Restoring Continence After Devastating Post-Obstetric Fistula Repair Incontinence: A Pilot Study Comparing...

Area of Science:

• Urogynecology
• Minimally Invasive Surgery
• Female Pelvic Medicine

Background:

• Post-obstetric fistula repair incontinence (POFRI) is persistent urinary leakage after successful fistula closure.
• Stress urinary incontinence (SUI) is a common complication following obstetric fistula repair.
• Evaluating novel treatments for POFRI is crucial for improving patient quality of life.

Purpose of the Study:

• To evaluate the efficacy and safety of Bulkamid injections for treating post-obstetric fistula repair incontinence (POFRI) with persistent stress urinary incontinence (SUI).
• To compare two Bulkamid injection techniques: cystoscopic-guided versus periurethral injections without cystoscopy.
• To assess patient-reported outcomes and objective measures of incontinence.

Main Methods:

• A prospective study involving women with POFRI and SUI treated with Bulkamid.
• Cohort 1: Cystoscopic-guided Bulkamid injection; Cohort 2: Periurethral Bulkamid injection without cystoscopy.
• Standardized questionnaires (ICIQ-UI SF, QUID) and pad weight testing were used for assessment at baseline, discharge, and 3 months postoperatively.

Main Results:

• At discharge, 72.7% of patients in the cystoscopic group and 64.7% in the periurethral group met the primary outcome.
• At 3 months, 40% and 60% of patients, respectively, reported improvement.
• Both techniques showed significant reductions in incontinence scores (QUID and ICIQ-UI SF) at 3 months; the periurethral approach was simpler.

Conclusions:

• Bulkamid injections offer promising short-term outcomes for SUI in women with POFRI.
• Both cystoscopic and periurethral approaches demonstrated effectiveness.
• The periurethral technique is simpler and avoids the need for cystoscopy, warranting further investigation in larger studies with longer follow-up.