Urethral anesthesia for periurethral bulking procedures in women

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Abstract
Objective: To evaluate the use of injectable xylocaine to provide anesthesia for transurethral and periurethral injections of Contigen and Durasphere to treat stress urinary incontinence caused by intrinsic sphincter deficiency. Methods and results: Using urodynamic evaluation, including uroflow, cystometry, and abdominal leak point pressure, stress urinary incontinence resulting from intrinsic sphincter deficiency was diagnosed in 52 women. These women were then given the opportunity to participate in a randomized double-blinded trial of Contigen (Bard) or Durasphere (Advanced UroScience). There were 26 women in each group. The standard 22-gauge needle was used for the Contigen injections, and an 18-gauge needle was used for the Durasphere injections. A total of 119 separate injection procedures were performed including retreatments. All women were treated in the office as outpatients. A total of 20–25 mL of 1% lidocaine with 1:200,000 epinephrine was used as described. All patients tolerated the procedure in an acceptable fashion. Minor side effects were observed with increasing volumes of lidocaine. Conclusions: Urethral anesthesia in women is a simple, efficacious, and safe technique that allows periurethral bulking to be performed in the office setting. As new bulking agents and techniques become more prevalent, they too should be able to be performed under this urethral anesthesia technique.

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