Imaging of Urethral Bulking Agents: A Sonographer's Perspective

Urethral bulking is an office procedure for treatment of stress urinary incontinence that has increased in popularity in recent years. Numerous types of urethral bulking agents have been used since its introduction in the 1930s. Typically, these agents are imaged using specialty 3D 360 degrees field-of-view transducers; however, a sonographer, during a pelvic or renal examination, may inadvertently find and image an echogenic structure near the urethrovesical junction in patients with a history of urethral bulking. Familiarizing oneself with the sonographic appearance of urethral bulking agents and optimizing techniques to obtain improved images of these agents may eliminate the need for additional imaging for the patient. Urethral bulking can be readily imaged with transducers commonly found in most ultrasound departments. This review will focus on the sonographic characteristics of urethral bulking agents and knowing when and how to use appropriate transducers to image the urethra.