Urethral bulking for recurrent stress urinary incontinence after midurethral sling failure

Neurourol Urodyn. 2017 Mar;36(3):722-726. doi: 10.1002/nau.23007. Epub 2016 Mar 31.


Aims: To assess the effectiveness of a polyacrylamide hydrogel (PAHG; Bulkamid®) in treating recurrent stress urinary incontinence (SUI) following a previous midurethral sling (MUS) implant.

Methods: This observational study, conducted since 2009, included 60 patients with recurrent SUI or mixed urinary incontinence (MUI) after a previous MUS and who chose to be treated with PAHG. Objective and subjective outcomes were assessed at 1, 6, and 12 months after the initial injection. Patients were classified as cured based on a negative cough test (supine and standing) and <2 g urine on 1-hr pad test and a VAS score improved by ≥90%. Improved were those with the loss of only a few drops of urine during the cough test and 2-10 g urine on 1-hr pad test or a reduction >50% compared with preoperative urine loss and a VAS score improved by ≥75%.

Results: The volume of PAHG injected in the current study ranged from 1-3 ml. Cured/improved rates were 93.3% (56/60), 88.3% (53/60), and 83.6% (46/55) at 1, 6, and 12 months, respectively. Patients with MUI had a cured urgency urinary incontinence rate of 36.8%, 47.4%, and 38.9%, respectively. Voiding dysfunction rates were 13.3% (8/60), 8.3% (5/60), and 1.8% (1/55) at 1, 6, and 12 months and urinary tract infection rates were 5% (3/60), 11.7% (7/60), and 3.6% (2/55), respectively. Other adverse events were short-term and/or observed in <4% of patients.

Conclusions: PAHG can be used to treat recurrent SUI after MUS failure with good outcome and low complication rates. Neurourol. Urodynam. 36:722-726, 2017. © 2016 The Authors. Neurourology and Urodynamics published by Wiley Periodicals, Inc.

Keywords: Bulkamid®; bulking agents; pelvic floor sonography; polyacrylamide hydrogel; recurrent stress incontinence; salvage therapy; tension-free vaginal tape.

Publication types

  • Observational Study

MeSH terms

  • Acrylic Resins*
  • Aged
  • Aged, 80 and over
  • Female
  • Humans
  • Hydrogels*
  • Middle Aged
  • Pelvic Floor / diagnostic imaging
  • Pelvic Floor / surgery*
  • Prosthesis Failure*
  • Retreatment
  • Suburethral Slings*
  • Treatment Outcome
  • Ultrasonography
  • Urinary Incontinence, Stress / diagnostic imaging
  • Urinary Incontinence, Stress / surgery*
  • Urologic Surgical Procedures*


  • Acrylic Resins
  • Bulkamid
  • Hydrogels