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Updated: May 10, 2026

Transvaginal Mesh Insertion in the Ovine Model
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Tension-Free Vaginal Tape versus Polyacrylamide Hydrogel Injection for Stress Urinary Incontinence - 5-Year

Anna-Maija Itkonen Freitas1, Camilla Isaksson1, Päivi Rahkola-Soisalo1

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Polyacrylamide hydrogel (PAHG) injections for stress urinary incontinence were not as satisfying as tension-free vaginal tape in a 5-year study. However, PAHG had fewer complications than the traditional mesh tape.

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Area of Science:

  • Urology
  • Minimally Invasive Surgery
  • Female Pelvic Medicine

Background:

  • Tension-free vaginal tape (mesh) is standard for female stress urinary incontinence (SUI).
  • Concerns exist regarding mesh safety.
  • Transurethral polyacrylamide hydrogel (PAHG) injection offers a minimally invasive alternative, but long-term outcomes are unknown.

Purpose of the Study:

  • To compare the 5-year patient satisfaction, efficacy, and safety of PAHG injections versus tension-free vaginal tape for SUI.
  • To assess if PAHG meets noninferiority criteria compared to traditional mesh treatment.

Main Methods:

  • A randomized, controlled, noninferiority trial was conducted.
  • 223 women with SUI were randomized to either tension-free vaginal tape or PAHG.
  • Patient satisfaction, effectiveness, and complications were assessed at 1, 3, and 5 years.

Main Results:

  • At 5 years, PAHG did not meet noninferiority criteria for patient satisfaction compared to tension-free vaginal tape.
  • Median satisfaction scores were 90 for PAHG vs. 98 for tape.
  • Complications occurred in 22.2% of PAHG patients versus 43.8% of tape patients.

Conclusions:

  • PAHG injection is not noninferior to tension-free vaginal tape for SUI regarding long-term patient satisfaction.
  • The tension-free vaginal tape group experienced twice the rate of peri- or postoperative complications.
  • Further research may explore optimizing PAHG for SUI treatment.