Obstetrics and Gynecology International another 5 cc of 1% xylocaine may be administered as above on either side. 7.4. Intravesical Bladder Neck Anesthesia. Immediately after periurethral and bladder neck injection, intravesical anes- thesia of the bladder neck is carried out. The cotton swab within the urethra is removed, and a red rubber catheter is placed to drain any residual urine. The bladder is retrograde ﬁlled with 30 cc of 1% xylocaine. The patient then stands or sits upright to ensure contact between the intravesical xylocaine and bladder neck. After 10 minutes, the bladder is drained completely, ﬁlled with 30 cc of sterile water at room temperature (to cool tissue during treatment), and the catheter removed. Complete evacuation of intravesical anesthesia is suggested, as xylocaine absorption may be sig- niﬁcantly increased in highly vascularized traumatized areas such as the bladder neck and proximal urethra following treatment with Renessa. 7.5. Postprocedure Oral Regimen. Patients are given a pre- scription for phenazopyridine 200 mg three times a day for three days to provide lower urinary tract analgesia. The administration of postprocedure antibiotics may be at the discretion of the physician. 8. Clinical Data A summary of prospective trials employing Renessa is pre- sented in Table 1 [18–22]. Inclusion criteria common to all studies were SUI and urethral hypermobility, with exclusion of those with a history of previous anti-incontinence surgery and those with primary urge-associated leakage in the presence of mixed incontinence. In the Appell and Elser trials, patients with a LPP of <60 cm H2O on urodynamics were not eligible for participation [19, 21]. Regarding 12 to 18 month eﬃcacy, patients treated with low-energy RF to 36 submucosal foci exhibited a ≥10 point score reduction in I-QOL ranging from 44% to 50.3%, and a ≥50% reduction in IEF ranging from 46.7% to 67%. An I-QOL score improvement of ≥10 points has been shown to correlate with patient perception of improvement as being “much better,” a ≥25% reduction in IEF, and a ≥25% reduction in stress pad weight [26]. Although no statistically signiﬁcant diﬀerence was observed by Lenihan et al. between treatment and sham groups regarding a ≥10 point improvement in I-QOL, a subanalysis of patients deemed to have moderate-to-severe SUI determined that 74% of those receiving treatment versus 50% of those receiving sham achieved such improvement (P = 0.03) [27]. Additionally, outcomes in this population were independent of menopausal status. Patients treated with transurethral RF collagen denatu- ration experienced rare long-term sequelae. No serious AE’s were reported in any of the aforementioned clinical trials, and no diﬀerence was seen in the incidence of AE’s between treatment and sham groups. 5 9. Discussion Renessa represents an oﬃce intervention for SUI that is safe and is without signiﬁcant AE’s or known long-term negative eﬀects. Safety has been conﬁrmed in animal studies with no evidence of posttreatment urethral obstruction or stricture formation. The putative mechanism of decreased funneling may be supported by both animal and human data in which LPP was found to improve following RF treatment [17, 19]. Eﬃcacy of transurethral collagen denaturation appears to be within range of that of PFMT. Alewijnse et al. reported 1-year success following PFMT (with randomization of 129 patients to PFMT alone versus PFMT plus one of three health education programs), citing a ≥50% improvement in IEF in 74.8% (64.4% by intent to treat) of patients overall [7]. In terms of actual number of leaks, Elser et al. reported a reduction in median weekly IEF from a 15.0 (1.0 − 245.0) to 7.5 (0.0 − 140.0) at 12 months (P = 0.0026) [21]. This is in line with data from the Alewijnse trial in which was reported a reduction in mean weekly IEF from 22.9 ± 24.1 to 7.8 ± 12.2 at 12 months (P < 0.001). In a large RCT of 530 patients randomized to individual or group PFMT, Janssen et al. reported similar data at 9 months, with a reduction in mean weekly IEF from 16.3 ± 15.8 to 8.6 ± 15.5 and from 14.4±15.3 to 6.1±10.5 for the individual and group patients, respectively, [8]. Eighteen-month data following Renessa shows improve- ments at 12 months to be durable [22]. This may be an advantage over PFMT, as durability following pelvic ﬂoor muscle rehabilitation may be wholly dependent upon continued therapy. We chose not to compare our data to bulking agents, as Renessa is indicated for SUI and not ISD. Additionally, as transurethral RF treatment is in-oﬃce, we did not compare such therapy to surgical anti-incontinence data. 10. Conclusion Radiofrequency collagen denaturation is a safe, nonsurgical, and in-oﬃce procedure for the treatment of female SUI, providing an improvement in quality of life. Such therapy may represent an alternative to PFMT or for those who have failed such treatment. 11. Coding References The current procedural terminology code (CPT) for the Renessa procedure is 53860. [1] K. Luber, “The deﬁnition, prevalence, and risk factors for stress urinary inconitinence,” Reviews in Urology, vol. 6, supplement 3, pp. S3–S9, 2003. [2] I. Nygaard, M. D. Barber, K. L. Burgio et al., “Prevalence of symptomatic pelvic ﬂoor disorders in US women,” Journal of the American Medical Association, vol. 300, no. 11, pp. 1311– 1316, 2008.