title: Urethral bulking for recurrent stress urinary incontinence after midurethral sling failure.
abstract: To assess the effectiveness of a polyacrylamide hydrogel (PAHG; Bulkamid®) in treating recurrent stress urinary incontinence (SUI) following a previous midurethral sling (MUS) implant.
  
  
  
  This observational study, conducted since 2009, included 60 patients with recurrent SUI or mixed urinary incontinence (MUI) after a previous MUS and who chose to be treated with PAHG. Objective and subjective outcomes were assessed at 1, 6, and 12 months after the initial injection. Patients were classified as cured based on a negative cough test (supine and standing) and <2 g urine on 1-hr pad test and a VAS score improved by ≥90%. Improved were those with the loss of only a few drops of urine during the cough test and 2-10 g urine on 1-hr pad test or a reduction >50% compared with preoperative urine loss and a VAS score improved by ≥75%.
  
  
  
  The volume of PAHG injected in the current study ranged from 1-3 ml. Cured/improved rates were 93.3% (56/60), 88.3% (53/60), and 83.6% (46/55) at 1, 6, and 12 months, respectively. Patients with MUI had a cured urgency urinary incontinence rate of 36.8%, 47.4%, and 38.9%, respectively. Voiding dysfunction rates were 13.3% (8/60), 8.3% (5/60), and 1.8% (1/55) at 1, 6, and 12 months and urinary tract infection rates were 5% (3/60), 11.7% (7/60), and 3.6% (2/55), respectively. Other adverse events were short-term and/or observed in <4% of patients.
  
  
  
  PAHG can be used to treat recurrent SUI after MUS failure with good outcome and low complication rates. Neurourol. Urodynam. 36:722-726, 2017. © 2016 The Authors. Neurourology and Urodynamics published by Wiley Periodicals, Inc.
authors.affiliation: Department of Gynecology and Obstetrics, Cantonal Hospital, Frauenfeld, Switzerland.
authors.forename: Irena
authors.initials: I
authors.lastname: Zivanovic
authors.affiliation: Department of Gynecology and Obstetrics, Cantonal Hospital, Frauenfeld, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Rautenberg
authors.affiliation: Department of Gynecology, German Red Cross Hospital Chemnitz-Rabenstein, Chemnitz, Germany.
authors.forename: Kurt
authors.initials: K
authors.lastname: Lobodasch
authors.affiliation: Coombe Women and Infants University Hospital, Dublin, Ireland.
authors.forename: Günther
authors.initials: G
authors.lastname: von Bünau
authors.affiliation: Department of Gynecology and Obstetrics, Cantonal Hospital, Frauenfeld, Switzerland.
authors.forename: Claudia
authors.initials: C
authors.lastname: Walser
authors.affiliation: Department of Gynecology and Obstetrics, Cantonal Hospital, Frauenfeld, Switzerland.
authors.forename: Volker
authors.initials: V
authors.lastname: Viereck
mesh_terms: D000180:Acrylic Resins; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D020100:Hydrogels; D008875:Middle Aged; D017773:Pelvic Floor / Q000000981:diagnostic imaging / Q000601:surgery*; D011475:Prosthesis Failure; D019233:Retreatment; D053825:Suburethral Slings; D016896:Treatment Outcome; D014463:Ultrasonography; D014550:Urinary Incontinence, Stress / Q000000981:diagnostic imaging / Q000601:surgery*; D013520:Urologic Surgical Procedures
chemical_list: D000180:Acrylic Resins; C528271:Bulkamid; D020100:Hydrogels
keywords: Bulkamid®; bulking agents; pelvic floor sonography; polyacrylamide hydrogel; recurrent stress incontinence; salvage therapy; tension-free vaginal tape