Outpatient Periurethral Injections of Polyacrylamide Hydrogel (Bulkamid) Under Local Anesthesia in the Office: A Prospective Single-center Series.

OBJECTIVE

To report our experience of outpatient periurethral injections of Bulkamid under local anesthesia in the office in female patients for stress urinary incontinence (SUI). Polyacrylamide hydrogel (Bulkamid) is a relatively recent bulking agent which may have a better safety profile than previous generations.

METHODS

The data of all women who underwent outpatient periurethral Bulkamid injections under local anesthesia in the office at a single academic center were collected prospectively between November 2019 and August 2023. This therapeutic option was offered to patients who had SUI if >80 years old and/or had multiple comorbidities or if they declined all other therapeutic options.

RESULTS

Ninety-two patients were included. The mean age was 78 years (30-97). Twenty-two patients experienced postoperative complications (21%), 17 were Clavien 1 complication, only 1 complication was Clavien= 4. The urinary symptoms profile (USP) SUI and overactive bladder symptom (OAB) subscores and the ICIQ-SF were all significantly improved at 3 months (P <.001). The VAS for urethral coaptation self-assessed by the surgeon at the end of the procedure was the strongest predictor of postoperative outcomes. Periurethral Bulkamid injections are feasible in an outpatient setting in the office using a simplified local anesthesia protocol with great tolerance and with similar functional outcomes than previously reported. The injections have a low rate of complications and every complication has been well tolerated.

CONCLUSION

These options may be of great value in frail patients and those looking for a minimally invasive treatment. The local anesthesia protocol with the office setting may be of particular interest.