Large urethral prolapse formation after calcium hydroxylapatite (Coaptite) injection
H Henry Lai1, Eric A Hurtado, Rodney A Appell
1Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, 4960 Children's Place, St. Louis, MO 63110, USA. laih@wudosis.wustl.edu
Summary
Calcium hydroxylapatite injections successfully treated stress urinary incontinence but led to urethral prolapse due to particle migration. Proper injection technique is crucial for urethral bulking agent safety and efficacy.
Area of Science:
- Urology
- Female Pelvic Medicine and Reconstructive Surgery
Background:
- Stress urinary incontinence (SUI) and intrinsic sphincteric deficiency (ISD) significantly impact quality of life.
- Previous anti-incontinence surgeries can complicate treatment options.
Observation:
- A 67-year-old woman with SUI and ISD received cystoscopic injections of calcium hydroxylapatite (Coaptite®) at the bladder neck and proximal urethra.
- Incontinence resolved initially, but seven months later, the patient developed voiding difficulty and a urethral mass.
- Examination revealed urethral mucosa prolapse obstructing the meatus, confirmed during surgery to be caused by migrated calcium hydroxylapatite particles.
Findings:
- Calcium hydroxylapatite particles migrated from the injection site (bladder neck/proximal urethra) to the distal urethra.
- This migration caused urethral prolapse, necessitating surgical intervention (incision and marsupialization).
Implications:
- Improper injection technique is a likely cause of urethral prolapse following bulking agent use.
- Meticulous attention to injection technique is paramount for successful and safe treatment with urethral bulking agents.
- Special caution is advised for patients with scarred urethras or prior extensive pelvic surgeries.
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