The use of Bulkamid as an adjunctive agent to an Advance XP sling for male post prostatectomy incontinence
Dr Sophie Plagakis (1), Professor Lewis Chan (1), Dr Thomas King (1), Associate Professor Vincent Tse (1)
(1) Concord Repatriation General Hospital, Sydney, Australia, (2) Macquarie University Hospital, Sydney, Australia, (3) Strathfield Private Hospital, Sydney, Australia
Bulkamid is a transparent polyacrylamide gel which is available for the treatment of incontinence. It has been widely evaluated in its role in female stress urinary incontinence, but there is no information in the literature on its utility in male stress urinary incontinence. Bulking agents have traditionally had limited success in the treatment of post prostatectomy incontinence. We present a small series of male patients with post prostatectomy incontinence, who have undergone transurethral injection of Bulkamid as an adjunct to a transobturator urethral sling for management of their condition.
We retrospectively analysed the case notes of eleven male patients who had developed urinary incontinence post prostatectomy and underwent transurethral injection of Bulkamid from 2016 to 2018. Data was collected on their preoperative pad weighs, urodynamics, the dose of Bulkamid used, alternative treatments had and post operative pad weighs and patient satisfaction.
Eleven patients were identified who underwent a transurethral injection of Bulkamid bulking agent. All patients were classified as mild incontinence using 1-2 pads per day (average 50g leak). Three patients underwent injection after the insertion of an Advance XP sling, whilst 8 patients had Bulkamid first and later underwent a sling procedure. Three patients (27%) had had adjuvant pelvic radiotherapy as part of their prostate cancer treatment. Four patients were found to have detrusor overactivity on urodynamics prior (36%) and were treated with a combination of anticholinergics and intravesical Botulinum Toxin A. Only three patients (27%) reported subjective improvement in symptoms, the other eight felt they were not improved. Of the improved patients, none had undergone prior radiotherapy. One patient had transient improvement in continence only and later underwent insertion of an Advance XP. Two thirds of the patients who underwent Bulkamid after their sling insertion were more likely to feel an improvement with the Bulkamid than those who had Bulkamid first.
Bulkamid offers limited improvement in select patients with an Advance XP sling. In our small series, it worked best in patients who had had a sling procedure first and avoided the need for further incontinence procedures. These data are in keeping with previously published series of alternative bulking agents. It represents a useful adjunct to men who seek a small improvement in leakage.