Urethral Bulking for Stress Urinary Incontinence
Urethral bulking is a minimally invasive procedure used to treat stress urinary incontinence (SUI) in women. I use Bulkamid®, a modern urethral bulking agent with strong data behind it.
What is Bulkamid®?
Bulkamid® is a soft hydrogel consisting of 97.5% water and 2.5% polyacrylamide. This composition makes it:
- Biocompatible
- Non-degradable
- Tissue-friendly
I use Bulkamid® because it resists the migration and reabsorption that gave older bulking agents trouble. It seems to last as long and cause as few problems, though the data comparing agents head to head is thin.
How urethral bulking works
The procedure involves:
- Injecting small amounts of Bulkamid® around the urethra
- Creating additional bulk to help the urethra close more effectively
- Improving urinary control during activities that increase abdominal pressure such as exercise, laughing, coughing, and sneezing
The Bulkamid® procedure
- Performed under local anesthesia in the office
- Takes about 10-15 minutes
- Typically involves 4 small injections
- Most patients are back to their normal routine within a day
Benefits of Bulkamid®
- Around 20-30% of women are fully dry (cured) at one to three years, and more see partial improvement; the exact numbers vary by study and how outcomes are measured
- Bulking is less effective and less durable than a midurethral sling, which is the more definitive fix. I offer it when you’d rather avoid surgery or aren’t a good candidate for a sling.
- Minimally invasive with quick recovery
- 7-year follow-up data shows about two-thirds of women maintain improvement or cure
- Can be repeated if necessary
- Preserves future treatment options
Who is a good candidate for Bulkamid®?
Bulkamid® may be a good option if you:
- Have stress urinary incontinence
- Want a minimally invasive, in-office procedure
- Prefer a quick recovery with minimal downtime
- Want to preserve other treatment options for the future
Recovery and results
- Most women return to normal activities within 24 hours
- You’ll often notice improvement right away
- You may see the full effect within a few weeks
Potential side effects
Some potential side effects include:
- Temporary discomfort or burning sensation when urinating
- Difficulty urinating
- Mild bruising or swelling
- Urinary tract infection (rare)
These effects are typically mild and short-lived.
Why Bulkamid® over older bulking agents?
Older bulking agents had issues with migration and reabsorption over time. Bulkamid® is a polyacrylamide hydrogel that stays where it’s placed, integrates well with surrounding tissue, and can be “topped up” if needed down the road. Seven-year follow-up data shows about two-thirds of women maintain their improvement or cure.
If you have stress urinary incontinence and want to talk about whether Bulkamid® makes sense for you, I’m happy to walk you through the options.
References
- Lose G, Sørensen HC, Axelsen SM, Falconer C, Lobodasch K, Safwat T. An open multicenter study of polyacrylamide hydrogel (Bulkamid®) for female stress and mixed urinary incontinence. Int Urogynecol J. 2010;21(12):1471-1477. doi:10.1007/s00192-010-1220-x
- Brosche T, Kuhn A, Gygax B, Hagmann B, Raio L. Seven-year efficacy and safety outcomes of Bulkamid for the treatment of stress urinary incontinence. Neurourol Urodyn. 2021;40(1):502-508. doi:10.1002/nau.24589
- Kasi AD, Pergialiotis V, Perrea DN, Khunda A, Doumouchtsis SK. Polyacrylamide hydrogel (Bulkamid®) for stress urinary incontinence in women: a systematic review of the literature. Int Urogynecol J. 2016;27(3):367-375. doi:10.1007/s00192-015-2781-y