Intrinsic sphincteric deficiency (ISD) sometimes exists alone but can also coexist with hypermobility. In patients that present with continued leakage following anti-incontinence surgery, the most likely cause is ISD. As mentioned above, while addressed to some extent with midurethral sling surgery, often times the most effective therapy for patients with ISD is periurethral injection therapy. Due to the fact that at rest the walls of the urethra do not come into contact, they are not able to form an appropriate seal to keep urine from leaking. Hence, placing a filler material under the walls of the urethra elevates the tissue back into contact with its opposite counterpart re-establishing a competent seal.
This procedure is performed in office and under a local anesthetic with results often seen that very day, and nearly complete continence established in the majority of patients in 3 injections or less. Risks include bleeding, infection and urinary retention, however these are not very common and should be discussed with your consulting physician before the procedure. El Camino Urology Medical Group is one of the highest volume providers of this therapy, and one of the few in the Bay Area offering this as an in office procedure, avoiding the bother and expense of operating rooms and surgical centers.
