Urethral bulking for recurrent stress urinary incontinence after midurethral sling failure

Abstract

Aims: To assess the effectiveness of a polyacrylamide hydrogel (PAHG; Bulkamid 1 ) in treating recurrent stress urinary incontinence (SUI) following a previous midurethral sling (MUS) implant. Methods: This observational study, conducted since 2009, included 60 patients with recurrent SUI or mixed urinary incontinence (MUI) after a previous MUS and who chose to be treated with PAHG. Objective and subjective outcomes were assessed at 1, 6, and 12 months after the initial injection. Patients were classified as cured based on a negative cough test (supine and standing) and <2 g urine on 1-hr pad test and a VAS score improved by !90%. Improved were those with the loss of only a few drops of urine during the cough test and 2-10 g urine on 1-hr pad test or a reduction >50% compared with preoperative urine loss and a VAS score improved by !75%. Results: The volume of PAHG injected in the current study ranged from 1-3 ml. Cured/improved rates were 93.3% (56/60), 88.3% (53/60), and 83.6% (46/55) at 1, 6, and 12 months, respectively. Patients with MUI had a cured urgency urinary incontinence rate of 36.8%, 47.4%, and 38.9%, respectively. Voiding dysfunction rates were 13.3% (8/60), 8.3% (5/60), and 1.8% (1/55) at 1, 6, and 12 months and urinary tract infection rates were 5% (3/60), 11.7% (7/60), and 3.6% (2/55), respectively. Other adverse events were short-term and/or observed in <4% of patients. Conclusions: PAHG can be used to treat recurrent SUI after MUS failure with good outcome and low complication rates. Neurourol.

Complications of urethral bulking therapy for female stress urinary incontinence

“…Overall safety profile was favourable with voiding dysfunction and UTI being the most commonly encountered complications. Interestingly, the incidence of these adverse events showed a substantial decline (13.3‐1.8% for voiding dysfunction and 5‐3.6% for UTI) during the follow‐up period (from 1 to 12 months, respectively) . Altman et al studied the safety and efficacy of Bulkamid™ in a cohort of 80 patients who were ineligible for midurethral sling surgery mainly due to medical comorbidities and history of failed invasive treatments.…”

Role of intrinsic sphincter deficiency with and without urethral hypomobility on the outcome of tape insertion

“…Data collection included medical history, patient characteristics, and intra‐ and postoperative complications up to 6 months. Preoperative SUI or stress‐dominant mixed urinary incontinence (MUI) were determined as previously described . Therapy outcome was assessed at 6 months .…”

“…Urodynamic testing was used to determine the urethral closure pressure and to select patients with ISD, that is, with a MUCP ≤20 cm H 2 O . Measurements were done with a Sedia SE‐6 (Sedia AG, Givisiez, Switzerland) or a Duet Logic (Medtronic Deutschland GmbH, Düsseldorf, Germany) with a microtip catheter . Specifically, measurements were taken with patients at rest in the 45° upright sitting position at 300 mL bladder filling using an eight French Gaeltec ® double microtip transducer withdrawn at 1 mm/s, and the transducer was orientated in the 3 o'clock position.…”

Re: Urethral bulking for recurrent urinary stress incontinence after midurethral sling failure

“…We appreciate the interest in our manuscript entitled “Urethral Bulking for Recurrent Stress Urinary Incontinence after Midurethral Sling Failure.” We agree with the authors that durability of bulking agent treatment may be an issue. However, this therapy offers a promising solution for patients not eligible for sling insertions or for patients wishing a minimal intervention …”