Prior to April 2022 only bulkamid bulging agent under general anaesthetic (GA) was offered for female patients who wished surgical management of stress urinary incontinence (SUI) in our unit. With the introduction of two newly appointed Urogynaecology consultants we wished to look at the management and outcomes of stress urinary incontinence surgery in our unit to help inform women of our management and surgical outcomes.

This was a retrospective audit of 52 patients who underwent SUI surgery over 2 years between 1st April 2022 and 31st March 2024. We assessed compliance towards NICE guidelines[1] by reviewing electronic case notes including clinic appointments, physiotherapy review, urodynamic studies, Multi Disciplinary Team meeting (MDT) discussions, operation notes, surgical admission and post operative clinic review to assess initial assessments and treatments, surgical care, cure rate and post operative complications (post operative pain, urinary tract infections (UTI), change in overactive bladder symptoms (OAB) and voiding dysfunction).

52 patients had SUI surgery over 2 years; 31 Bulkamid, 7 colposuspension and 14 autologous fascial sling. 

52/52 completed initial management with physiotherapy/incontinence nurse, 52/52 urodynamics confirmed SUI, 52/52 discussed in MDT. All bulkamid  (31/31) were day cases under Local Anaesthesia (LA). All colposuspension/autologous fascial sling patients had one night admission. 5/52 were repeat SUI surgery, 5/5 received secondary bulkamid (1 previous Trans Vaginal Tape (TVT), 4 previous bulkamid). 

Complications; 2/52 bladder injury with autologous fascial sling, requiring delayed trial without catheter (TWOC). Voiding dysfunction; 1 autologous fascial sling failed initial TWOC, 1 colposuspension failed 2 TWOCs and required ISC but for <1/12, 1 double voiding required after bulkamid. 4 returned to hospital for procedure related event 30 days post operatively, 2 for voiding dysfunction for subsequent TWOC, 2 for delayed initial TWOC after bladder injury. 0/52 were admitted to hospital for a procedure related event. No patients with post op chronic pain. 1 post operative UTI following bulkamid. 1 post operative wound infection following colposuspension. 

Cure rates; of those reviewed all patients have improved/cured SUI (>95%), 1 bulkamid no change awaiting autologous fascial sling, 2 bulkamid wished top up of bulkamid after improved SUI symptoms. OAB; 1 new OAB treated with bladder retraining, 2 OAB same, 3 OAB>before; 1 received botox after bulkamid.

Our unit now successfully offers all surgical management options for SUI, including bulkamid under LA, colposuspension and autologous fascial sling procedures, with adherence to NICE guidelines, minimal complications and excellent outcomes achieved, especially for bulkamid, with >95% cured/improved.

Our unit can use this data to better inform our women of our local management and outcomes of SUI surgery, that we comply with national guidelines and can offer all 3 surgical procedures for SUI, including bulkamid under LA, colposuspension and autologous fascial slings. Preliminary data including cure rates look excellent (>95% cured/improved) with minimal complications. 

The BSUG mentorship scheme has been a helpful means for us to offer colposuspensions and is recommended for other new consultants considering introducing new surgical procedures, especially following the post mesh era, which interrupted a lot of training opportunities for Urogynaecology trainees.

Urinary incontinence and pelvic organ prolapse in women: management. NICE guideline [NG123]Published: 02 April 2019