(Poster 156) The Rise of Urethral Bulking: Trends in Polyacrylamide Hydrogel Use

Objectives: Since FDA approval in 2020, the use of polyacrylamide hydrogel (PAHG), a urethral bulking agent, has grown as a first-line treatment for stress urinary incontinence (SUI). In some patients, PAHG is favored over mesh mid-urethral sling (MUS) due to its lower risk profile, despite offering lower SUI cure rates. Studies suggest 64% of patients favor PAHG over MUS as initial SUI treatment. However, it is unclear if patient and/or surgeon preference has changed PAHG use over time, either as an individual treatment or at time of prolapse repair. This study aims to characterize usage of PAHG for surgical treatment of female SUI by high-volume Urogynecologic surgeons.

Methods: A retrospective review was performed to evaluate SUI surgical procedure rates among two high-volume urogynecologists at a tertiary academic center using CPT codes derived from electronic medical records. Surgeries were stratified by SUI procedure alone or at time of prolapse surgery. Data was collected between January 2020 and March 2025.

Results: Overall rate of PAHG use for SUI increased between 2021 to 2025 from 35.1% (n=20/57) in 2021 to 54.1% (n=13/24) as of March 2025. Conversely, the overall rate of MUS decreased from 100% (n=23) in 2020 to 45.8% (n=11/24) in 2025. For concomitant SUI procedure at time of prolapse repair, PAHG has increasing use at 30% (n=7/23), 10% (n=4/39), 30% (n=17/57), 38% (n=19/71) and 54.5% (n=6/11), while MUS has decreased from 69% (n= 16), 89% (n=35), 70% (n=40), 62% (n=31) and 45% (n=5) in 2021, 2022, 2023,2024 and 2025 respectively.

Conclusions: Since its introduction to our institution in 2021, polyacrylamide hydrogel has been quickly adopted and performed at steadily higher rates, with increasing adoption for concomitant anti-incontinence procedures during pelvic organ prolapse repairs. This evident trend demonstrates a growing preference for PAHG amongst physicians as well as patients. Whether PAHG eventually surpasses the mid-urethral sling as the preferred treatment for female SUI remains an open question. Our next steps are to examine how SUI treatment outcomes compare in these groups.