Trends in the Treatment of Stress Urinary Incontinence in a Tertiary Care Center After the Introduction of Polyacrylamide Hydrogel.

Abstract

<h4>Introduction</h4>For women with bothersome stress urinary incontinence (SUI), a urethral sling is the gold-standard surgical treatment. Despite the high efficacy of slings for SUI, up to a 20%-30% rate of complications or adverse effects have been reported, and there can be a period of convalescence postoperatively. Given this, the less invasive approach of urethral bulking may be utilized. A number of bulking agents can be used to improve urethra coaptation. Polyacrylamide hydrogel (PAHG) is a bulking agent that received FDA approval in 2020 and is reported to have longer efficacy for the treatment of SUI compared to prior bulking agents. We sought to assess trends in the usage of surgery and urethral bulking for SUI treatment in women at a single academic medical center before and after the introduction of PAHG.<h4>Methods</h4>This is a retrospective cohort study of all new patients seen with an ICD-10 diagnosis of SUI (N39.3) at an academic tertiary care center from June 2019 to June 2023. Our multidisciplinary clinic was established in May 2019. Patients were included if they underwent an interventional treatment for SUI with urethral bulking, sling (either mesh or autologous fascia), or Burch colposuspension. Patients were stratified to before and after the introduction of PAHG to our clinic in April 2021. The primary endpoint was the percent of new patients seen in clinic with SUI who were treated with urethral bulking compared to surgical treatment.<h4>Results</h4>A total of 478 new patients with SUI were seen and 279 treated with an invasive procedure by 5 URPS trained surgeons. In total, 109 of these patients underwent treatment in the 20 months before PAHG was introduced into the clinic and 170 patients in the 27 months after. Use of urethral bulking for new patients seen for SUI increased from 56% to 69.1% (p = 0.04) of patients with SUI who underwent a procedure. When the total number of new patients presenting with a diagnosis of SUI was analyzed by 12-month period, there was an overall increase in the number of procedures for SUI, which was driven by an increase in the percent of new patients who were treated with bulking.<h4>Conclusions</h4>The introduction of a PAHG resulted in increased utilization of urethral bulking for patients newly presenting with SUI to a tertiary care center.