Outpatient periurethral injections of polyacrylamide hydrogel (Bulkamid®) under local anesthesia in the office: a prospective single-center series.

Objective: To report our experience of outpatient peri-urethral 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 peri-urethral 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-year-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%), seventeen were Clavien 1 complication, only one complication was Clavien =4. The USP SUI and OAB subscores and the ICIQ-SF were all significantly improved at 3 months (p<0.001). The VAS for urethral coaptation self-assessed by the surgeon at the end of the procedure was the strongest predictor of postoperative outcomes. Peri-urethral Bulkamid® injections are feasible in an outpatient setting in the office using a simplified local anesthesia protocol with a 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.