{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T06:15:31Z","timestamp":1788329731407,"version":"build-2803163510"},"reference-count":20,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurourology and Urodynamics"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Urethral bulking agents are established minimally invasive treatments for stress urinary incontinence (SUI), though efficacy varies among available materials. Comparative evidence on contemporary bulking agents, particularly polyacrylamide hydrogel (PAHG), remain limited. This study aimed to compare retreatment rates following primary periurethral bulking with PAHG versus other FDA\u2010approved agents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a multicenter retrospective cohort study of women undergoing primary periurethral bulking for SUI or stress\u2010predominant mixed urinary incontinence between 2011 and 2024. Only current FDA\u2010approved bulking agents were included. The primary outcome was retreatment, defined as any subsequent anti\u2010incontinence procedure, including repeat bulking injections. Retreatment rates were estimated using Kaplan\u2013Meier methods, with comparisons between PAHG and other agents, as well as between index and non\u2010index patients treated with PAHG. Cox proportional hazards models assessed predictors of retreatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 623 women undergoing periurethral bulking, 268 (43.0%) received PAHG, 332 (53.3%) calcium hydroxyapatite, 12 (1.9%) polydimethylsiloxane, and 11 (1.8%) carbon\u2010coated zirconium oxide. The median follow\u2010up was 2.2 years (IQR 0.9\u20136.6). Overall, 223 patients (36.6%) underwent retreatment at 2 years (80.7% with repeat bulking, 11.2% with urethral sling placement, and 8.1% underwent both repeat bulking and urethral sling placement). Bulking injection with PAHG was associated with lower retreatment rates compared with other agents (1\u2010year: 16.5% vs 34.8%; 2\u2010year: 24.4% vs 44.3%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). After adjusting for comorbidities and procedural factors, PAHG use remained independently associated with a reduced risk of retreatment (HR: 0.53, 95% CI: 0.38\u20130.75;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) as did concomitant prolapse surgery (HR: 0.40, 95% CI: 0.22\u20130.72;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Retreatment rates following PAHG injection did not differ between index and non\u2010index patients (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.73).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this large multicenter cohort, PAHG was associated with significantly lower two\u2010year retreatment rates compared with other FDA\u2010approved bulking agents, with consistent effectiveness across index and non\u2010index patients. PAHG may represent a more durable bulking option than legacy agents for the treatment of SUI in real\u2010world practice, though long\u2010term data remains limited.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/nau.70435","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T05:47:32Z","timestamp":1788328052000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real\u2010World Results of Urethral Bulking With Polyacrylamide Hydrogel Versus Legacy Injectables: A Retrospective Study"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4790-9233","authenticated-orcid":false,"given":"Courtney K.","family":"Pfeuti","sequence":"first","affiliation":[{"name":"Mayo Clinic Department of OB\/Gyn Division of Urogynecology Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8043-9640","authenticated-orcid":false,"given":"Katherine S.","family":"King","sequence":"additional","affiliation":[{"name":"Mayo Clinic Kern Center for the Science of Health Care Delivery Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John B.","family":"Gebhart","sequence":"additional","affiliation":[{"name":"Mayo Clinic Department of OB\/Gyn Division of Urogynecology Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7425-022X","authenticated-orcid":false,"given":"Emanuel C.","family":"Trabuco","sequence":"additional","affiliation":[{"name":"Mayo Clinic Department of OB\/Gyn Division of Urogynecology Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2281-5609","authenticated-orcid":false,"given":"John A.","family":"Occhino","sequence":"additional","affiliation":[{"name":"Mayo Clinic Department of OB\/Gyn Division of Urogynecology Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annetta M.","family":"Madsen","sequence":"additional","affiliation":[{"name":"Mayo Clinic Department of OB\/Gyn Division of Urogynecology Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7471-2500","authenticated-orcid":false,"given":"Aqsa A.","family":"Khan","sequence":"additional","affiliation":[{"name":"Mayo Clinic Department of Urology Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4674-2598","authenticated-orcid":false,"given":"Brian J.","family":"Linder","sequence":"additional","affiliation":[{"name":"Mayo Clinic Department of OB\/Gyn Division of Urogynecology Rochester Minnesota USA"},{"name":"Mayo Clinic Department of 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