Periurethral mass formations following bulking agent injection for the treatment of urinary incontinence

Purpose: Durasphere® is gaining popularity as a bulking agent for treating women with stress urinary incontinence. We present a series of patients with periurethral mass formation following Durasphere® injection. Materials and Methods: The charts of 135 women with a mean age of 69.4 years (range 46 to 83) who underwent Durasphere® periurethral injections were retrospectively reviewed. Patients who had a periurethral mass were identified and their clinical data were collected and analyzed. Results: Four patients (2.9%) were diagnosed with periurethral mass formation 12 to 18 months (average 14.7) following a Durasphere® injection. Clinical presentation varied, including irritative voiding symptoms, pelvic pain and urinary incontinence. All patients were found to have a tender and tense periurethral mass. A radiopaque mass was revealed during videourodynamic study in 1 patient. Incision, and transvaginal and endoscopic drainage or transvaginal excision were used to treat these masses. Intraoperative and pathological findings as well as operative outcomes are presented. Conclusions: Irritative or obstructing voiding symptoms, pelvic pain or a periurethral mass in patients with a history of Durasphere® or other periurethral bulking agent injection should alert the physician to the possibility of periurethral mass formation. The true incidence of this late complication remains to be determined.