{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T10:29:33Z","timestamp":1786357773189,"version":"build-2736575974"},"reference-count":15,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurourology and Urodynamics"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Post\u2010obstetric fistula repair incontinence (POFRI) refers to persistent urinary leakage after successful fistula closure. This study evaluated Bulkamid for POFRI using two techniques: cystoscopic\u2010guided injections versus periurethral injections without cystoscopy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We performed a prospective study of women with POFRI and persistent stress urinary incontinence (SUI) treated with Bulkamid at the Freedom from Fistula unit in Tamatave, Madagascar. Cohort 1 underwent cystoscopic Bulkamid injection; Cohort 2 underwent periurethral Bulkamid injection without cystoscopy. The International Consultation on Incontinence Questionnaire\u2010Urinary Incontinence Short Form (ICIQ\u2010UI SF), Questionnaire for Urinary Incontinence Diagnosis (QUID), and pad weight testing were obtained at baseline, discharge, and 3 months postoperatively. The primary outcome, Patient Global Impression of Improvement (PGI\u2010I), was collected at discharge and 3\u2010month follow\u2010up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In January 2025, Cohort 1 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200911) underwent cystoscopic injection, and in June 2025, Cohort 2 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200917) underwent periurethral injection. The primary outcome was met by 8\/11 (72.7%) patients in Cohort 1 at discharge and 2\/5 (40%) at 3\u2009months. In Cohort 2, 11\/17 (64.7%) patients met the primary outcome at discharge and 6\/10 (60%) at 3 months. Combined, 19\/28 (67.9%) patients achieved \u201csuccess\u201d at discharge and 8\/15 (53.3%) at 3\u2009months. At 3\u2009months, both cohorts demonstrated significant reductions in mean QUID (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and ICIQ\u2010UI\u2010SF scores (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011). Two patients developed recurrent vaginal fistulas, both successfully repaired.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Bulkamid provided promising short\u2010term outcomes for SUI in women with POFRI. Both cystoscopic and periurethral approaches were effective, the periurethral technique was simpler and avoided cystoscopy. Larger studies with longer follow\u2010up are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/nau.70407","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T09:40:16Z","timestamp":1786354816000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Restoring Continence After Devastating Post\u2010Obstetric Fistula Repair Incontinence: A Pilot Study Comparing Cystoscopic vs Periurethral Bulkamid"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6040-4152","authenticated-orcid":false,"given":"Aidan J.","family":"Kennedy","sequence":"first","affiliation":[{"name":"Department of Urology Corewell Health William Beaumont University Hospital Royal Oak Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Breen","sequence":"additional","affiliation":[{"name":"Freedom from Fistula Clinic Analankininina University Hospital Center Tamatave Madagascar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1153-0966","authenticated-orcid":false,"given":"Nikta Rezakahn","family":"Khajeh","sequence":"additional","affiliation":[{"name":"Department of Urology Corewell Health William Beaumont University Hospital Royal Oak Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4717-5751","authenticated-orcid":false,"given":"Bernadette M. M.","family":"Zwaans","sequence":"additional","affiliation":[{"name":"Department of Urology Corewell Health William Beaumont University Hospital Royal Oak Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth M.","family":"Peters","sequence":"additional","affiliation":[{"name":"Department of Urology Corewell Health William Beaumont University Hospital Royal Oak Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry T.","family":"Sirls","sequence":"additional","affiliation":[{"name":"Department of Urology Corewell Health William Beaumont University Hospital Royal Oak Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70348-1"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.03.008"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.15724"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15546"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001687"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.70384"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-010-1202-5"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/JU.0000000000002720"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.12176"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2011.03.020"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.22533"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.urology.2019.08.004"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-024-02188-4"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.22436"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/nau.24589"}],"container-title":["Neurourology and Urodynamics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/nau.70407","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/nau.70407","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/nau.70407","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T09:40:17Z","timestamp":1786354817000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/nau.70407"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,10]]},"references-count":15,"alternative-id":["10.1002\/nau.70407"],"URL":"https:\/\/doi.org\/10.1002\/nau.70407","archive":["Portico"],"relation":{},"ISSN":["0733-2467","1520-6777"],"issn-type":[{"value":"0733-2467","type":"print"},{"value":"1520-6777","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,10]]},"assertion":[{"value":"2026-02-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"nau.70407"}}