Urinary incontinence (UI) affects approximately 51–53% of women and 14% of men in the United States, with risk factors including age, race/ethnicity, obesity, diabetes, and chronic disease1. Around 16% of women experience mixed urinary incontinence (MUI), significantly impacting quality of life. Intravesical onabotulinumtoxinA (Botox®) is effective for urgency urinary incontinence (UUI), while polyacrylamide hydrogel (Bulkamid®) has shown efficacy in stress urinary incontinence (SUI). Although both modalities are used for MUI, limited data exist on their combined use in Hispanic women. This study evaluates the efficacy of synchronous intravesical Botox® and Bulkamid® injections in Hispanic women with MUI.

We retrospectively reviewed female patients who underwent combined intravesical Botox® (100 units) and periurethral Bulkamid® injections in a single operation for MUI between January 2024 and August 2025. Data included demographics, body max index (BMI), prior incontinence interventions, overactive bladder (OAB) medications, and pre- and postoperative postvoid residual (PVR). The primary outcome was self-reported complete symptom resolution 3–5 weeks post-procedure.

Twenty-five patients were analyzed. Mean age at the time of the procedure was 57.2 years, 80% were Hispanic, and mean BMI was 34.2 kg/m2. Thirty-five percent had predominant SUI, 40% predominant UUI, and 28% had equally bothersome MUI. Sixteen percent had prior intravesical Botox®, 12% pelvic floor physical therapy (PFPT), and one had a sacral neurostimulator. All used OAB medications prior to the procedure, with 32% reporting partial benefit. Mean preoperative PVR was 15.4 mL; 48% had a positive stress test. One patient developed transient postoperative urinary retention. Sixty percent achieved complete symptom resolution at 3–5 weeks, however the remaining 40% reported persistent but improved symptoms with no significant bother. Mean postoperative PVR was 65.9 mL. Thirteen percent needed to restart OAB medications; 4% required repeat Botox®, 4% combined Botox® + Bulkamid®, and 4% additional Bulkamid® therapy and PFPT. At the 3-5 month follow up, 29% of the complete responders remained asymptomatic, however, 50% of these patients needed re-treatment with Botox® at 12 months.

Combined intravesical Botox® and periurethral Bulkamid® injections appear to provide meaningful short-term symptom improvement in women with mixed urinary incontinence, including the Hispanic population. The high rate of complete resolution or non-bothersome residual symptoms suggests this synchronous approach may effectively address both urgency and stress components in selected patients. Although postoperative PVR increased and some patients required retreatment over time, the low complication rate and reduced need for ongoing OAB therapy support the clinical utility of this strategy.

Synchronous intravesical Botox® and periurethral Bulkamid® injections appear to be effective for Hispanic women with MUI, yielding 60% complete symptom resolution within 3–5 weeks, and providing long term symptoms control for some patients. An 87% were able to discontinue OAB medications. Although PVR increased postoperatively, its clinical impact remains uncertain. Larger randomized studies are warranted to confirm the safety and efficacy of this combined approach.

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