Ultrasound Evaluation of the Urethra and Bladder Neck Before and After Transurethral Bulking.

OBJECTIVES: The aims of the study were to describe ultrasound findings in women with stress urinary incontinence (SUI) after transurethral injection of Coaptite, to describe symptoms 3 months after injection, and to determine whether there was an association between degree of improvement and sonographic findings.

METHODS: This is a prospective cohort study of women with SUI undergoing transurethral Coaptite injection. Subjects completed the Urinary Distress Inventory and Incontinence Severity Index preinjection and 3 months postinjection. Translabial ultrasound was performed immediately after and 3 months postinjection. Two- and three-dimensional images were captured to measure the dimensions and location of Coaptite in relation to the bladder neck as well as degree of coaptation. Change in volume of injection over time was calculated using these measurements.

RESULTS: Twenty subjects were enrolled in the study. At 3 months, 45% of subjects had 90% or greater improvement, 45% had 50% to 75% improvement, and 10% had less than 30% improvement. Mean distance of Coaptite from the bladder neck at 3 months was not statistically different from the distance immediately after injection. There was a 40.9% to 45.8% mean reduction in volume at 3 months as well as a 39.5% reduction in coaptation. Degree of improvement was associated with mean change in volume over time: those with the least improvement had the greatest reduction in volume. Volume of initial injection, percent coaptation, and number of vials used to perform the injection were not associated with patient symptoms.

CONCLUSIONS: In this series, 90% of patients who underwent Coaptite injection for SUI reported 50% or greater improvement. The volume of Coaptite decreased by 40% over time, and the degree of shrinkage correlated with clinical outcomes.