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Bulking Agent/Collagen Injection
This minor outpatient procedure is used for stress incontinence in men and women when the sphincter controlling outflow of urine is weakened or incompetent. Done under local anesthesia, collagen or another substance is injected into the area around the urethra. This adds bulk, which better compresses the sphincter. A skin test is required before the procedure to determine if any allergic reaction might occur to the collagen, if used.
The cure rate of this procedure is reported to be somewhat higher for women than men. The collagen used can be absorbed by the body over time, so the procedure may need to be repeated. In addition, other materials exist that work as effectively as collagen and may last longer (silicon-coated beads and Coaptite).
Artificial Urinary Sphincter
Performed most often for men and only rarely for women, this procedure creates a functioning artificial urinary sphincter using a cuff, tubing, and a pump. The cuff goes around the sphincter and is connected to a pump, which is placed in the scrotum for men and the labia for women. Squeezing the pump causes the pressure to be released in the cuff, thus allowing urination to begin.
This procedure is generally considered only after other treatments have failed, and it is most commonly done for men after prostate surgery. Because of where the pump is placed, activities such as bike riding may not be recommended.
Each procedure has published cure rates that can range between 75% and 95%. If one is considering surgery for stress incontinence, they should ask the surgeon what his or her success rates have been for the proposed surgery. If surgery does not cure incontinence, it often does improve symptoms significantly.
Several factors can influence the success of any surgical procedure, such as medical conditions like diabetes, other genital or urinary problems, or previous surgical failures. The patient should be prepared to undergo a thorough physical and testing to determine not only the cause of urinary incontinence, but also other factors that may influence success of a procedure.
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