Predictive Measurement of Urethral Mobility for Successful Transurethral Bulkamid Application in Women with Stress Urinary Incontinence.

Background/Objectives: Bulking agents such as Bulkamid® are well-established surgical options for the treatment of stress urinary incontinence (SUI). Pelvic floor sonographic imaging is readily accessible and may assist in identifying patients who are more likely to benefit from bulking therapies. Urethral mobility appears to significantly influence treatment outcomes and can be classified into hypo-, normo-, and hypermobility. The primary aim of this study was to evaluate the impact of sonographic urethral mobility on the success rate of Bulkamid® injections. The secondary objective was to assess differences between pre- and postoperative urinary incontinence scores. Methods: In women with SUI, linear dorsocaudal movement (LDM) of the urethra was measured sonographically. The International Consultation on Incontinence Modular Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) was completed prior to Bulkamid® injection. Patients were categorized into hypo-, normo-, and hypermobility groups based on their LDM measurements. Results: A total of 130 patients participated, with 101 undergoing both pre- and postoperative sonographic assessment. The difference in LDM before and after treatment was calculated. Patients with normomobile urethras (n = 79) exhibited the greatest mean improvement in continence scores, with LDM changes ranging from 6 to 24 mm and an average ICIQ-UI SF score reduction of 3.8 points. Patients with hypomobile (n = 16) or hypermobile urethras (n = 6) also demonstrated improvements, but to a lesser extent than the normomobile group. Conclusions: This study indicates that patients with a normomobile urethra experience the most significant improvement in continence outcomes following Bulkamid® injection. Urethral mobility assessment via sonography may serve as a valuable preoperative tool and appears to play a crucial role in predicting treatment success with bulking agents.