International Urogynecology Journal

, Volume 28, Issue 11, pp 1657–1661 | Cite as

Bulkamid (PAHG) in mixed urinary incontinence: What is the outcome?

  • Stefan MohrEmail author
  • Christine Marthaler
  • Sara Imboden
  • Ash Monga
  • Michel D. Mueller
  • Annette Kuhn
Original Article


Introduction and hypothesis

Mixed urinary incontinence (MUI), defined as mixed symptoms of stress urinary incontinence (SUI) and overactive bladder (OAB), is a difficult entity if conservative treatment has failed. Cure rates are low compared with SUI, particularly the OAB component, may deteriorate after sling insertion. Bulking agents pose an appealing alternative for the treatment of MUI. They have shown beneficial effect in small case studies, but larger series are lacking. The aim of this prospective study was an analysis of treatment efficacy and safety profile of the bulking agent, Bulkamid, in female patients with MUI.


One hundred fifty-four women with MUI symptoms (components of SUI/OAB within the limits of 60–40% either way) received bulking therapy with polyacrylamide hydrogel (Bulkamid). Patients were followed-up 3 months postoperatively. Primary outcome was the domain Incontinence impact on the King’s Health Questionnaire (KHQ). Secondary outcomes were the other KHQ domains, visual analog scale (VAS), and International Continence Society (ICS) standardized pad weight test as objective measurement of incontinence.


Statistically significant improvements were found for all KHQ domains, pad weight test, and the visual analog scale (VAS) before and after bulking. Overall complication rate was 13%.


This study has shown improvement in MUI after bulking therapy according to both subjective and objective outcomes. We can advocate bulking therapy for treating MUI, as it is simple and safe and shows both objective and subjective improvement and relief. Long-term results (up to 1 year) are awaited.


Bulking agent Bulking therapy Periurethral bulking Stress urinary incontinence Overactive bladder Mixed urinary incontinence 


Compliance with ethical standards

Conflicts of interest


Supplementary material

192_2017_3332_MOESM1_ESM.jpg (513 kb)
ESM 1 (JPEG 513 kb)


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Copyright information

© The International Urogynecological Association 2017

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyInselspital, Bern University Hospital, University of BernBernSwitzerland
  2. 2.Department of Obstetrics and GynecologyPrincess Anne HospitalSouthhamptonUK

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