Retrospective analysis of the efficacy and safety of polyacrylamide hydrogel (Bulkamid®) peri-urethral bulking injection at the time of pelvic floor repair in women with pelvic organ prolapse and urodynamic stress incontinence. A pilot study

Aims: Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are common conditions that often co-exist. One way of managing women with both conditions is to perform a combined surgical approach with a tension-free vaginal tape (TVT) placed at the time of pelvic floor repair. Raised awareness of complications associated with mesh in the UK has led to a pause in TVT procedures meaning there is no widely available one-step surgical procedure for these patients. We aim to investigate whether peri-urethral bulking with polyacrylamide hydrogel (Bulkamid®) performed at the time of pelvic floor repair is a safe procedure and whether it improves stress urinary incontinence. Methods: Validated questionnaires (ICIQ-UI-SF and ICIQ-VS) were completed by women undergoing peri-urethral bulking alone for stress urinary incontinence (SUI), and women undergoing concomitant pelvic floor repair and peri-urethral bulking for POP and SUI. The scores from questionnaires pre- and post-operatively, and any surgical complications were documented and compared. Results: Both control and study groups showed overall improvement in continence scores with the average improvement in the study group being 7.24 and in the control group being 4.73. Statistical analysis showed that the difference in ICIQ-UI SF scores between the two groups was not statistically significant) (p = 0.059). Using the global impression questionnaire, 80% of women from the study group and 65.4% in the control group reported improvement in their incontinence symptoms. Conclusion: Peri-urethral bulking performed at the time of pelvic floor repair improves urinary symptoms and is a safe procedure.