Are You Dry? Urethral Bulking Agent Retrospective Review

Objectives: The objective of this retrospective review was to evaluate the clinical treatment efficacy of polyacrylamide hydrogel (PAHG) urethral injections for women with stress urinary incontinence (SUI) or mixed urinary incontinence (MUI).

Methods: This was an Institutional Review Board approved retrospective cohort study evaluating patients treated with a polyacrylamide hydrogel urethral bulking agent for SUI or MUI (with predominant stress incontinence symptoms) from August 2022 to August 2023. All patients who received the polyacrylamide hydrogel were included in the study and those without adequate follow up were excluded from the analysis. The primary outcome was treatment success, defined as either patient reported high satisfaction, resolution of incontinence, or subjective improvement by 70% or greater. The secondary outcome included post-operative complications including voiding dysfunction and urinary tract infection (UTI) within 4 weeks of the procedure. Patient characteristics were assessed by chart review, and included age, body mass index (BMI), race, ethnicity, parity, urinary incontinence indication, number of polyacrylamide hydrogel injections, prior incontinence surgery, prior hysterectomy and other gynecologic non urinary surgeries performed concomitantly.

Results: A total of 49 patients received polyacrylamide hydrogel urethral injections from August 2022 to August 2023. Patient characteristics included a mean age of 52 (SD 11.6), body mass index 31.3 (SD 5.99), 48 of white race (98%), of which 34 (69%) patients identified as Hispanic ethnicity. Of our patients, 28 (57%) had SUI and 21 (43%) had MUI. One patient was lost to follow up. For the primary outcome, 36 patients (75.0%) reported high satisfaction, symptom resolution, or subjective improvement of symptoms by 70% or greater. There was no difference in outcomes among those with SUI or MUI (Fisher Exact Test, p=0.75). Two patients (4.27%) required a temporary foley catheter for post-operative urinary retention and 3 patients (6.25%) developed UTIs, which treated with antibiotics.

Conclusions: Polyacrylamide hydrogel urethral injections are an effective treatment option for SUI and MUI, with good chances of success and low rates of complications. Women in the community should be screened for urinary incontinence and offered this therapy when appropriate.