Login to Access Video or Poster Abstract: MP40-10
Sources of Funding: None

Introduction

While pubovaginal and midurethral slings are highly effective interventions for stress urinary incontinence (SUI), persistent or recurrent incontinence is not uncommon and can significantly impact patients' quality of life. Multiple studies have shown the relative success of repeat sling procedures in this population, however, not all patients desire further operative interventions. The goal of this study is to evaluate the efficacy of urethral bulking agents for SUI in the setting of failed prior sling which has only been studied in very small populations in the past.

Methods

This is a retrospective review of patients who underwent urethral bulking agent injections for a primary complaint of stress urinary incontinence following failed sling. The outcomes assessed were patient reported improvement, need for further interventions for incontinence and the Michigan Incontinence Symptom Index (M-ISI), which is a validated questionnaire that has a range of 0-32 for symptom score and 0-8 for bother score with higher scores indicating worse incontinence. Values for questionnaires were obtained from the patient's pre-procedure visit and following their last injection. Demographic data, type of prior sling procedure, and type of bulking agent utilized were also reported.

Results

From May of 2009 to March of 2016, 73 patient underwent injection of urethral bulking agents following failed sling. Of these patients, 49 had prior mesh midurethral slings, 20 had prior fascial pubovaginal slings, and 4 had undergone both procedures. Average time from sling placement was 40.5 months. Following injection, 67.1% of patients reported at least moderate improvement in incontinence, while 24.7% reported total resolution of incontinence and 32.9% endorsed minimal or no improvement. The majority of patients (75.3%) required further injections to maintain or augment their results. Only 19.2% of patients went on to undergo more invasive operative interventions for incontinence. Pre-procedure average M-ISI symptom score was 23.1 with a bother score of 5.2. Post-procedure, these values were 18.9 and 4.2 respectively. No difference was found in symptom resolution based on prior sling type or bulking agent used.

Conclusions

Urethral bulking agents are a viable option for improving SUI following failed sling procedures. The majority of patients have at least moderate improvement in symptoms and do not opt for more invasive interventions.

Funding

None