Macroplastique, a urethral bulking agent for stress urinary incontinence mimicking a bladder tumour

Urinary incontinence is a stigmatised condition with high prevalence and significant patient morbidity. Stress urinary incontinence (SUI) is a subtype of incontinence particularly prevalent in middle-aged to older women—often seen as a sequelae of childbirth or pelvic surgery. Treatment has proved challenging with a chequered history. Urethral bulking agents have been developed as a minimally invasive treatment option for mild to moderate SUI. Following injection, the agent causes mild deformation of the urethral anatomy leading to reduced incontinence as higher pressures are subsequently required for incontinence to occur. Macroplastique is unusual in that it relies on an influx of fibroblasts and subsequent scarring to sustain its long term efficacy. This scarring leads to unusual and potentially confusing appearances on imaging. This case presentation is of a patient with a long history of SUI and associated surgical management, including the use of Macroplastique, whose unrelated routine imaging raised the possibility of bladder tumour.