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Using Bulkamid to Treat Stress Urinary Incontinence
June 16, 2021
A Middlesex Health urologist is treating stress urinary incontinence in a new way.
Dr. Dana Kivlin, medical director for the Middlesex Health Center for Continence & Pelvic Health, is treating some patients using Bulkamid, a hydrogel that can provide long-lasting relief of stress urinary incontinence symptoms. The use of Bulkamid, which was approved by the U.S. Food & Drug Administration in 2020, requires a minimally invasive surgical procedure. No incisions are made. Instead, a simple injection in the urethra is done at the level of the sphincter muscle and can result in significant improvement in incontinence.
Stress urinary incontinence is a common problem that impacts women of all ages. One in four women will experience this in their lifetime. Stress urinary incontinence is when urine leaks during moments of physical activity that increase abdominal pressure, such as when you cough, sneeze, laugh or exercise. It’s caused by a weakness in your pelvic floor and sphincter muscles, which prevent your urethra from closing fully when sudden pressure is placed on your bladder. Surgery is sometimes needed to correct the problem.
Bulkamid is made mostly of water and polyacrylamide to form a hydrogel. When it is injected, additional volume is added to the urethra to help keep it closed. The hydrogel acts as scaffolding for your body to deposit collagen, fibroblasts and healthy support tissue onto. As a result, women experience a relief in stress urinary incontinence symptoms.
There are few surgeons offering this option, but since May, Dr. Kivlin has used Bulkamid to treat about 20 patients. It is currently being offered as an outpatient surgical procedure at Middlesex Health, and the injections are administered under light sedation. It is covered by nearly all insurances.
The procedure takes about five to 10 minutes, and there is no down time after the procedure. Once the procedure is complete, there is a small risk of transient urinary retention, and this occurs in only 1 percent to 5 percent of patients. If this happens, a small catheter is used briefly to help empty the bladder. There is also a small risk of getting a urinary tract infection, which is why antibiotics are given the day of the procedure.
“Bulkamid is a low risk, high reward type of procedure,” Dr. Kivlin says. “It helps patients avoid more invasive procedures that come with longer recovery and higher risks.”
There are both non-surgical and surgical treatment options for those who have stress urinary incontinence. Your physician will discuss what option is best for you.
It is worth noting that this is not the first time a bulking agent has been used to treat stress urinary incontinence. Bulking agents have been used in the past, but the effect of these other bulking agents would often wear off quickly — within one to two years, or even as early as six months.
Bulkamid’s composition makes it different from other bulking agents. It is much more durable, Dr. Kivlin says, pointing to studies out of Europe that show efficacy for up to seven years. If needed, injections can be given, and patients can resume normal activity the following day.
Stress urinary incontinence can also be treated surgically using a urethral sling. During this procedure, a small piece of mesh is placed under the urethra to help restore support to the urethra. Dr. Kivlin sas it’s been considered the gold standard with a high cure rate, but it comes with more risks. It is a more invasive procedure that requires a longer recovery.