Urethral bulking for stress incontinence
Stress Urinary Incontinence (SUI) is leakage of urine occurring on physical exertion. It may occur when coughing or sneezing, walking or exercising. It is caused by a weak sphincter (a muscle at the bladder neck), or by poor support to the bladder neck from the pelvic floor muscles and ligaments.
Why am I being offered urethral bulking
Exercises for the pelvic floor muscles is used as the first line of treatment for stress 8incontinence, and you may already have tried this. If the leakage continues and remains a problem despite pelvic floor exercises, then surgery may be required. You may also be offered surgery for other conditions such as prolapse at the same time. Mr Alak Pal will discuss this further with you.
What is urethral bulking
Urethral bulking is a surgical procedure for stress urinary incontinence. A bulking material such as collagen is injected surrounding the urethra close to the bladder neck helping it to stay closed when you are physically active, coughing or sneezing.
What are the benefits
Urethral bulking may not completely cure stress urinary incontinence but will improve it. About half of the women who have this treatment feel that they are cured of stress incontinence. Some patients find that one treatment is not enough to stop the leakage. If this is the case, a second treatment after 4-6 weeks may be required. In some, the effects wear off after a few years and they require further injections.
What will happen before surgery
A urodynamic assessment of bladder muscles is carried out before surgery for stress incontinence. This is a test to find out the cause of your bladder problems and to see how well your bladder empties. It involves filling your bladder with water via a thin tube in your bladder which is removed as soon as the test is over.
How is the surgery performed
A small camera is passed along the urethra and the bulking material is injected using a very fine needle through this into the walls of the urethra in 3-4 places. This can be done under local anaesthesia or under general anaesthesia in an operating theatre.
What will happen after surgery
We will ask you to pass urine before you leave the hospital. If you have difficulty passing urine the nurse may need to pass a catheter to empty your bladder. This catheter may be left in for a short period of time, typically a few days to a week. You will be allowed to go home with the catheter.
Risks and side effects of continence surgery
Voiding difficulty: Approximately 5% of women may have some difficulty in emptying the bladder in the short term and if this happens, we may send you home with a catheter for up to a week. If you still have difficulty emptying your bladder after 10 days, then we may need to teach you how to empty your own bladder with a small catheter.
Bladder overactivity: Any operation around the bladder has the potential for making the bladder overactive, leading to symptoms such as urgency (needing to rush to the toilet) and frequency (needing to visit the toilet more often than normal).
Try to drink 1½-2 litres (3-4 pints) of fluid each day, mostly plain water.
Avoid things that may irritate your bladder, such as tea, coffee, fizzy drinks, alcohol, very acidic juices, chocolate, tomatoes.
Keep your bowels regular by eating plenty of fruit and vegetables, wholemeal bread and cereals. Constipation can affect your bladder emptying.
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Patient seen for : Dilation and Curettage
Dr Alak Pal was great. He made me feel comfortable and explained everything clearly, including next steps. Would recommend.
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Patient seen for : Total Abdominal Hysterectomy
From the initial appointment, surgery, aftercare and to my final appointment, Mr Pal was extremely professional and understanding to my particular medical circumstances. The entire abdominal hysterectomy procedure was extremely satisfactory. He spent time listening to any concerns that I had and explained clearly and simply the process surrounding the surgery. I would highly recommend him for anyone contemplating such a procedure. Additionally, post-surgical care and appointments were excellent too.
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