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Approximately one in five women will develop stress urinary incontinence (SUI), and of those undergoing surgical management, up to 50% will experience recurrent stress incontinence over time. In Ontario, approximately 5% of women will undergo a repeat stress incontinence procedures in the 10 years after a midurethral sling (the primary SUI procedure used over the last decade). Management of patients with recurrent incontinence after the failure of prior procedures is challenging. A recent Cochrane review failed to identify any high-quality studies to direct patient management for this situation. In a subset of women with recurrent incontinence, repeat operative procedures are not feasible, and therefore urethral bulking agents are an attractive option. They are minimally invasive, and well-suited for intrinsic sphincter deficiency, which is common after multiple incontinence procedures; however, the substantial cost associated with them limits their utilization in Canada. There are very few contemporary reports of the efficacy of bulking agents for recurrent urinary incontinence; a recent systematic review of bulking agents primarily identified patients with mild untreated stress incontinence. The objective of our study was to report our results of a series of patients treated with polyacrylamide hydrogel (Bulkamid) after failed stress incontinence surgeries.

The use of polyacrylamide hydrogel in the setting of failed female stress incontinence surgery