(Poster 86) Risk of Stress Urinary Incontinence After Urethral Bulking and Prolapse Surgery

Objectives: Polyacrylamide hydrogel (PAHG) is a low-risk treatment for stress urinary incontinence (SUI) that is increasingly used as a first line surgical option. Despite growing evidence for its efficacy, limited outcome data exist in patients with SUI undergoing surgery for pelvic organ prolapse (POP). The primary objective of this study is to evaluate the risk of persistent postoperative SUI after PAHG at the time of POP surgery. Our secondary objective is to determine whether risk varies by type of preoperative SUI: occult, which could potentially be exacerbated by surgical repair, versus overt.

Methods: This is an ongoing retrospective cohort study from a large academic medical center that was deemed exempt by our IRB. Female patients with POP and demonstrable SUI who underwent PAHG and POP surgery were included. Our primary composite outcome (higher bother) was defined as bothersome SUI at the six-week postoperative visit as determined by a positive cough stress test (CST) or a postoperative Urinary Distress Inventory (UDI-6) stress subscale score >33.3. Secondary outcomes were UDI-6 stress subscale score and postoperative complications including urinary tract infection, urinary retention and de novo urge incontinence. Clinical characteristics and postoperative measures were compared using Chi-square test, Fisher’s exact test, Student’s t-test and Mann-Whitney U Test, as appropriate.

Results: Sixty patients underwent PAHG and POP surgery. At baseline,14 had occult SUI and 46 had overt SUI. Preoperatively, SUI groups were largely similar at however, patients with occult SUI were older, had a lower body mass index, were less likely to have preoperative urinary urgency and were more likely to have an obliterative procedure. Most patients (89.5%) had intrinsic sphincter deficiency (ISD) defined as a leak point pressure < 100 cm H20 (Table 1). Postoperatively, the median UDI-6 stress subscale score was 0 (interquartile range (IQR) 0-20.9), the risk of positive CST was 11.0%, and bothersome SUI was 16.4%. These measures did not differ by type of preoperative SUI (Table 2).

Conclusions: In this analysis of patients undergoing POP surgery with concomitant PAHG, the risk of postoperative SUI did not differ by preoperative SUI type (overt vs occult) and was similar to the 18% reported risk of SUI at 3 months postop after PAHG alone. This data suggests that PAHG is a low-risk and effective option for patients with preoperative SUI undergoing prolapse surgery and may be of particular benefit among older patients with comorbid conditions.

Table 1: Clinical characteristics of patients undergoing PAHG at the time of prolapse surgery. Means with standard deviation (SD), median with IQR or counts and percentages. BMI (body mass index).
Table 2: Postoperative urinary incontinence and complications. Means with SD, median with IQR or counts and percentages. POD1 (postoperative day 1).