Do periurethral injections with Bulkamid for the treatment of stress urinary incontinence truly fail at 24 months?

Introduction: Stress urinary incontinence (SUI) is the most common type of urinary incontinence in women. Patients with SUI experience involuntary leakage of urine with increases in intra-abdominal pressure. The prevalence rate of SUI ranges from 29-75% depending on age, with a peak incidence between 45-49 years of age. First-line treatment of SUI consists of conservative management such as lifestyle modifications and pelvic floor muscle training. If conservative treatment fails, surgical management is the most effective treatment option. Unfortunately, these surgical procedures are invasive and carry several potential complications. Urethral bulking is becoming an increasingly common second-line treatment option for SUI. Bulkamid® (polyacrylamide hydrogel) is a urethral bulking agent and is the only injectable bulking agent currently approved for use in Canada to treat SUI. Bulking agents have been shown to have increasing failure rates after 24 months post-treatment. Thus, the primary purpose of this study was to determine the failure rate, and time to failure for Bulkamid® periurethral injections. Secondarily, we aim to study the risk factors associated with the failure of the procedure. Methods This was a retrospective study, reviewing 227 charts of all patients who have undergone periurethral bulking with Bulkamid® for SUI at the Lois Hole Hospital for Women, Royal Alexandra Hospital, and Kaye Edmonton Clinic in Edmonton, Alberta from January 1, 2014, until December 31, 2019. Multiple logistic regression will be used to evaluate the bivariable relationship between the discussed and agreed upon patient and procedural characteristics, and the risk of Bulkamid® treatment failure. Expected outcomes/benefits of the research: We hope the results of this research will establish an initial database of information regarding Bulkamid® use and outcomes in Edmonton, Alberta, which will enable us to better understand the role that Bulkamid® plays in the management algorithm of SUI. Exploring certain risk factors that may affect outcomes of Bulkamid® treatment will provide insight into prognostic factors in the treatment of patients presenting with varying degrees of SUI. Finally, the results of this study may influence the need to determine the role of Bulkamid® injections as a concurrent and adjuvant treatment to first-line surgical procedures to aid in the development of optimal management regimens.