(Poster 30) Polyacrylamide Hydrogel Bulking Cure Rates by BMI

Objectives: Obesity is associated with anesthetic complications and may impact the decision to pursue urethral bulking for stress urinary incontinence (SUI) treatment. Obesity increases failure of midurethral sling, but little is known about the effect on polyacrylamide hydrogel (PAGH) urethral bulking outcomes. This study aims to assess if increasing BMI is also associated with lower cure rates for patients treated with PAHG urethral bulking for SUI.

Methods: This is a preliminary chart review of patients who desired PAHG urethral bulking as initial surgical management for symptoms of SUI from September 2020 to November 2024. Patients with a remote history (>5 years) of surgical treatment for SUI were included in the study. Patient demographics, including BMI and treatment outcomes were then collected after each PAHG injection. Objective cure was defined as requiring less than 3 injections, a negative cough stress test after last injection, and no additional surgical treatment for SUI.

Statistical analysis was done by an intention-to-treat principle. Two-sample t-tests or Wilcoxon rank-sum tests were used for continuous variables and Chi-square tests or Fisher’s exact tests were used for categorical variables. Patients who were lost to follow-up were considered to be objective fails for treatment. Loss to follow-up was defined as absence of follow-up post procedure.

Results: Two hundred ninety-nine patients were included. Fifty-two met criteria for objective cure and 147 failed, of which 128 were lost to follow-up. The median BMI of the patients included was 30.73. Patients with objective cure had a significantly lower BMI compared to those with an objective failure (BMI 27.65 vs 31.18, p 0.002). Race and ethnicity were also significantly associated with cure rates (p 0.005). Black patients overall had lower cure rates compared to other races/ethnicities. These statistically significant differences persisted after excluding patients who were lost to follow up.

Conclusions: Increasing BMI is correlated with increased risk of failure after PAGH injections. This association exists despite the strict criteria to qualify a patient as objectively cured following PAGH injections. Further analyses will address the significant loss to follow up, but these preliminary data may aid in patient counseling.