Failure Rate, Time to Failure, and Associated Risk Factors: Polyacrylamide Hydrogel Injection for the Treatment of Stress Urinary Incontinence in a Large Cohort.

INTRODUCTION

Stress urinary incontinence (SUI) imposes a high healthcare burden and significantly affects quality of life and daily functioning. While midurethral slings remain the standard surgical treatment, periurethral bulking with polyacrylamide hydrogel (PAHG) is increasingly utilized. Existing studies focus on PAHG success, and have been limited by small sample sizes and short follow-up. This study aimed to assess PAHG failure risk, time to failure, and the likelihood of repeat injections, while identifying associated risk factors.

HYPOTHESIS: Periurethral injection with PAHG for SUI in a complex patient cohort, will have a significant failure rate within 24 months, with a mean time to failure under 2 years and a high rate of repeat SUI surgery.

METHODS

We conducted a retrospective review of all SUI patients who underwent PAHG injection at a single center from January 1, 2014, to August 31, 2020. We defined subjective PAHG failure as patient-reported recurrent SUI symptoms.

RESULTS

Among the 256 patients who underwent PAHG injection during the study period, 35.9% (N = 92) experienced PAHG failure within 2 years (mean time to failure 9.061 months (SD 11.60 months)). Repeat PAHG injection was performed in 12% (N = 30), while 15% (N = 38) underwent other incontinence surgery. Multivariable analysis did not show any factors associated with increased risk of PAHG failure.

CONCLUSIONS

Polyacrylamide hydrogel for SUI, in medically and surgically complex patients, has similar failure rates and mean time to failure, as in uncomplicated patients.