Bulkamid® injection as a salvage treatment option in patients with recurrent stress urinary incontinence: medium term outcomes from a tertiary unit

Loufopoulos I1, Kapriniotis K1, Pakzad M1, Noah A1, Gresty H1, Greenwell T1, Ockrim J1, Faarax Shirwac H1

Research Type


Abstract Category

Female Stress Urinary Incontinence (SUI)

Abstract 277
Female Stress Urinary Incontinence
Scientific Podium Short Oral Session 19
Friday 9th September 2022
12:00 - 12:07
Hall D
Incontinence Pad Test Stress Urinary Incontinence Surgery
1. Department of Urology, University College London Hospital

Ioannis Loufopoulos



Hypothesis / aims of study
The outcomes for Bulkamid® injection as a primary procedure for stress urinary incontinence (SUI) have been well reported. However, the outcomes for patients with previous failed SUI surgery are less known. The aim of our study is to identify the factors which could predict the outcomes of Bulkamid® injection as a salvage treatment alternative.
Study design, materials and methods
Data collected prospectively between 2017-2021 was analysed retrospectively. All patients had had at least one previous anti-incontinence operation. Data including demographics, urodynamic parameters, type and number of previous anti-incontinence procedures, number and total injected amount of Bulkamid® were analysed. Outcomes were assessed with number of pads where possible, and were categorised as dry, improved or wet according to patient satisfaction. Shapiro-Wilk tests of normality were performed.
Results are shown on Table 1. Twenty patients with mean age of 63 (range 32-88) years were treated with a mean follow up 17 (range 2-52) months. Fourteen patients had one set of injections and six had two injections. The overall success rate was 35% (10% dry, 20% improved and 70% failed) with 30% successful after one injection and 35% after two injections. 

Four of eight patients with Type III SUI had a 50% chance of success (37.5% dry and 12.5% significantly improved after the first injection), whereas no improvement was observed in the 5 patients with Type IIA / IIB SUI (100% failure). One patient with mixed urinary incontinence had no improvement after the Bulkamid®  injection. 

The success rate for patients with one previous procedure was 37% (25% dry, 12.5% improved), whereas the success rate for patients with two or more previous procedures was 25% (0% dry, 25% improved). 

Patients who had previous TOT/TVT-O insertion, autologous rectus fascial sling or Macroplastique® injections showed higher success rate (63% dry or improved), whereas patients with TVT, colposuspension, SNS/Botox or complex reconstruction were poor responders (16% dry or improved).

Injection of more than 2.2ml of Bulkamid® had better outcomes compared to smaller volumes (55% versus 35% success).
Interpretation of results
Patients with multiple previous procedures seemed to do less well than those with a single previous procedure. Interestingly, patients with Type III SUI did better than those with persistent Type IIA/IIB SUI, and those with previous obturator tapes and autologous slings seemed to do better than those with TVT or colposuspension, which may suggest that bulking injections treat sphincteric deficiency better than hypermobility.
Concluding message
The success rate of Bulkamid® injection as salvage therapy was significantly lower than reported in the literature as a primary therapy. Further prospective studies of Bulkamid® are in process for patients with recurrent SUI.
Figure 1 Table 1. Outcomes of Bulkamid® injections for recurrent SUI
Funding None Clinical Trial No Subjects Human Ethics Committee Audit department of our hospital Helsinki Yes Informed Consent Yes

Continence 2S2 (2022) 100343
DOI: 10.1016/j.cont.2022.100343

16/06/2024 07:57:42