (abstract). International Continence Society 43rd Annual Meeting, 29–30 Aug 2013, Barcelona, Spain.
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Hegde, A., Willy Davila, G., Abbas Shobeiri, S. (2017). Imaging of Urethral Bulking Agents. In: Shobeiri, S. (eds) Practical Pelvic Floor Ultrasonography. Springer, Cham. https://doi.org/10.1007/978-3-319-52929-5_11
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DOI: https://doi.org/10.1007/978-3-319-52929-5_11
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