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