Use of periurethral injections of polyacrylamide hydrogel for treating post-vesicovaginal fistula closure urinary stress incontinence

Aims: Following successful closure of obstetric genitourinary fistula, stress urinary incontinence (SUI) is a common and challenging problem. Despite many decades of various treatment options, the effective management of post-fistula SUI remains unresolved. This study aims to assess the feasibility of periurethral injections of polyacrylamide hydrogel, commonly used for urinary stress incontinence in non-fistula women, in women with post-fistula closure SUI. Material and Methods: Women with urinary incontinence following successful fistula closure were assessed to exclude detrusor overactivity and urinary residual volumes of more than 100 mL. The urethrovesical junction was identified and polyacrylamide hydrogel was injected through the periurethral skin and vaginal epithelium at three sites. Results: Four women with post-fistula SUI were treated with polyacrylamide hydrogel injections. Three of the four women were dry post-operatively and remained continent at discharge. Conclusion: In the short-term, periurethral injections of polyacrylamide hydrogel appears to be a promising method to treat post-obstetric fistula urinary stress incontinence. © 2014 Japan Society of Obstetrics and Gynecology.