Macroplastique is an injectable soft-tissue urethral bulking agent for treating adult female stress urinary incontinence primarily due to intrinsic sphincter deficiency. Macroplastique is injected into the tissues surrounding the urethra. The increased “bulk” allows the urethra to close more effectively and prevents urine from leaking.
The procedure to inject Macroplastique can be performed in your doctor’s office or in an outpatient clinic or hospital in approximately 30 minutes. Prior to the procedure, the doctor will give you an antibiotic to reduce the risk of infection. Upon the start of the procedure, the doctor will give you local anesthetic in the tissues near your bladder to reduce discomfort.
A small optical instrument (cystoscope), placed in the urethra, is used during the procedure to allow your doctor to view your urethra and bladder while injecting Macroplastique into the surrounding urethral tissue. Your doctor will also fill your bladder to halfway with water or saline to better view the implantation area. The optical instrument is removed after the injection and your treatment is complete.
Frequently Asked Questions
What can I expect after the procedure?
- To stay at the treatment facility until the numbness from the anesthetic is gone and they can urinate on their own. If you have difficulty urinating after the procedure, a catheter may be inserted temporarily until you urinate normally.
- To receive a prescription for antibiotics to prevent infection. It is important to take this antibiotic to reduce the risk of a urinary tract infection.
- To resume their normal daily activities and return to work within a few days.
Will I need more than one treatment?
In the clinical trial, about half of the patients requested an additional treatment to either further improve or cure their incontinence. Cogentix Medical recommends patients wait 12 weeks between treatments to allow healing and accurately see the full effect of the first treatment.
What are the long-term results?
The long-term results with Macroplastique have not been established. Eighty-four women participated in the Macroplastique clinical trial for 2 years. Using the same physician’s scoring system reported at 12 months (Stamey Grade), 63 out of these 84 women were improved at 2 years. However, too many women did not attend their 2-year exam to assess improvement at 2 years. Therefore, the actual improvement rate beyond 12 months is unknown.
If your symptoms do not improve or if symptoms return after treatment with Macroplastique, there are other options available. You may require further treatment for stress urinary incontinence or you may have an additional form of incontinence or other urology or gynecology problem that needs to be diagnosed and treated. For example, many women have mixed incontinence, such as a combination of SUI and urge incontinence, where urge incontinence is a sudden and uncontrollable urge to urinate. If this were the case, your doctor would work with you to determine an appropriate treatment option for your urge incontinence. Treatment with Macroplastique does not prevent you from receiving other types of incontinence treatments – either for SUI or another form of incontinence.
Are there times when Macroplastique should not be used?
You cannot be treated with Macroplastique if you have an infection or inflammation of the kidney, bladder or urinary tract, or vagina. Your doctor will test your urine to ensure you do not have a urinary tract infection because the Macroplastique injection cannot be performed until an infection has been treated. Also, Macroplastique cannot be injected if the tissue around your urethra does not look healthy to the doctor. This treatment has not been evaluated in pregnant women or women who had a child within the past year.
What are the risks I should know about?
As with any treatment, there are risks involved. It is important to discuss risks and side effects with your doctor before undergoing any type of medical treatment. Risks following a Macroplastique treatment include pain related to the procedure (which can be controlled with pain medication), a small amount of blood in your urine, having to use the bathroom more often or more urgently, delayed voiding, painful urination, and/or urinary tract infection. There is also a potential risk related to receiving anesthesia during the treatment. An additional risk is that you may experience no benefit from Macroplastique treatment. This could happen if Macroplastique is placed too deeply in the tissue, thereby creating poor bulking around the urethra. Also, if you have a different type of incontinence (i.e., urge incontinence) or your incontinence condition worsens (i.e., due to urethral hypermobility), Macroplastique may not be an effective treatment for you. Many of the side effects reported in the clinical study occurred within 7 days after treatment and resolved within 30 days. You should talk to your doctor about these side effects and how they can be resolved.