In a prospective, observational study, Altman and colleagues (2017) examined the effects of transurethral polyacrylamide hydrogel injection in patients considered ineligible for mid-urethral sling surgery. A total of 81 patients received treatment with transurethral polyacrylamide hydrogel injection. Subjects were considered ineligible for placement of a mid-urethral sling based on significant co-morbidity (48 %), 1 or more previously failed invasive treatments (16 %), mixed UI (27 %), continuous incontinence (5 %), or previous pelvic radiation therapy (4 %). Longitudinal assessment of subjective treatment outcomes was performed using the validated UDI and the PFIQ at baseline, 2, and 6 months. To deal with repeated measurements, mixed linear models were used to examine changes in the outcomes over time. There was a significant improvement in the overall UDI score from baseline to month 2 follow-up (FU) (p < 0.001). No major differences between the month 2 and 6 FUs were observed. The largest difference in effect was observed for the irritative and stress subscales; 25 patients (33 %) requested a 2nd injection at the month-2 FU visit. At month-6 FU, the UDI scores for patients having had only 1 injection were largely unchanged, whereas all UDI domains worsened further for patients having had a 2nd injection at the month-2 visit. After the injection, there were 3 minor AEs (3.7 %) and no serious AEs. The authors concluded that in patients considered ineligible for mid-urethral sling surgery, transurethral injection with polyacrylamide hydrogel may alleviate UI symptoms. Repeat injections did not improve outcomes in this complicated group of patients.