How does bulking therapy compare to TVT surgery in stress urinary incontinence?

This article looked at patients' change in quality of life (QoL) and sexual function following tension-free vaginal tape (TVT) compared to polyacrylamide hydrogel injection (PAHG) for stress urinary incontinence (SUI). The authors found that both treatments improve QoL and sexual function, with greater SUI improvements with TVT.

SUI affects up to 46% of adult women. It involves urine leakage when moving during activities such as coughing or laughing puts pressure on the bladder. It can have a severe impact on QoL. The first-line treatment for SUI is pelvic muscle training. However, many women require surgery to improve SUI symptoms. TVT is the most common surgical option. It uses a mesh tape inserted into the vagina around the urethra (the tube that passes urine from the bladder) to provide support. Mesh complications have raised concerns about erosion, obstruction, and pain. 

An alternative treatment is bulking agents such as PAH. This involves the use of injections with a bulking agent into the bladder neck. This narrows the bladder neck so the urine is less likely to leak. This has previously been used in elderly patients because it is minimally invasive and has been shown to be effective and safe. However, a comparison between PAHG bulking therapy and TVT in terms of QoL has not been done in younger women with SUI.

There were 212 women involved in this trial. 104 patients received TVT. 108 patients received PAHG bulking injections. Patients filled up questionnaires about their symptoms and QoL. The follow-up period for this trial was 1 year. 

There were significant improvements in urinary symptoms and QoL compared to the beginning of the study in both groups. However, there were greater improvements in the TVT group compared to the PAHG group. 

There was also an improvement in sexual satisfaction seen in both groups following treatment. 

Health-related QoL self-reported outcomes were found to be improved in both groups. Physical function and social function were found to have benefitted more the TVT group when compared to the PAHG group. 

The authors found that both TVT and PAHG improved QoL, urinary symptoms, and sexual function for patients with USI. QoL and incontinence symptoms were more improved in the TVT group. 

This study was carried out over a short time frame. Also, questionnaires are not the most reliable evaluation method as they are recall-dependent.