Abstract
INTRODUCTION AND OBJECTIVES:
Urethral bulking with polyacrylamide hydrogel (PAHG) is a minimally invasive treatment for stress urinary incontinence (SUI). Though postoperative urinary retention (POUR) is considered an adverse event, it may represent optimal urethral coaptation and outcomes. We aim to evaluate whether POUR impacts outcomes following PAHG.
METHODS:
A retrospective review of 251 women who underwent PAHG injection for SUI at our tertiary referral center between Jun 2021-Feb 2025 was performed. Logistic regression assessed associations between POUR and four outcomes: symptom recurrence, repeat PAHG, subsequent sling placement, and urinary tract infections (UTI). POUR was defined as a post void residual >150 ml managed with an indwelling 12 Fr foley or office urethral dilation. Analyses were performed using a complete-case dataset.
RESULTS:
POUR occurred in 52 patients (20.7%). Symptoms recurred in 95 (36.1%), repeat PAHG injection in 29 (11.0%), and sling placement in 19 (7.2%). SUI recurrence was lower in the POUR group (19.2% vs 39.2%, p=0.01), while repeat procedures were comparable between groups (Figure 1). Electing for repeat PAHG (OR=0.43, [0.10–1.28], p=0.18) or sling placement (OR=0.49 [0.08–1.82], p=0.36) was similar between groups. UTIs occurred in 13% of patients with POUR and 8% without (p=0.34). Management of POUR with isolated urethral dilation had higher odds of symptom recurrence (OR = 0.80 [0.21 - 2.98]) compared to foley placement (OR = 0.13 [0.05-0.33], p=0.03) (Figure 2), with an average catheterization time of 1.8 days.
CONCLUSIONS:
POUR treated with foley placement was associated with lower rates of symptom recurrence following PAHG injection, suggesting transient retention may reflect effective urethral coaptation rather than overtreatment or poor surgical technique. Further prospective studies are needed to validate POUR as a predictor of outcomes.