(Poster 24) To Bulk or Not to Bulk? Symptom Return After Periurethral Bulking Agent

Objectives: The impact of menopausal status on the rate of symptom return of polyacrylamide hydrogel peri-urethral bulking agent injection for stress urinary incontinence (SUI) has not been investigated. This study’s objective is to determine whether menopausal status or age impacts the rate of symptom return after polyacrylamide hydrogel bulking agent injection.

Methods: This was a retrospective chart review of subjects receiving polyacrylamide peri-urethral bulking injections at a single institution from January 2021 to June 2024. This study was approved by the institutional review board (Protocol number: 23-06026125). Data was abstracted on age, menopausal status, vaginal estrogen use, medical history, urodynamics results, and post-procedure outcomes. Subjects were then stratified by menopausal status and age. Our primary outcome was the rate of symptom return after periurethral bulking by menopausal status. Secondary outcomes included rates of symptom return by age, urethral pressure profilometry (UPP) on urodynamics, and rate of repeat procedure for SUI. Urethral pressure profilometry was evaluated to assess if UPP parameters are related to symptom return. Data was calculated using Chi-square tests and Wilcoxon Rank Sum Test with P-values < 0.05 considered statistically significant.

Results: Of one hundred subjects who underwent peri-urethral bulking injections, 64% of subjects returned for interval follow-up at a median of 170 days from the index procedure. Pre-menopausal subjects had a higher rate of symptom return at 3 or more months post procedure. (p=0.1708). Subjects in the younger age cohort less than 60 years had a higher rate of symptom return at 3 or more months post procedure (p=0.4805). Higher median maximal urethral closing pressure (MUCP) was associated with premenopausal individuals (p=0.01) and higher median MUCP was associated with higher rate of symptom return (p=0.89). There were no statistically significant differences with respect to repeat procedures on menopausal status.

Conclusions: Premenopausal status, younger age, and higher median maximal urethral closing pressure were associated with increased rates of symptom return at 3 or more months after periurethral bulking injection. Future studies are needed with larger sample size to better characterize factors associated with interval symptom return.