Bulkamid® Injections

What is Bulkamid?

Bulkamid is a soft, water-based gel injected into the wall of your urethra, the tube that carries urine out of your body. It's designed to stay in place long-term, adding bulk to the tissue so your urethra can close more fully and stop leaks.

What conditions does it treat?

Bulkamid treats stress urinary incontinence (SUI), which happens when you leak urine because of extra pressure on your bladder, for example when you exercise, cough, laugh or sneeze. This is usually caused by weakened muscles in your pelvic floor, or a weakened muscle at the neck of your bladder.

What are the benefits of having Bulkamid?

Bulkamid is a minimally invasive treatment. It can be done under local anaesthetic in around 10 to 15 minutes, which can suit you well if a general anaesthetic isn't an option for you, or if you want a quicker recovery.

Are there different types of approaches?

Bulkamid injections can be given under local, spinal or general anaesthetic, and this affects where your procedure happens. Choosing local anaesthetic means your procedure may take place in an outpatient clinic or in theatre, depending on what's available. Choosing spinal or general anaesthetic means your procedure will always take place in theatre.

What happens before the operation?

Before Bulkamid is offered, you'll usually have a test called urodynamics, done in an outpatient clinic, which gives your doctor more information about how your bladder works. Your case is then discussed at a multidisciplinary team meeting to check Bulkamid is the right option for you.

Current guidance recommends trying conservative measures for around 3 months before surgery, including:

• lifestyle changes and weight management
• fluid intake advice
• pelvic floor muscle training.

You can choose to decline these and go ahead with Bulkamid instead.

Once you've given your consent, you'll be placed on a waiting list. How long you wait can depend on whether you've chosen local, spinal or general anaesthetic. If you often get urine infections, your GP may prescribe antibiotics beforehand to help stop an infection developing and reduce the chance of your procedure being cancelled.

On the day, your surgeon will confirm the procedure with you and ask for your consent. You'll have a quick urine test to check you don't have an infection, then be asked to change and lie on a couch ready for the injections.

What happens during the procedure?

1. You're given your chosen anaesthetic. For local anaesthetic, this means a small needle plus a gel placed inside your urethra.
2. Your surgeon passes a thin telescope (a cystoscope) through your urethra into your bladder, using sterile water to help them see clearly.
3. Guided by the telescope, your surgeon places 3 to 4 injections of Bulkamid gel along the wall of your urethra. You might feel a brief, sharp scratch each time.
4. The gel adds bulk to the tissue straight away, helping your urethra close more fully.
5. The sterile water used during the procedure passes out naturally the next time you go to the toilet.

Under local anaesthetic, the whole procedure usually takes 15 to 20 minutes.

What does recovery look like?

In hospital, you'll be asked to pass urine successfully before you're allowed home. If you've had local anaesthetic in an outpatient clinic, your appointment usually takes 1 to 3 hours in total and you go home the same day. If you've had a general or spinal anaesthetic, you'll recover in the access lounge, and while staying overnight is possible, it isn't usual after Bulkamid. You may be given antibiotics to take before you leave.

At home, you may feel some discomfort at first, but this usually settles quickly. For the first 10 days, avoid using tampons and avoid sexual intercourse. You'll have a telephone follow-up with a urogynaecology specialist nurse to talk through your recovery, your symptoms and any questions you have.

What are the risks and complications?

Common, usually short-lived effects include:

• a burning or stinging feeling when passing urine
• some discomfort, which soon settles
• minor bleeding.

Less common risks include:

• your bladder not emptying fully at first, which may need a short period of self-catheterisation (this can be taught to you before or after your injections)
• a urinary tract infection.

Individually, rare after-effects occur in fewer than 1 in 250 patients, though how much they affect you can vary from person to person. It's worth asking your surgeon about the risks that matter most to you.

Bulkamid isn't suitable for everyone. It shouldn't be used in men, in anyone with a current urine infection, or in anyone with an uncorrected narrowing (a stricture) of the urethra. If you're on medication that suppresses your immune system, or you have an autoimmune condition, your surgeon will take extra care in discussing whether it's right for you.