Sling or Bulking agent: What do women choose?

Illiano E1, Trama F2, Costantini E1

Research Type


Abstract Category

Female Stress Urinary Incontinence (SUI)

Abstract 506
Open Discussion ePosters
Scientific Open Discussion Session 19
Thursday 28th September 2023
12:50 - 12:55 (ePoster Station 3)
Exhibit Hall
Incontinence Stress Urinary Incontinence Surgery Grafts: Synthetic
1. Andrology and urogynecological Clinic. Santa Maria Terni Hospital, University of Perugia, 2. Urologic Clinic, Santa Maria delle Grazie,Pozzuoli,Naples

Ester Illiano



Hypothesis / aims of study
Following FDA warming for the treatment of IUS are used alternative techniques such as bulking agents (BU),sometimes even in I-line. Indications for performing bulking agent are still not entirely clear.The guidelines do not identify to which population it is applicable.Currently, bulking agent is identified as a procedure to be offered as an alternative to sling implantation, either first- or second-line.The indications currently are the same.It might be useful to understand then which procedure women prefer to undergo after careful consunselling.The aim of our study is to evaluate, in women with naïve IUS,   after   careful   counselling,   the   treatment   preference   between   sling   implantation   and   BU (Bulkamid®) infiltration;and what characteristics the two groups have
Study design, materials and methods
It is a prospective study conducted from July 2021 to July 2022.Women with naïve IUS for surgical treatment regardless   of   the   degree   of   urethral   hypermobility   were   included;   women   with   POP, previous   anti	incontinence   surgery,   with   neurological   diseases   were   excluded.   Preoperative evaluation includes medical history, objective examination, dynamic urologic ultrasonography, urodynamic examination,according to ICS criteria .Follow-up visits are performed at 1 month,3,6,12 months after surgery and annually , with the same preoperative evaluations except for urodynamic examination which is performed at 6 months after surgery.Stress urinary incontinence was defined according to ICS standardization and classified
according to the Ingelmann-Sundberg scale.Urinary symptoms were evaluated using the standardized questionnaire UDI6.TOT surgery was performed by an expert surgeon using the out-in transobturator technique originally described by Delorm.Objective cure for SUI was defined as the absence of urine leakage during the stress test. Subjective cure was defined by a “no answer” to question 3 of the UDI-6 questionnaire.The study was approved by the Ethics Committee of our institution. All patients signed informed 
At   the   time   of   diagnosis,careful   counselling   was   conducted   by   providing   the   patient   with   the
following information:
• "The BU involves the infiltration by cystoscopy of a volumizing agent at the level of the continence muscle;   whilesling   implantation   involves   the   placement   of   a   prosthesis   at   the   urethral   level   by vaginal access."
•”At       our       hospital       the       hospitalization       is       one       day       for       both       procedures."
•"The   BU,   unlike   the   sling,   allows   you   to   resume   daily   activity   from   the   next   day."
•"Long-term	outcomes	are better	with	sling	than	with	BU."
• "In case of failure BU can be repeated and does not compromise subsequent sling implantation, while     more	complicated     is     the     treatment     of     persistence/recurrence     after     sling"
•   "BU   has   urinary   retention   as   a   complication;   while   a   sling   can   result   in   extrusions/exposures ,urinary retention, UTI, dyspareunia" The patient was left free to choose between the two types of treatment
80   patients   with   mean   age   50±7.07   years   were   included.   Most   women   choose   to   perform   BU (61.3%   vs	38.8%,p<0.0001)   and   compared   to   those   who   choose   sling   are   older   (52.5±6.8   vs 48.3±6.7,p=0.009),   and   have	no   help   at   home  living   alone   (30   %  vs  12.5%,p=0.001),   and   may have comorbidities (35.5% vs 18.3%, p=0.02) .Most women who choose BU were nurse and colf (Graph1). These women have justified their choice with the type of work, physically tiring and with the fact that they cannot be absent for so long. While women who choose slingwere housewives or unemployed (Graph1)
Interpretation of results
Our results showed that after careful counselling, patients choose the treatment that best meets their current needs in these moment.Women who do not have family help during convalescence, or who do heavy work and cannot get away from the workplace for a long time,or who have family problems (children, elderly to be cured, disabled....)prefer an alternative to sling.They prefer a procedure that allows them to return as quickly as possible to daily life.Sometimes the social, family needs of the patients for the patient himself are worth more than the probable clinical results.They accept a compromise:to be not completely dry and not forever, however, they can continue everyday life from the very beginning.In addition, for young women, avoiding early implantation of a sling, aware of the results but also the complications is a valid reason to prefer bulking agent
Concluding message
It is possible to offer a tailored surgery, only after careful counselling, allowing everyone to choose  consciously
Figure 1
Funding None Clinical Trial No Subjects Human Ethics Committee Ceas Helsinki Yes Informed Consent Yes
22/07/2024 10:37:34