Normal saline injected into 9 sites of the distal anterior one-third of the vagina using a small 30-gauge needle. The injections were performed at 10, 12 and 2 o'clock in 3 different levels of the urethra 1-2 cm apart (distal, mid and proximal).

The participants will receive 2 injections at 4-6-week intervals.

One-hour pad test standardized by International Continence Society (ICS):

• started by putting one pre-weighted pad,
• patient drinks 500 ml in <15 min- then sits or rests,
• patient walks for 30 min,
• patient performs the following activities: standing up from sitting, coughing vigorously, running on the spot for 1 min, bending to pick up an object from the floor, and washing hands in running water for 1min
• the total amount of urine leaked is determined by weighing the pad.

Interpretation:

The upper limit of weight increase for the 1-hr test in continent women is 1.4 grams.

A weight gain of less than 1.4 g during 1-hr test could be a result of sweating or vaginal discharge.

An increase of 1-10 g is classified as representing mild incontinence, 11-50 g moderate and >50 g severe incontinence.

The visual analog scale (VAS) is pain rating scale. Scores are based on self-reported measures of symptoms that are recorded with a single handwritten mark placed at one point along the length of a 10-cm line that represents a continuum between the two ends of the scale-"no pain" on the left end (0 cm) of the scale and the "worst pain" on the right end of the scale (10 cm).

The Patient Global Impression of Improvement (PGI-I) is a validated generic tool for assessment of the over-all improvement or deterioration that the patient may experience following the treatment.

The PGI-I is a transition scale that is a single question asking the patient to rate their urinary tract condition now, as compared with how it was prior to before beginning treatment on a scale from 1. Very much better to 7. Very much worse.

Therefore, lower values correlate with increased satisfaction.