Intraurethral cross-linked hyaluronic acid/dextranomer (DEXSUI®) injection versus mid-urethral sling for stress
Mehmet Adıyeke1, Suna Yıldırım Karaca1, S Anil Ari1
1School of Medicine, Department of Obstetrics and Gynecology, Izmir Bakircay University, Izmir, Turkey.
Objectives:
Stress urinary incontinence (SUI) is a prevalent condition that impairs quality of life; while midurethral sling (MUS) surgery is the standard treatment, intraurethral bulking injection offers a minimally invasive alternative. This study aimed to compare the efficacy and safety of intraurethral cross-linked hyaluronic acid/dextranomer (CLHA/Dx, DEXSUI®) injection with midurethral sling surgery in the treatment of stress urinary incontinence in women.
Methods:
This retrospective study included women who presented with stress urinary incontinence to İzmir Bakırçay University, Çiğli Training and Research Hospital between January 2024 and June 2025. Patients underwent either midurethral sling surgery or intraurethral CLHA/Dx (DEXSUI®) injection. Exclusion criteria included urge incontinence, urinary tract infection, and BMI > 35 kg/m². Quality of life was assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Urogenital Distress Inventory-6 (UDI-6), and Incontinence Quality of Life Questionnaire (I-QOL) questionnaires. Treatment success was defined by Patient Global Impression of Improvement (PGI)-I scores.
Results:
Midurethral sling (MUS) was associated with significantly longer operative time (30.5 ± 7.8 vs. 11.4 ± 4.3 min, p < 0.001) and longer hospital stay (median 1 vs. 0 day, p < 0.001). At 1-month follow-up, complete dryness rates were similar (82.4% vs. 79.4%, p = 0.76). Both groups demonstrated significant improvement in ICIQ-SF, UDI-6, and Incontinence Quality of Life Questionnaire (I-QOL) scores compared with baseline (all p < 0.05), with slightly greater improvement observed in the MUS group; between-group differences were not statistically significant. Subgroup analysis by stress urinary incontinence (SUI) severity revealed consistently high dryness rates across mild, moderate, and severe categories, without significant intergroup differences.
Conclusions:
Intraurethral CLHA/Dx injection achieved clinical outcomes comparable to MUS, offering a less invasive alternative for SUI treatment.
