Minimally invasive methods of correction of involutive changes in the genitals and stress urinary incontinence in females using implants based on hyaluronic acid modified with polyethylene glycol diglycidyl ether: A prospective study

Background. Surgical interventions for early forms of pelvic organ prolapse and urinary incontinence may be associated with a risk of complications. Correction using hyaluronic acid (HA)-based implants is a modern, minimally invasive technique. Its outcomes depend on the properties of the drugs used and require clarification. Aim. To evaluate the efficacy and safety of soft tissue implants for intimate contouring and urinary incontinence repair using HA modified with polyethylene glycol diglycidyl ether (PEGDE), REPART G. Materials and methods. The study included 30 females with a mean age of 45±5.5 years. The patients were divided into two groups: Group 1 (n=15) with mild and moderate stress urinary incontinence (SUI) and Group 2 (n=15) with involutive genital changes. Routine perineological examination methods were used to assess the condition before treatment: gynecological examination, Valsalva test, cough test, assessment of the degree of pelvic organ prolapse according to the POP-Q classification, and pelvic floor muscle strength according to the Oxford scale. Before the treatment and 3 months after the treatment, the frequency of incontinence and sexual dysfunction was compared using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, PISQ-12. To confirm the diagnosis of SUI, Group 1 patients underwent a comprehensive urodynamic examination (according to ICS guidelines), as well as an ultrasound of the urethrovesical segment and perineum before the treatment and 2 weeks, 6, and 9 months after the treatment. In Group 1, patients received paraurethral injections of the 24 mg/mL REPART G Deep implant at 4 points (0, 3, 6, 9 o’clock positions), 1.0 mL at each point. In Group 2, contouring was performed by injecting 1–4 mL (depending on the amount required for the correction of the existing defect) of the REPART G Normal implant. Results. Questionnaires showed significant improvements in certain aspects of sexual function and a decrease in the frequency of urinary incontinence episodes after treatment. Patients with urinary incontinence demonstrated a significant improvement in the ultrasound parameters of the urethrovesical segment in the early stages, with a partial return to baseline by Month 9 after treatment. Adverse reactions were rare, transient, and had no impact on the overall aesthetic and functional effect. Conclusion. Soft tissue implants based on HA modified with polyethylene glycol diglycidyl ether (PEGDE), REPART G, demonstrated a good tolerance and significant improvement in tissue structure, urological symptoms, and sexual function in the correction of mild SUI and involuntary changes in the genital area. They enable delicate and safe restoration of the tissue structure, reducing the severity of symptoms in case of age-related tissue changes.