Reconstruction of Urethral Sphincter With Polyacrylamide Hydrogel.

Area of Science:

• Urology
• Female Pelvic Medicine
• Minimally Invasive Surgery

Background:

• Urethral bulking agents offer an alternative to midurethral slings for stress urinary incontinence (SUI) in women.
• While generally safe, bulking agents have shown lower cure rates compared to slings.
• The Cystoscopic Reconstruction of External Sphincter Technique (CREST) aims to enhance the natural urinary sphincter function.

Purpose of the Study:

• To evaluate the safety and efficacy of injecting polyacrylamide hydrogel (PAHG) into the female external urinary sphincter (EUS) components using the CREST technique.
• To provide initial data on a novel approach for SUI treatment.

Main Methods:

• A retrospective chart review of 113 female patients undergoing CREST with PAHG for initial SUI treatment.
• Exclusion criteria included prior SUI surgery, pelvic organ prolapse, neurological conditions, or radiation history.
• Outcomes assessed included subjective and objective cure rates, and adverse events like urinary retention, infection, and urgency.

Main Results:

• A median follow-up of 3 months was recorded for 113 patients.
• 85% reported subjective improvement, with 69% achieving subjective cure and 69% demonstrating objective cure.
• Minor complications included transient retention (9 patients), UTIs (8 patients), and de novo urgency (5 patients); no serious adverse events occurred.

Conclusions:

• The CREST technique, involving PAHG injection into the EUS, represents a novel method for SUI treatment.
• Preliminary data suggest this technique can improve urethral injection outcomes for SUI.
• The CREST procedure demonstrated a favorable safety profile with minimal complications.