Bladder neck bulking injection Information for patients Gynaecology
What is a bladder neck bulking agent? It is a treatment option for stress urinary incontinence in women. What are the benefits of this treatment? This treatment is suitable for women where major surgery is not an option, when surgery has not been successful, in women who may accept an improvement in symptoms rather than cure and for women who have not completed their family or have not yet had any children. The cure rate for this treatment is around 40-50% and the reported improvement rate is 60-80%. What are the risks of having this treatment? This is usually a safe procedure but, as with any treatment, there are risks and these include: Difficulty emptying your bladder following the treatment (about 10%). This usually resolves within the first 24 hours and is unlikely to be a long-term problem. Some women may need to use a catheter which allows the bladder to empty continuously. Alternatively, you may be taught how to use an 'in and out' catheter (self-catheterisation) which is performed intermittently until the problem is resolved. Discomfort or pain while passing urine. This usually resolves within the first 24 hours and can be relieved with simple pain relief. Blood when passing urine (haematuria). This usually resolves within the first 48 hours. Infection may occur in your urinary tract. A repeat injection may be required at a later date to achieve a better result. page 2 of 8
As with any procedure we must seek your consent beforehand. Staff will explain the risks, benefits and alternatives where relevant before they ask you for your consent. If you are unsure about any aspect of the procedure or treatment proposed, please do not hesitate to ask for more information. How is it done? In Sheffield, we use a bulking agent named Bulkamid. This is a polyacrylamide gel. The gel is injected into the tissues around the base of the urethra (the tube through which urine passes from the bladder). This adds volume to the tissues surrounding this tube to help reduce the bladder opening. This treatment can be done using a local anaesthetic (you are awake) in a clinic setting or under a general anaesthetic (you are asleep) in a theatre setting. The bladder neck with bulking injection page 3 of 8
What are the alternatives? Alternative surgical options include synthetic tape operations (TVT), a colposuspension or an autologous fascial sling. They all have different risks and benefits. The doctor or nurse will discuss each option with you and provide you with the relevant information leaflets. How can I prepare for my treatment? If your treatment is to be carried out using a local anaesthetic in clinic then you do not need to take any special precautions. If your treatment is to be performed under a general anaesthetic, then please read the information leaflets provided at your outpatient and pre-operative assessment appointments. They will provide you with useful information so that you know what to expect during your admission to hospital. It is important that you tell us of any health problems you have and any medication you take. Please continue with any medication unless otherwise advised. To make sure that you are in the best possible health before you have your operation, you should: If you are a smoker, try to give up or cut down Lose weight if advised Eat a well-balanced diet Try to stop or cut down on drinking alcohol It is very important that you do not have sexual intercourse in the month that your surgery is planned unless you use barrier methods of contraception page 4 of 8
What will happen before my operation? You may be asked to attend the pre-operative assessment clinic on the day of your gynaecology clinic appointment or an appointment will be arranged approximately 5-10 days before your operation. At this clinic you will see a nurse practitioner and possibly an anaesthetic doctor. A physical examination and blood tests will be carried out and any other investigations that are necessary for your operation to go ahead. When will I be able to go home after my operation? You would be expected to be able to go home on the same day. A few hours after the treatment you will be encouraged to go to the toilet to pass urine. The nurse will then check that you are emptying your bladder efficiently following the treatment. When can I return to normal activities? Most women are able to resume normal work and daily activities within 1 day after the treatment. You should avoid heavy lifting and strenuous physical exercise and sexual intercourse for 2-3 weeks following the treatment. Is there anything I should look out for when I go home? You should contact your GP or the Gynaecology Outpatient Department if you have any of the following: Difficulty or pain when passing urine (24 hours after treatment) Blood in urine (48 hours after treatment) You begin to feel feverish or unwell Pain that is not controlled with paracetamol or ibuprofen (simple pain relief) page 5 of 8
Will I have a follow up appointment? Yes, you will be seen in the Gynaecology Clinic in approximately 3 months following the treatment. Who can I contact if I have any questions? If you need any further information then please do not hesitate to contact: Urogynaecology Specialist Nurse: 0114 226 8441 Gynaecology Outpatient Clinic: 0114 226 8441 Gynaecology Ward G2: 0114 226 8367 (after the operation) page 6 of 8
Further information Urinary Incontinence (NHS Choices) www.nhs.uk/conditions/urinary-incontinence Bulkamid www.bulkamid.com page 7 of 8
Produced with support from Sheffield Hospitals Charity Working together we can help local patients feel even better To donate visit www.sheffieldhospitalscharity.org.uk Registered Charity No 1169762 Alternative formats can be available on request. Please email: alternativeformats@sth.nhs.uk Sheffield Teaching Hospitals NHS Foundation Trust 2018 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Email infogov@sth.nhs.uk PD7494-PIL3067 v3 Issue Date: May 2018. Review Date: May 2021