Urethral bulking agents: a retrospective review of primary versus salvage procedure outcomes
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ORIGINAL ARTICLE
Urethral bulking agents: a retrospective review of primary versus salvage procedure outcomes Ciara M. E. Daly1 · Jini Mathew1 · Judey Aloyscious1 · Suzanne Hagen1 · Veenu Tyagi1 · Karen L. Guerrero1 Received: 23 June 2020 / Accepted: 12 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Urethral bulking agents (UBA) have traditionally been offered as salvage procedures for recurrent stress urinary incontinence (SUI). We compare the success of UBA in patients that had undergone a previous procedure for SUI (SalvageUBA) to the SUI surgery naïve (Primary-UBA). We hypothesised a positive effect in both Primary and Salvage-UBA with potentially poorer rates of response in the salvage group. Methods Retrospective case series of patients having their first UBA (2010–2018). Primary outcome was to assess any difference in patient reported success between groups. Patient-reported improvement was assessed on a 4-point scale: ‘cured, improved, no change, worse’ and treatment ‘success’ defined as ‘cured’ or ‘improved’. A multivariate analysis, adjusting for plausible differences between groups, was undertaken in IBM SPSS Statistics (2016). Results 135 Primary-UBA and 38 Salvage-UBA were performed. Complete follow-up was obtained for 114 patients (66%): 86 Primary and 28 Salvage. Median follow-up time: 33 months. In 2012, 47% (8/17) of all UBA were Salvage-UBA, whilst in 2018, the majority were Primary-UBA (92%, 46/50). Success was not significantly different between Salvage-UBA 75% (21/28) versus Primary-UBA 67% (58/86) (Wald χ2 = 0.687, df = 1, p = 0.407). Top-up rates were similar: 14% (n = 4/28, Salvage-UBA) versus 15% (n = 13/86, PrimaryUBA) (χ2 = 0.011, df = 1, p = 0.914). Conclusion The number of women opting for UBA has increased substantially. No significant differences were noted for success with Salvage-UBA compared to Primary-UBA. Keywords Urethral · Bulking · Incontinence · Primary · Salvage
Introduction and purpose Surgical management of stress urinary incontinence (SUI) is under intense scrutiny. Mesh procedures for SUI were routine until recent years; a current pause is in place within the United Kingdom (UK) [1]. Urethral bulking agents (UBA) are minimally invasive, non-mesh, day-case or office procedures for SUI. Traditionally, they have been offered as salvage procedures when surgical procedures (e.g. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00345-020-03413-7) contains supplementary material, which is available to authorized users. * Ciara M. E. Daly [email protected] 1
Department of Urogynaecology, Queen Elizabeth University Hospital, Glasgow, Scotland
colposuspension, autologous fascial sling and mid-urethral mesh-tape) have failed to improve symptoms sufficiently, or when comorbidities make patients unsuitable for these procedures. A Cochrane review (2017) concluded UBA were inferior to surgery for SUI at 1-year follow-up but had a better safety profile [2]. Despite the inferior su
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