Study design, materials and methods
ICIQ-FLUTS and ICIQ-VS questionnaires (PRO-patient reported outcomes) were completed by women having urogynaecological procedures as part of routine entry into the British Society of Urogynaecology (BSUG) database. We compared the symptom scores of 10 women having isolated peri-urethral injection with polyacrylamide hydrogel with 7 women having prolapse repair and peri-urethral bulking injection in a one-step procedure. All patients had between 1.5 – 2ml of polyacrylamide agent injected peri-urethrally as per the manufacturer’s protocol. Patients receiving peri-urethral injection alone were assessed pre-procedure and all scored 0 for the ICIQ-VS indicating that did not have pelvic organ prolapse. Patients having concurrent prolapse repair had a variety of pelvic floor prolapse procedures (vaginal hysterectomy, anterior and posterior prolapse repair). They all had a postoperative vaginal pack and size 12 urinary catheter inserted overnight and removed the following morning.
Interpretation of results
It remains a subject of debate whether prolapse repair and peri-urethral injection should be performed as a one-step procedure. Prolapse repair routinely involves insertion of a vaginal pack and placing an indwelling catheter post-operatively for between 24-48 hours. The argument against performing concomitant surgery is that by placing an indwelling catheter, there is a risk of causing local redistribution of the polyacrylamide hydrogel and therefore reducing it's effect to reduce stress urinary incontinence. Our preliminary results show that the use of peri-urethral agents at the time of prolapse surgery is not detrimental to continence outcomes and that the improvement in symptoms for these 2 groups is similar. The results seen using ICIQ-FLUTS and ICIQ-VS as validated questionnaires post-operatively is in line with previous studies looking at patient reported outcomes (PRO) following peri-urethral injections [2,3].