What are urethral bulking agents and when indicated?

• A. Injectables around the urethral lumen to decrease coaptation; indicated for ISD or when a sling is not feasible.
• B. Surgery to shorten the urethra; indicated for all SUI.
• C. A device to widen the urethra; indicated for urinary retention.
• D. Injectables around the urethral lumen to increase coaptation; indicated for ISD or when a sling is not feasible.

Answer: (D)

Urethral bulking agents are injectable substances placed around the urethral lumen to increase tissue bulk and improve coaptation of the urethral walls. This enhanced closure helps prevent leakage during increases in abdominal pressure. They’re used when the cause of stress urinary incontinence is intrinsic sphincter deficiency or when a sling procedure isn’t feasible due to anatomy, prior surgeries, or patient factors. Unlike a treatment that widens or shortens the urethra, bulking agents aim to strengthen closure by adding volume, making the option described as injectables around the urethral lumen to increase coaptation the best match.