Urethral bulking for recurrent stress urinary incontinence after previous midurethral sling

• Main Authors: Zivanovic, I, Rautenberg, O, Lobodasch, K, Bünau, G von, Walser, C, Viereck, V
• Format: Conference Proceeding
• Language: eng ; ger
• ISSN: 0016-5751; 1438-8804
• DOI: 10.1055/s-0036-1592793

Aims: To assess the effectiveness of a polyacrylamide hydrogel (PAHG; Bulkamid®) 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 and mixed urinary incontinence (MUI) after a previous MUS and chose to be treated with the 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 on 1h 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 1h pad test or a reduction > 50% compared with preoperative urine loss and a VAS score improved by ≥75%. Results: The volume of PAHG injected ranged from 1 to 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 urge urinary incontinence in 36.8%, 47.4% and 38.9%, respectively. Voiding dysfunction rates were 13.3%, 8.3% and 1.8% at 1, 6 and 12 months and urinary tract infection rates were 5%, 11.7% and 3.6%, respectively. Other adverse events were short-term and/or observed in < 4% of patients. Conclusions: PAHG can be used to treat recurrent SUI and MUI after previous MUS with good outcome and low complication rates.