The aim of the present study is to analyze the outcomes of urethral bulking in the treatment of non-neurogenic female stress and mixed urinary incontinence and to assess predictors of clinical outcomes. We retrospectively included all consecutive patients affected by stress or mixed urinary incontinence and treated with urethral bulking. Outcomes were evaluated via the PGI-I questionnaire and the 24-h pad test. Between January 2010 and January 2020, we treated 216 patients (Bulkamid n = 206; Macro-plastique n = 10). The median age at surgery was 66 years (IQR 55-73.75). The median follow-up was 12 months (IQR 12-24). In total, 23.8% of patients were subjected to prior incontinence surgery, 63.8% of patients were affected by genuine stress urinary incontinence, 36.2% reported mixed urinary incontinence, whereas detrusor overactivity was confirmed in only 24.9%. The dry rate was 32.9%; nevertheless, 69.9% of patients declared themselves "very improved" or "improved" (PGI-I1-2). Low complications were observed, mostly classified as Clavien I. After univariate and multivariate analyses, the only statistically significant independent predictor of "dry" outcome was the 24 h pad test, p < 0.001. Urethral bulking could be proposed with more expectations of success in patients with mild urinary incontinence. Patients affected by moderate-severe incontinence are less likely to obtain clinical success; therefore, they should be carefully counselled about clinical expectations before the procedure.
Journal of clinical medicine. 2022 Mar 12*** epublish ***
Alessandro Giammò, Paolo Geretto, Enrico Ammirati, Alberto Manassero, Luisella Squintone, Marco Falcone, Elisabetta Costantini, Giulio Del Popolo, Enrico Finazzi Agrò, Antonella Giannantoni, Vincenzo Li Marzi, Vito Mancini, Stefania Musco, Mauro Pastorello, Donatella Pistolesi, Oreste Risi, Paolo Gontero
Struttura Complessa di Neuro-Urologia, Città della Salute e della Scienza, Presidio CTO-USU, 10126 Torino, Italy., Clinica Urologica, Università di Perugia, 06123 Perugia, Italy., Neuro-Urologia, AOU Careggi, 50134 Firenze, Italy., Clinica Urologica, Università di Tor Vergata, 00133 Roma, Italy., Clinica Urologica, Università di Siena, 53100 Siena, Italy., Clinica Urologica, AOU Careggi, 50134 Firenze, Italy., Clinica Urologica, Università di Foggia, 71122 Foggia, Italy., Clinica Urologica, Ospedale Sacro Cuore Don Calabria, 37024 Negrar, Italy., Clinica Urologica, Università di Pisa, 56126 Pisa, Italy., Clinica Urologica, Ospedale di Treviglio, 24047 Treviglio, Italy.