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| Injections péri-urétrales de Bulkamid en consultation et en ambulatoire : étude monocentrique rétrospective (Outpatient periurethral injections of polyacrylamide hydrogel (BulkamidÒ) under local anesthesia in the office: a prospective single-center series ) Faurie, Brice - (2023-10-18) / Universite de Rennes - Injections péri-urétrales de Bulkamid en consultation et en ambulatoire : étude monocentrique rétrospective
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Langue : Anglais Directeur(s) de thèse: Peyronnet , Benoit Discipline : Urologie Classification : Médecine et santé Mots-clés : incontinence urinaire à l'effort, personnes âgées, injection périurétrale, traitement, anesthésie locale, ambulatoire
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Résumé : Polyacrylamide hydrogel (BulkamidÒ) is a relatively recent bulking agent which may have a better safety profile than previous generations. The objective of this study was to report our experience of outpatient peri-urethral injections of Bulkamid under local anesthesia in the office in female patients for stress urinary incontinence (SUI). The data of all women who underwent outpatient peri-urethral Bulkamid injections under local anesthesia in the office at a single academic center were collected prospectively between November 2019 and August 2023. This therapeutic option was offered to patients who had SUI if > 80-year-old and/or had multiple comorbidities or if they declined all other therapeutic options. Ninety-two patients were included. The mean age was 78 years (30-97). Twenty patients experienced postoperative complications (21%), nineteen were Clavien 1 complication, only one complication was Clavien = 4. The USP SUI and OAB subscores and the ICIQ-SF were all significantly improved at 3 months (p<0.001). The VAS for urethral coaptation self-assessed by the surgeon at the end of the procedure was the strongest predictor of postoperative outcomes. Peri-urethral Bulkamid injections are feasible in an outpatient setting in the office using a simplified local anesthesia protocol with a great tolerance and with similar functional outcomes than previously reported. The injections have a low rate of complications and every complication has been relatively well tolerated. These options may be of great value in frail patients and those looking for a minimally invasive treatment. The local anesthesia protocol with the office setting may be of particular interest in current times with challenging access to the operative room in many institutions. Other studies are needed to confirm these findings. Abstract : Polyacrylamide hydrogel (BulkamidÒ) is a relatively recent bulking agent which may have a better safety profile than previous generations. The objective of this study was to report our experience of outpatient peri-urethral injections of Bulkamid under local anesthesia in the office in female patients for stress urinary incontinence (SUI). The data of all women who underwent outpatient peri-urethral Bulkamid injections under local anesthesia in the office at a single academic center were collected prospectively between November 2019 and August 2023. This therapeutic option was offered to patients who had SUI if > 80-year-old and/or had multiple comorbidities or if they declined all other therapeutic options. Ninety-two patients were included. The mean age was 78 years (30-97). Twenty patients experienced postoperative complications (21%), nineteen were Clavien 1 complication, only one complication was Clavien = 4. The USP SUI and OAB subscores and the ICIQ-SF were all significantly improved at 3 months (p<0.001). The VAS for urethral coaptation self-assessed by the surgeon at the end of the procedure was the strongest predictor of postoperative outcomes. Peri-urethral Bulkamid injections are feasible in an outpatient setting in the office using a simplified local anesthesia protocol with a great tolerance and with similar functional outcomes than previously reported. The injections have a low rate of complications and every complication has been relatively well tolerated. These options may be of great value in frail patients and those looking for a minimally invasive treatment. The local anesthesia protocol with the office setting may be of particular interest in current times with challenging access to the operative room in many institutions. Other studies are needed to confirm these findings. | |||