Polyacrylamide hydrogel (Bulkamidâ) is a relatively recent bulking agent which may have a better safety profile
than previous generations.
The objective of this study was to report a preliminary 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-uretral Bulkamid injections under local anesthesia in the office at a single academic center were collected prospectively between November 2019 and November 2021. 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. All the injections were performed by two surgeons. The local anesthesia protocol comprised a urethral xylocaïne gel instillation 15 minutes before injection. Inhalation of nitrous oxide was added in case of discomfort during the injections. The injection tolerance was evaluated using a Visual Analog Scale (VAS) right at the end of the injection.

Thirty one patients were included. The mean age was 79 years ( 30-97). None had urethral hypermobility on physical examination, 51% had a history of previous anti incontinence surgery and the mean maximum urethral closure pressure was 26 cmH2O. The mean VAS for injection was 5 (0-10). Nitrous oxide was needed for 11 patients (35.5%). Six patients experiences postoperative complications (19%): it was AUR in all cases solved by an indwelling catheter for 48 hours in five cases and for 10 days in one case (Clavien 1). All patients were discharged the same day except two (success of day-case management=93.6%). There was one readmission for acute urinary retention (5.5%). The functional outcomes are presented in table 1. The USP SUI and OAB subscores and the ICIQ-SF were all significantly improved at 3 months (p<0.001). At 3 months eleven patient were very much improved (PGII=1; 35.5%), nine were improved or slightly improved (PGII=2 or 3, 29.0%) and eleven patients were unchanged (PGII=4, 35.4%).

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 complications has been relatively well tolerated, resolved by a small indwelling catheter (Clavien1).
Figures associated show the mains results.

These options may be of great value in frail patients and those looking for a minimally invasive treatment. Other studies are needed to confirm these findings.