In women, intra-urethral injections of GAX collagen are performed transurethrally or periurethrally. In the latter approach, the proximal urethra and bladder neck are visualized under direct cystoscopy. A 22G spinal needle is advanced parallel to the urethra in the periurethral tissue up to the bladder neck, and its position is confirmed by cystoscopy. Aliquots of collagen are then injected cystoscopically into the periurethral tissues to occlude the urethra. If intraluminal extravasation occurs, the injection is stopped, and another injection site is chosen. At the end of the procedure performed under local anesthetics, the patient is asked to cough or strain while in the supine position and then in the upright position. If leakage still occurs, more collagen is injected. If no leakage occurs, and there is no urinary retention, the patient is discharged from the hospital. When the procedure is performed under general anesthesia and the bladder is filled, an 8F feeding tube is inserted to empty the bladder and then removed. All patients receive perioperative antibiotics. If patients remain incontinent after treatment, re-injections of collagen are performed. Satisfactory results are usually obtained within 3 treatment sessions.