Stress urinary incontinence (SUI) affects a large proportion of middle-aged and elderly women. When all conservative means are ineffective, a surgical treatment including retropubic suspension, pubovaginal and tension-free slings, is contemplated. Intra-urethral injections with bulking agents have been used as an alternative to the mentioned surgical procedures with alternate results. Many urethral bulking agents are available, such as bovine glutaraldehyde cross linked (GAX) collagen, polytetrafluoroethylene (Teflon), polydimethyl-sillxane elastomer (silicone), carbon coated zirconium beads, hyaluronic acid/dextranomer, and autologous tissues such as fat and cartilage. These substances may be injected in a retrograde or antegrade fashion in the periurethral tissue and whether one route of injection is better than another is not well documented in the literature. We briefly describe the main injection techniques and devices of the most common bulking agents used in the treatment of female SUI.
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