The outcomes for Bulkamid® injection as a primary procedure for stress urinary incontinence (SUI) have been well reported. However, the outcomes for patients with previous failed SUI surgery are less known. The aim of our study is to identify the factors which could predict the outcomes of Bulkamid® injection as a salvage treatment alternative.

Data collected prospectively between 2017-2021 was analysed retrospectively. All patients had had at least one previous anti-incontinence operation. Data including demographics, urodynamic parameters, type and number of previous anti-incontinence procedures, number and total injected amount of Bulkamid® were analysed. Outcomes were assessed with number of pads where possible, and were categorised as dry, improved or wet according to patient satisfaction. Shapiro-Wilk tests of normality were performed.

Results are shown on Table 1. Twenty patients with mean age of 63 (range 32-88) years were treated with a mean follow up 17 (range 2-52) months. Fourteen patients had one set of injections and six had two injections. The overall success rate was 35% (10% dry, 20% improved and 70% failed) with 30% successful after one injection and 35% after two injections. 

Four of eight patients with Type III SUI had a 50% chance of success (37.5% dry and 12.5% significantly improved after the first injection), whereas no improvement was observed in the 5 patients with Type IIA / IIB SUI (100% failure). One patient with mixed urinary incontinence had no improvement after the Bulkamid®  injection. 

The success rate for patients with one previous procedure was 37% (25% dry, 12.5% improved), whereas the success rate for patients with two or more previous procedures was 25% (0% dry, 25% improved). 

Patients who had previous TOT/TVT-O insertion, autologous rectus fascial sling or Macroplastique® injections showed higher success rate (63% dry or improved), whereas patients with TVT, colposuspension, SNS/Botox or complex reconstruction were poor responders (16% dry or improved).

Injection of more than 2.2ml of Bulkamid® had better outcomes compared to smaller volumes (55% versus 35% success).

Patients with multiple previous procedures seemed to do less well than those with a single previous procedure. Interestingly, patients with Type III SUI did better than those with persistent Type IIA/IIB SUI, and those with previous obturator tapes and autologous slings seemed to do better than those with TVT or colposuspension, which may suggest that bulking injections treat sphincteric deficiency better than hypermobility.

The success rate of Bulkamid® injection as salvage therapy was significantly lower than reported in the literature as a primary therapy. Further prospective studies of Bulkamid® are in process for patients with recurrent SUI.

Continence 2S2 (2022) 100343
DOI: 10.1016/j.cont.2022.100343