Periurethral injection of Bulkamid® for neurogenic vs. non-neurogenic female patients with stress urinary incontinence.

INTRODUCTION

Data on bulking agents for stress urinary incontinence (SUI) in neurogenic patients remain limited, especially regarding polyacrylamide hydrogel (PAHG, Bulkamid®), now commonly used. This study evaluates the efficacy, safety, and tolerability of Bulkamid® in neurogenic women with SUI.

METHODS

From January 2020 to January 2025, we prospectively analyzed women undergoing periurethral Bulkamid® injections at a single center. Outcomes in neurogenic patients were compared to those without neurological disease. All procedures were performed outpatient under local anesthesia.

RESULTS

Fifteen neurogenic and 91 non-neurogenic women underwent treatment. Among neurogenic patients, 73.3% (11/15) reported improvement at 3 months (PGI-I). Four experienced transient acute urinary retention (27%). Self-catheterization was required in 3 patients; 2 remained unchanged post-procedure, and 1 improved. After a median 7-month follow-up, 66.7% of neurogenic patients remained dry or showed improvement. Complication rates were comparable between groups (20 vs. 27%, P=0.50). Treatment efficacy at 3 months was also similar (66.7% neurogenic vs. 63.3% non-neurogenic improved or very much improved; P=0.88).

CONCLUSION

Bulkamid® shows comparable safety and efficacy in neurogenic and non-neurogenic women with SUI. However, benefits in patients performing self-catheterization remain uncertain and warrant further investigation.