BULKAMID®: SHOULD WE BULK-A-LOT?
K. WONG1, M. SULTANA2, J. THOMAS 3, W. GELMAN 4, V.ANDREWS 1;
1Obstetric and Gynaecology,Univ. Hosp. Lewisham, London, United Kingdom, 2Obstetricand Gynaecology, Ashford and St Peter's Hosp. NHS Fndn. Trus, London,United Kingdom, 3Ashford & St Peters NHS foundationtrust, Chertsey, United Kingdom, 4Ashford and St.Pater'sNHS Trust, Chertsey, United Kingdom.
Introduction: Stress urinaryincontinence(SUI) has a negative impact on a women’s quality oflife, and is increasing in prevalence1. Bulkamid® is aminimally invasive surgical treatment for the management of SUI. Thebulking agent reduces the urethral lumen and changes the urethralpressure profile preventing urine leakage when the surroundingmuscles are contracted2. The company recommends injectingbetween 1.5-2.0mls, and this is supported by previous data whichshowed that when using less that 1.5mls the outcome is suboptimal at6 months follow up3.
Objective: To investigatehow the volume of Bulkamid® used within the manufacturers guidelinesimpacted on quality of life at one year.
Methods: Aprospective audit of women who had Bulkamid® for the management oftheir SUI or mixed urinary incontinence from 2013 to 2014. Women werecontacted 12 months following surgery and completed the InternationalConsultation on Incontinence Modular Questionnaire (ICIQ)questionnaire. This assesses the impact of symptoms of incontinenceon quality of life and outcome of treatment.
Results:Thirty-eight women underwent periurethral bulking with Bulkamid®.Twenty-three (61%) women were contactable 12 months after theprocedure. Older women were significantly more likely to report animprovement in quality of life compared to younger women. Parity, BMIand amount of Bulkamid® injected per procedure had no impact onoutcome.Table 1: Results of continuous data collected
* unpaired ttest
Conclusions: Older women were more likely to besatisfied one year after treatment than those who were younger. Theactual volume of Bulkamid® used within the manufacturer’sguideline did not have an impact on quality of life.
References:1) "Longitudinal studies assessing the incidence and naturalhistory of stress incontinence estimate an annual incidence of 4% to10%"
2) "A bulking agent is a material injected into thewall of the urethra to improve urethral coaptation in women sufferingfrom stress incontinence. The concept was initially described in the1930s when sodium morrhuate and paraffin were used to augmenturethral resistance. Sclerosing agents were also used for inducingpermanent urethral scaring to improve urinary leakage. Eventually,collagen and autologous fat were found to be efficacious, and onlycollagen demonstrated proven safety and endured extensive testing,becoming the gold standard for injectable agents."
3) "Womentreated with 1.6mls of Bulkamid were significantly more likely to becured than when 1.2mls was injected."
Table1: Results of continuous data collected
Amountof Bulkamid® (ml)