The Impact of Treatment Setting on Periurethral Bulking.

Abstract

Introduction and hypothesis: Whether treatment setting impacts periurethral bulking efficacy is unknown. We hypothesized that periurethral bulking treatment failure rates would be greater for office versus operating room procedures.

Methods: A retrospective cohort study including 113 patients undergoing polyacrylamide hydrogel periurethral bulking at a single academic medical center between 1 September 2022 and 30 March 2024 was carried out. Demographic and clinical variables, procedural details, patient satisfaction, and retreatment rates were abstracted. Primary outcomes included 6-month treatment failure, defined as no improvement following treatment, decision for additional therapy, or aborted procedure. Secondary outcomes included 12-month treatment failure and 6- and 12-month retreatment rates. Chi-squared, Fisher's exact, Mann-Whitney U, and t tests were applied, and logistic regression was used to identify factors associated with treatment failure.

Results: The 6- and 12-month treatment failure rates in the operating room versus office cohorts were 32.4% vs 51.3% (p = 0.05) and 48.1% vs 50.0% (p = 0.87) respectively. Retreatment rates and modality did not differ. Approximately 15% of office cases but no operating room cases were unable to be completed as planned (p < 0.01). Office setting was associated with 3.23 increased odds of 6-month treatment failure (p < 0.05).

Conclusions: Periurethral bulking in the office may be more likely to result in early treatment failure than bulking performed in the operating room, but any benefit appears short lived, with similar 12-month treatment failure and retreatment rates. Our findings, together with consideration of individual patient characteristics and resource optimization, can guide decisions regarding the appropriate treatment setting for periurethral bulking.