Perineal ultrasound for the assessment of urethral bulking agent placement (Bulkamid®): A technical note

Stress urinary incontinence (SUI) is a major public health issue affecting up to 45 % of women, contributing to a decreased quality of life. Various treatment options are currently available for the management of SUI but an increasing number of women are opting for urethral bulking as first-line treatment due to concerns regarding mesh-related morbidity associated with sling surgery. Urethral bulking is currently offered to patients with SUI, mixed urinary incontinence, and after failure of a mid-urethral sling procedure. Nevertheless, the optimal injection site and volume of the urethral bulking agent remain unknown. Perineal ultrasound, through the precise analysis of injection site positioning, could help enhance injection techniques and improve the understanding of failure mechanisms or complications. The aim herein is to describe the technique for performing perineal ultrasound after injection of a urethral bulking agent (Bulkamid®) and the ultrasound imaging findings typically observed at different timepoints during SUI management.