A national population-based cohort study of urethral injection therapy for female stress and mixed urinary incontinence: the Danish Urogynaecological Database, 2007–2011

Introduction and hypothesis: Urethral injection therapy (UIT) has been performed since the early 20th century and a variety of agents have been launched. In 2006, polyacrylamide hydrogel (PAGH) was introduced and is now widely used as an agent. The objective was to evaluate the efficacy of PAGH based on a national population over a 5-year period (2007–2011) and the influence of patient-related factors, surgeon experience, and department volume. Methods: A retrospective cohort study was carried out based on data from the Danish Urogynaecological Database (DugaBase). Results: A total of 731 women were registered in the DugaBase. Cure was achieved in 75 out of 252 women (29.8%) and no leakage at all in 23 out of 252 (9.1%) at the 3-month follow-up. The mean total International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score decreased from 16 (SD 3.8) to 10.6 (SD 6.2; p < 0.001). UIT was performed at 16 departments, of which four high-volume departments performed 547 out of 814 UITs (67.2%). Women with severe UI had a decreased chance of cure (all ICIQ-SF scores), as did women on antimuscarinic drugs (adjusted OR 0.14; 95%, CI 0.04–0.41 “frequency”) and (adjusted OR 0.33; 95%, CI 0.13–0.82, “amount”). Women treated by a high-volume surgeon had a higher chance of cure (OR 4.51; 95% CI, 1.21–16.82, “frequency”) and a lower risk of 30-day hospital contacts (OR 0.27; 95% CI 0.09–0.76). Conclusion: The study represented a cure for UIT among women in an everyday life setting. A surgeon learning curve for UIT was indicated, as was assigning interventions to fewer hands to improve the surgical training value and consequently the cure rate for women with UIT.