Effect of Procedure Setting on Urinary Retention After Bulkamid Injection

Urethral Bulkamid is a U.S. Food and Drug Administration-approved nonsurgical treatment for stress urinary incontinence and stress-predominant mixed urinary incontinence due to intrinsic sphincter deficiency. This procedure is commonly performed in the operating room (OR). An office Bulkamid procedure offers an alternative with benefits, including reduced cost, increased accessibility, and avoidance of anesthesia. Urinary retention is a known complication of Bulkamid. Data comparing retention rates between OR and office settings remains limited.

This study aimed to compare rates of postprocedure urinary retention following Bulkamid procedures performed in an OR versus an office setting.

A retrospective review of 155 medical charts from Bulkamid procedures performed between 2020 and 2024 was conducted. Data included demographics, medical history, and information on postoperative urinary retention. Statistics were performed to assess for differences in postoperative outcomes based on location.

Patients who underwent Bulkamid procedures in the office experienced higher rates of immediate postoperative urinary retention (21.1%) compared with those treated in an OR (7.7%) (P=0.02); however, this result was not significant when adjusted for age, body mass index (BMI), and parity. A greater proportion of office patients performed intermittent self-catheterization after the procedure (15.8%) versus none in the OR (0.0%) (P=0.0001). Patients who experienced immediate urinary retention had a higher mean age (67.5 y vs 60.2 y; P=0.05) and lower BMI (27.9 vs 32.2; P=0.05), regardless of setting. Surgical history did not affect retention rates.

While an office Bulkamid procedure offers many advantages, it is associated with higher observed rates of immediate postoperative urinary retention.