3 in 10 women in the UK experience urinary incontinence with stress urinary incontinence (SUI) being the most common. Surgical options for the management of SUI in the UK include autologous facial sling (AFS), colposuspension and urethral bulking agent (UBA). Within our unit, we offer all three procedures where we found the highest uptake with UBA followed by AFS, then colposuspension. This study presents our unit experience with AFS and UBA. The primary aim of this study is to evaluate patient reported improvement following UBA and AFS procedures. The secondary outcome is to evaluate complications such as urge urinary incontinence and post-procedure chronic pain between both groups. Procedure specific complications such as, intermittent self-catheterisation and supra-pubic pain with AFS and post-procedure UTI and urethral pain following UBAs were also assessed.

This was a retrospective audit of urethral bulking agent (UBA), and autologous facial sling (AFS) cases completed at a single centre in the United Kingdom. Data was collected using the British Society of Urogynaecology (BSUG) database for AFS between 2018 and 2024 and for UBA between 2023 to 2024, as well as using electronic patient records for comparable sample sizes between both groups. Patients on the BSUG database have been all consented to use their data for audit and research. Patients Global Impression of Improvement (PGI-I) questionnaires for incontinence were used and were conducted over telephone follow-up. Questions on post-procedure complications were also included

22 cases of UBA procedures were identified for this study from records, there were 19 responses. 49 cases of AFS procedures were identified, there were 20 responses. SUI symptom evaluation between both groups found varying results. In the UBA group, 68% of patients reported some improvement in their symptoms of SUI, 11% reported no change in symptoms and 21% reported worsened SUI.   In the AFS group, 90% reported an improvement in symptoms with 60% reporting symptoms being very much better. 5% had no change to SUI and 5% reported worsened SUI. 
Post-procedure complications were comparable between the UBA and AFS groups. 16% of patients who had UBA reported having new urge incontinence since having the procedure. For patients having AFS, 21% reported new urge incontinence post-surgically. There were no reported cases of chronic pain in either group. 
For procedure specific complications in the AFS group 10% of patients had intermittent self-catheterisation for <6-weeks and 25% of patients reported suprapubic pain <6-weeks. In the UBA group 11% of patients developed UTI requiring treatment and 11% had urethral pain post procedure for <6-weeks.

From the results of the study, most patients undergoing the UBA and AFS procedures had improvement in their SUI. The AFS group had a higher improvement in their SUI symptoms when compared to the UBA group. There was a higher rate of worsening of SUI symptoms with UBA when compared to AFS. The complication rates of new urge incontinence with UBA and AFS were similar. There was no reported chronic pain in either groups. The results of this study are limited by its small sample size; however, they provide valuable insights into the evaluation of surgical treatment options for SUI at our unit. This study highlights the importance of appropriate patient counselling for decision-making on surgical management options for SUI.

This retrospective audit found a higher rate of improvement of stress urinary incontinence with autologous facial slings when compared to urethral bulking agents.