SUFU 2021: Short-Term Outcomes of Periurethral Injection of Polyacrylamide Hydrogel (Bulkamid®) for Stress Urinary Incontinence with Intrinsic Sphincter Deficiency, Post Mid-Urethral Sling, and Post Mesh Sling Excision

( Polyacrylamide Hydrogel (PAHG), Bulkamid®, is a non-particle-based urethral bulking agent that has demonstrated longer-term durability compared to other bulking agents. This study examined short-term outcomes of PAGH injection in an initial cohort, specifically looking at women with intrinsic sphincter deficiency (ISD), post mesh sling excision, and/or refractory stress urinary incontinence (SUI).

Demographics, clinical characteristics, and urodynamic data were collected in women undergoing urethral bulking with PAHG at a single tertiary referral institution. Post-operative assessments (PGI-I, % improvement, overall satisfaction, UDI-6, adverse events, and further SUI treatment) were conducted at 6 weeks and 3 months. 25 women were treated with PAHG, mean age was 56 (SD 16), mean BMI was 26.71 (SD 6.52). Among 15 women receiving PAHG as primary treatment for SUI, 5 demonstrated VLPP < 60 cmH20 consistent with ISD. One woman had SUI previously managed with a non-PAHG bulking agent. Six women with a history of mesh sling excision received PAHG. Three women had recurrent SUI after prior MUS, two were previously treated with alternate urethral bulking agents.

After a minimum of 6-week follow-up, 17/24 respondents reported that post-procedure condition was much better or very much better with 80% median symptom improvement, and 8.5/10 median satisfaction. One patient received repeat PAHG injection with 80% improvement after the second injection and no further SUI. Two patients with persistent SUI are planned for repeat PAHG bulking. Complication rates were low, with no serious adverse events. The authors acknowledge that longer follow-up with a larger cohort is needed to assess the durability of PAHG.

Presented by: Justina Tam, Pansy Uberoi, Hannah Koenig, Alvaro Lucioni, Kathleen Kobashi, Una Lee

Department of Urology, Virginia Mason Medical Center, Seattle WA

Written by: Diane K. Newman, DNP, CRNP, FAAN, BCB-PMD, Nurse Practioner and Co-Director, Penn Center for Continence and Pelvic Health Adjunct Professor of Urology in Surgery during the 2021 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Winter Meeting
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