ABSTRACT
This chapter is divided into two sections: surgical treatment of the underactive or incompetent bladder outlet and surgical treatment of the nonrelaxing or hyperactive bladder outlet (detrusor-sphincter dyssynergia). First introduced in Europe in 1996, Bulkamid is composed of 2.5% polyacrylamide hydrogel and 97.5% water for injections. At present, and in most Western countries, it is recommended that outside of investigative protocols, physicians should not offer stem cell therapy to patients with stress incontinence. Botulinum toxin A (BTX-A), with its ability to induce a reversible chemical sphincterotomy, provides another option. Reasons for failure include problems fitting the condom catheter as well as detrusor areflexia, which can result in poor bladder emptying despite an incompetent bladder outlet. BTX-A injection is a solution for patients with neurogenic hyperactive bladder outlet who have not decided to undergo surgical sphincterotomy.
