Introduction: Polyacrylamide hydrogel (PAHG) (Bulkamid®) is a transurethral bulking agent that has demonstrated safety, efficacy, and durability in the treatment of stress urinary incontinence in women. Initial clinical trials report a post-procedure urinary tract infection (UTI) rate of 3.5%. While manufacturer information recommends pre-procedure antibiotics, the American Urological Association best practice statement is uncertain about antibiotic prophylaxis, and real-world practice is varied. Therefore, we report a single institution’s experience with UTI following PAHG urethral bulking.
Methods: Charts of patients who underwent PAHG urethral bulking from May 2020 to March 2021 were retrospectively reviewed. Demographic characteristics were collected, along with pre-procedure urinalyses (UA) and if prophylactic antibiotics were administered. In addition, charts were reviewed for post-procedure UTI. UTI was defined by prescription of antibiotics for UTI symptoms within 14 days of the procedure. Statistical analysis examining significant differences between groups that did and did not have post-procedure UTI was performed using Fisher’s exact test.
Results: During the study period, 103 women underwent PAHG for urethral bulking by 3 FPMRS surgeons at a single institution. 72 (69.9%) received pre-procedure prophylactic antibiotics. On pre-operative UA, 93 (88.3%) were positive for leukocyte esterase, 23 (22.3%) for blood, and only 1 was positive for nitrites. Only 3 of these samples resulted in a positive urine culture.
Eleven of the 103 (10.7%) patients were prescribed antibiotics within 14 days of PAHG urethral bulking for a UTI. Of the 3 patients with incidentally positive urine cultures prior to the procedure, only one developed UTI symptoms and was treated with antibiotics. Presence of blood or nitrites on pre-procedure UA was not significantly related with post-procedure UTI. However, leukocyte esterase positivity was significantly related with post-procedure UTI (p = 0.03).
Limitations include that this was a retrospective study and therefore not powered to determine UTI rate.
Conclusions: In this cohort of real-world practice of PAHG urethral bulking, the incidence of UTI was 10.7%. Administration of prophylactic antibiotics varied and was not associated with lower rates of post-procedure UTIs. Although leukocyte esterase on pre-procedure urinalyses correlated with post-procedure UTIs on this initial analysis, more studies are needed to meaningfully guide clinical practice.
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