[Transurethral injection of polyacrylamide hydrogel (Bulkamid®) for the treatment of recurrent stress urinary incontinence after failed tape surgery].
OBJECTIVE
The objective of this study was to evaluate the cure effect of a transurethral injection of Bulkamid® for recurrent female stress and mixed urinary incontinence in women who had undergone failed tape surgery. Our hypothesis was that cure effect of Bulkamid® is positive in patients when previous tape anti-incontinence surgery has been unsuccessful.


METHODS
Retrospective clinical study.


METHODS
Department of Obstetrics and Gynecology, 1st Medical Faculty, Charles University and General Faculty Hospital in Prague.


METHODS
This retrospective study featured 34 patients with recurrent urinary incontinence (SUI: 28, mixed: 6 - predominant symptom was SUI) after unsuccessful tape anti-incontinence surgery. 25 of the patients had undergone anti-incontinence surgery more than once. The cure effect of a transurethral injection of Bulkamid® was evaluated an average of 29 months after the surgery; the minimum period after surgery was 6 months. Subjective assessment of the leakage of urine was based on the International Consultation on Incontinence Questionnaire - Short form (ICIQ-UI SF) filled in before and after surgery. An improvement in urinary incontinence was defined as a drop in the score of more than 50%. Objective assessment of leakage of urine was assessed by cough test. The cure effect was evaluated by VAS (Visual Analogue Scale) score and by using the five-point Likert score. Ethical committee approval was obtained, and all subjects gave written informed consent to participate in the study.


RESULTS
The mean age of patients was 71.03 years, mean body mass index (BMI) 29.12 and mean parity 1.91. The cough test showed that 4/34 (11.8%) of patients had negative results for this test after the operation. The ICIQ-UI SF questionnaire showed that 14/34 (41.2%) of our patients were dry or improved after surgery. The mean VAS score was 62.4 after the operation. The Likert score was 4 or 5 (cured or improved) after the operation for 88.2% of patients.


CONCLUSIONS
Our hypothesis that the cure effect of Bulkamid® operation would be positive in patients who have undergone previous unsuccessful tape anti-incontinence surgery was partially confirmed. The Likert and VAS scores indicate that the effect of Bulkamid® surgery is good; however, an evaluation of the cure effect of this procedure based on the ICIQ-UI SF score is less positive. This kind of operation, which is minimally invasive, is less arduous for patients, and it is also suitable for patients who have refused further surgical treatment.
A
A
Martan
J
J
Mašata
K
K
Švabík
R
R
El-Haddad
P
P
Hubka
J
J
Krhut
D000180:Acrylic Resins / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D020100:Hydrogels / Q000008:administration & dosage*; D007267:Injections; D008875:Middle Aged; D012189:Retrospective Studies; D053825:Suburethral Slings; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000601:surgery*
D000180:Acrylic Resins; D001672:Biocompatible Materials; C528271:Bulkamid; D020100:Hydrogels; C016680:polyacrylamide gels