Procedures for Intrinsic Sphincter Deficiency

Sling procedures are recommended for women who have intrinsic sphincter deficiency with coexisting hypermobility or as first-line treatment for ISD. These procedures involve placing a sling, made of either autologous or heterologous material under the urethroversical junction and anchoring it to retropubic or abdominal structures or both.

Periurethral bulking injections are recommended as a first-line treatment for women with ISD who do not have coexisting hypermobility. This procedure consists of injection of materials such as polytetrafluoroethylene, collagen, or autologous fat under cystoscopic guidance into an incompetent periurethral area.

Periurethral bulking injections are recommended as a first-line surgical treatment for men with ISD. The mechanism for improvement after injection therapy may reflect an improvement in urethral coaptation and possibly compression.

Artificial sphincter is recommended for ISD patients who are unable to perform intermittent catheterization and have severe stress urinary incontinence that is unresponsive to other surgical treatments. Because of the high complication rate, this treatment is rarely used as primary therapy.