Single-Incision Sling Versus Polyacrylamide Hydrogel During Transvaginal Prolapse Surgery for Occult Stress Urinary Incontinence: A Retrospective Cohort Study

Abstract

Objective: This study compared the outcomes of the bulking agent polyacrylamide hydrogel (PAHG) with a single-incision sling (SIS) for treating occult stress urinary incontinence (SUI) in association with vaginal prolapse surgery. Methods: This was a retrospective study of patients who underwent transvaginal surgical correction of pelvic organ prolapse and received either SIS or urethral bulking with PAHG for occult SUI. Demographic and perioperative data were extracted from the charts. The primary outcomes were Urinary Distress Inventory–6 (UDI-6) scores, Incontinence Impact Questionnaire–7 (IIQ-7) scores, and incontinence episodes documented by 3-day bladder diaries collected 24 months after surgery. Secondary outcomes included complications such as adverse events, rates of urine retention with prolonged catheterization, and urinary-tract infections. Results: Thirty patients had the bulking agent using PAHG with the prolapse surgery for occult incontinence and 23 patients has SIS. Twenty-two patients from each group completed the postoperative questionnaires. UDI-6 scores were low in both groups with bulking versus SIS value (19 versus 11; p = 0.096). The stress subscale median value for bulking versus SIS was 33 versus 0; p = 0.009. IIQ-7 median value was 0 for both groups. The median Foley catheter duration for the bulking group versus the SIS group was 1 versus 5 days (p = 0.015). Conclusions: SIS and PAHG were equally satisfactory for treating occult SUI with similar total UDI-6 and IIQ-7 scores; yet, the UDI-6 stress subscale was significantly better for the SIS group, but with more short-term voiding dysfunction. (J GYNECOL SURG 20XX:000)