Implacement: Therapy: Treatment, Effects & Risks

Implacement therapy is a minimally invasive surgical procedure indicated for stress incontinence. Here, a substance is injected into the area of the urethra to correct urinary behavior by intentionally narrowing the tube.

What is impaction therapy?

A procedure called implacement therapy is a minimally invasive procedure for the surgical treatment of incontinence. So-called implacement therapy is a minimally invasive procedure for the surgical treatment of incontinence. This treatment method has been used in Europe since 1998 for mild to moderate stress incontinence. Implacement therapy is used to narrow the urethroversial junction, or the middle portion of the urethra, thus relieving the sphincter muscle. This procedure is performed in female patients suffering from stress incontinence. Stress incontinence is the involuntary leakage of urine due to increased pressure build-up, for example when lifting, coughing or sneezing. Stress incontinence is caused by damage to the uterus or muscle weakness of the pelvic floor. A lowered uterus can promote this form of incontinence. Such therapy is indicated when previous conservative treatment methods have not led to the desired success. Conservative therapies may include pelvic floor training, pelvic floor electrostimulation, hormone therapy, or other drug therapies.

Function, effect, and goals

Implacement therapy is used in female patients with stress incontinence. The goal of this therapy is to relieve the sphincter muscle by narrowing the urethroversial junction or the mid-urethra. To achieve this, reactive periurethral tissue consolidation must be obtained by injection. The components of the injection differ by the type of method. Substances such as endogenous fat, collagen (structural proteins of connective tissue) or dextranomer/hyaluronic acid gel can be used. The gel is biosynthesized from natural sugars and is very tolerable due to its non – allergenic components. The hyaluronic acid has a high stability and can be applied in different forms due to its three-dimensional structure. Which substance is used is decided by the specialist, depending on the area of application. Implacement therapy is performed with a so-called implacer during local anesthesia. The implacer consists of four individual syringes. This allows the substance to be injected under the mucous membranes in four different places at the same time. To begin the procedure, the bladder must first be emptied through a catheter. The implacer can then be inserted. The surgeon calculates in advance how far it must be inserted in order to place the injection at the correct site, using the urethral length measurement. This is calculated as follows: Urethral length / 2 = middle third of urethra. The procedure is usually performed on an outpatient basis. The substance is injected either next to the urethra or through a cytoscope into the connective tissue layer below the mucosa of the urethra. Instead of a cytoscope, a so-called guide cannula can also be used here. The procedure usually takes no longer than 20 minutes. Continence can be completely or partially restored in about 70-80% of cases. If the first injection does not lead to the desired result, it can be repeated after 6-8 weeks. After about 4 years, a new implacement therapy may be necessary, as the body has absorbed the injected substance. However, this is decided by the treating physician based on the symptoms and medical history. Postoperative implacement therapy should additionally support urinary behavior with physiotherapeutic pelvic floor exercises or stimulating electrotherapy. A strong pelvic floor can improve the closure of the urethra and positively influence the achieved result of the surgical therapy in the long term. Strengthening the pelvic floor muscles is of high importance, especially in cases of postnatal stress incontinence or due to weak connective tissue.

Risks, side effects and dangers

Complications or side effects occur only in rare cases.The substance of the injection does not pose any risks, as it is either the body’s own fat or the body’s own proteins of the connective tissue and the dextranomer/hyaluronic acid copolymer gel is produced from non-allergenic components with the help of a biotechnological process. This prevents pathogens from entering the body and rejection of the material has not yet been observed. In rare cases, the injected substance may become detached and no longer adequately support the sphincter. Postoperatively, despite the minimally invasive procedure, a complete follow-up should be carried out by the attending specialist in order to exclude possible complications. The residual urine values and general urinary behavior should be checked regularly. If the residual urine values are pathological, the urinary bladder cannot empty completely, the urethra could possibly be too narrow due to the impaction therapies and a so-called residual urine remains. This can cause the urinary bladder to stretch excessively and causes severe pain. In addition, if urine remains in the bladder, infections may occur. In this case, the bladder should be relieved immediately by means of a bladder catheter. Furthermore, postoperative urinary urgency symptoms or suburethral abscess formation may occur. If abscess formation occurs, it can only be diagnosed with an imaging procedure, such as sonography, and subsequently treated adequately. If urinary urgency symptoms occur, they can be treated with parasympatholytics. In principle, prophylactic administration of antibiotics should be considered after impaction therapy to prevent possible complications such as infection.