Bulkamid for Recurrent SUI After Suburethral Sling Revision: Single-Center Study

Postoperative stress urinary incontinence (SUI) following autologous or synthetic suburethral sling revision is underreported and can significantly affect quality of life. Polyacrylamide hydrogel (PAHG, Bulkamid) is a minimally invasive option with limited data in this population.

The objectives of this study were to evaluate the safety and efficacy of Bulkamid injections for recurrent or persistent SUI after suburethral sling revision and to identify factors associated with treatment response.

This was a retrospective, single-center, multisurgeon study including women treated from 2019 to 2024 with Bulkamid for persistent SUI or stress-predominant mixed urinary incontinence (MUI) after sling revision. Incontinence severity was assessed via pad use, validated questionnaires (Urogenital Distress Inventory-6 [UDI-6], Incontinence Impact Questionnaire-7 [IIQ-7]), and subjective patient report. Outcomes were analyzed using nonparametric and categorical statistical methods; significance was set at P<0.05.

Forty-one patients were included. Median follow-up after sling revision was 32.4 months and 8.3 months post-Bulkamid injection. Most patients underwent partial midurethral sling excision (90.2%) primarily for obstruction (56.1%). Median pad use decreased from 2 to 0 (P=0.01). Among 27 patients with paired UDI-6 scores, median total scores improved from 66.7 to 44.4 (P=0.005), particularly for urinary frequency and pain. Symptom improvement was significant in patients with SUI only (P=0.016) but not in patients with MUI (P=0.258). Two patients required subsequent pubovaginal sling placement, and 4 received intravesical botulinum toxin A. No predictors of repeat injection were identified.

Bulkamid injection is a safe and effective minimally invasive treatment for recurrent SUI after sling revision, with the greatest benefit in patients with isolated SUI and those receiving a single injection. Patients with MUI or prior synthetic slings may experience less improvement.