Periurethral injections of polyacrylamide hydrogel for the treatment of female recurrent stress urinary incontinence

Study Objective: To assess the efficacy of periurethral injections (PIs) of polyacrylamide hydrogel (PAHG, Bulkamid) for the treatment of recurrent stress urinary incontinence (rSUI) in women previously treated with midurethral sling procedures. Design: This prospective study included women with rSUI. The International Consultation on Incontinence Questionnaire short form (ICIQ-SF) and the Patient Global Imrovement Impression (PGI-I) were used to evaluate incontinence and patient satisfaction after treatment. The impact of incontinence on quality of life (QoL) was assessed using the Incontinence Impact Questionnaire (IIQ-7). Patients were evaluated at baseline, 1-, 3-, 6- and 12-month follow-up. Setting: University teaching hospital. Patients: Women referred to our Institution for rSUI after midurethral sling procedures were elegible for the study. Twenty-one patients were enrolled. Intervention: Patients were treated with PIs of PAHG. All the procedures were performed in outpatient setting. Measurements and Main Results: Efficacy of the procedure was defined as answers 1 or 2 at the PGI-I questionnaire (subjective success) at 12-month follow-up. One patient (4.7%) was lost at 12-month follow-up. The efficacy of the procedure was 52.4%. The subjective responder rate was 71.4%; 23.8% of the patients reported no change and no patient experienced worsening of symptoms. The mean number of episodes of urine leakage/ 24 h and the mean leakage/24 h significantly decreased after treatment. At 12-month follow-up, the IIQ-7 scores significantly ameliorated compared with baseline. Five patients (23.8%) reported adverse events related to the procedure: urinary tract infection in three patients (14.3%) and injection site pain in two patients (9.5%). Conclusion: Few studies investigated rSUI treatment after midurethral sling procedure failure and none of these evaluated the use of PIs. This is the first study investigating this topic and demonstrated that PIs of PAHG are efficacious in about half of the patients for the treatment of rSUI.