Bulking Agents - Do they work for Men with Stress Incontinence?

A recent article published on IncontinenceNetwork provided information about using collagen injections to treat various forms of urinary incontinence. This peaked my interest because I have wanted to have this done to correct the stress incontinence that I have.

My stress incontinence is caused by injuries to my bladder neck during a TURP (Transurethral Resection of the Prostate) three years ago. Most men who undergo a TURP will develop some form of incontinence.  Depending on extensive the TURP is, it can destroy  the muscle and tissue in the bladder neck.

I have talked to my urologist on several occasions about the possibility of trying some of the bulking agents to correct this. When we first talked she seemed positive about trying it. However at a follow-up appointment she was not as enthusiastic. She indicate her reticence for the following reasons:

• My stress incontinence is not severe enough to try a sling. (This is true.)
• None of the bulking agents available today are FDA approved for use in men. This doesn't mean she can't use them. The Botox is also not approved by the FDA for urge incontinence.
• There is little data on the efficacy of bulking agents in men. Some studies indicate it may be as low as 50%.
• My bladder neck is so scarred from the TURP that she might not be able to inject it.

Needless to say, I was very disappointed, particularly in light of the fact that one time she seemed to very willing to do it. She would do it if I requested, but felt that it would not be the right thing to do. I had to acquiesce to her opinion, in spite of my disappointment.

I decided to do my research to accumulate some "ammunition" in case I had the courage to bring the subject up again. I spent a fair amount of time doing research on bulking agents for males. I have conversations or exchanged emails with Customer Support personnel at Boston Scientific, Uroplasty Inc., and C.R. Bard Company on the efficacy of their particular products for men with stress incontinence. These individuals were very helpful, even providing copies of clinical studies done for men.

Men have two urinary sphincters, an internal one and an external one. The internal sphincter  is a continuation of the bladder detrusor muscle and is not under voluntary control. Its primary function is to prevent urine escaping during ejaculation. However, it does retain some tension and so contributes to male continence. Some sources indicate the internal sphincter may be more important for continence in males than the external sphincter. As stated above TURP or prostatectomy can damage or remove the muscles controlling this sphincter.

Whether females have one or two sphincters depends on who you read. I have read some sources that indicate only one, others that indicate two, and still others the indicate a "long" one extending from the bladder neck to the voluntary pelvic muscles.

In my case I developed both stress and urge incontinence.  I'm fortunate to have access to intravesical Botox (link) injections for my urge incontinence. However, Botox does not help with stress incontinence.