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Bulkamid — Polyacrylamide Hydrogel (PAHG)

Bulkamid is a polyacrylamide hydrogel (PAHG) — a soft, injectable, non-particulate bulking agent for female stress urinary incontinence. It has emerged as the best-evidenced and safest-profile bulking agent in contemporary practice.

Composition​

  • 97.5% sterile water + 2.5% cross-linked polyacrylamide polymer
  • Non-particulate homogeneous hydrogel — no microspheres or particles
  • Does not migrate (no particulate fragments to embolize)
  • Biocompatible, non-antigenic

Injection Technique​

  • Transurethral injection under direct cystoscopic visualization
  • 3 or 4 injection sites around the mid-urethra at the 2, 6, and 10 o'clock (or 3, 6, 9, and 12 o'clock) positions
  • Injected into the submucosal/periurethral plane until visible mucosal coaptation
  • Typical total volume: 1–3 mL
  • Outpatient procedure under local or MAC

Evidence​

  • Long-term success: 42–70% at multi-year follow-up[1][2]
  • Durable beyond 5–7 years in extended follow-up series
  • No reported erosions or migration — the distinguishing safety advantage
  • Low de novo urgency compared with other agents
  • Reinjection is straightforward if initial response wanes

Indications​

  • Primary surgical therapy for female SUI in patients who decline sling surgery
  • Second-line after failed sling in selected patients
  • Elderly or medically complex patients unable to tolerate sling surgery
  • Contemporary trend: Bulkamid increasingly offered as an alternative first-line option even in sling-eligible patients due to favorable safety

Guideline Endorsement​

The 2023 AUA/SUFU Guideline on Surgical Treatment of Female SUI endorses bulking agents (with Bulkamid as the preferred agent) as a valid non-sling option.[3]

References​

1. Gallo K, Weiner H, Mishra K. An Update on Surgical Management for Stress Urinary Incontinence. Current Opinion in Obstetrics & Gynecology. 2024;36(6):433–438. doi:10.1097/GCO.0000000000000989

2. Hoe V, Haller B, Yao HH, O'Connell HE. Urethral Bulking Agents for the Treatment of Stress Urinary Incontinence in Women: A Systematic Review. Neurourology and Urodynamics. 2021;40(6):1349–1388. doi:10.1002/nau.24696

3. Kobashi KC, Vasavada S, Bloschichak A, et al. Updates to Surgical Treatment of Female Stress Urinary Incontinence (SUI): AUA/SUFU Guideline (2023). Journal of Urology. 2023;209(6):1091–1098. doi:10.1097/JU.0000000000003435

See also: Macroplastique, Polypropylene Mesh.