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Periurethral injection with polyacrylamide after previous TVT surgery

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Abstract

Introduction and hypothesis

The aim of this registry study was to assess the clinical utility of using periurethral bulking with polyacrylamide hydrogel in women with stress urinary incontinence (SUI) after previous midurethral sling surgery.

Methods

The study period was 2007 through 2019. Using data from the Norwegian Female Incontinence Registry we included 57 women who had received Bulkamid® because of insufficient improvement or recurrent SUI after previous retropubic TVT surgery. The primary outcome was cure of SUI, and secondary outcomes were patient satisfaction, degree of leakage, change in urgency incontinence (UUI), free flow rate, postvoid residual volume, and complications. Descriptive statistics were used to characterize data and Wilcoxon signed-rank test to compare pre- and postoperative results for pairs, with level of significance at p < 0.05.

Results

Pure SUI was seen in 19 (33.3%) while 38 (66.7%) had mixed incontinence. Postoperatively 72.9% had a negative stress test and 73.7% were satisfied with treatment. There was only 1 complication in 67 injections (1.5%). De novo UUI occurred in five patients, corresponding to 8.8% of the whole study group, but 26.3% among those with no preoperative UUI problems. Among the patients with preoperative UUI, 39.5% were cured of this problem and a further 36.8% were improved.

Conclusions

The cure rate and satisfaction rate of periurethral bulking with polyacrylamide after previous MUS are favorable and complications are rare. There seems to be a risk of overactive bladder symptoms developing in women with no such symptoms preoperatively.

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Acknowledgements

Tomislav Dimoski, MBA, system developer at the registry, designed the application we used to extract the data. Statistician Tore Morten Viland, MA, gave valuable statistical advice.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Vestfold Hospital Trust, PO Box 2168, Postterminalen, 3103, Tønsberg, Norway

    Siv Svennevik Myhr, Martin Rakovan & Hjalmar A. Schiøtz

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  1. Siv Svennevik Myhr
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  2. Martin Rakovan
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  3. Hjalmar A. Schiøtz
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Contributions

SS Myhr: Protocol development, data collection and analysis, manuscript writing

M Rakovan: Data analysis, manuscript editing

HA Schiotz: Protocol development, data collection and analysis, manuscript writing

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Correspondence to Hjalmar A. Schiøtz.

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Myhr, S.S., Rakovan, M. & Schiøtz, H.A. Periurethral injection with polyacrylamide after previous TVT surgery. Int Urogynecol J 33, 1017–1022 (2022). https://doi.org/10.1007/s00192-021-04891-y

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  • DOI: https://doi.org/10.1007/s00192-021-04891-y

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