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Operations: Therapeutic injection into bladder neck, including cystoscopy.

Insurance code: M5630

Introduction: This information is written by John Fairbank and is provided for the benefit of his patients. Additional information will be given during consultation in the clinic and during the pre-operative discussion. It is not appropriate for all surgeons’ individual practice or for all patients.

Purpose of operation: This operation is carried out to help urinary incontinence.

Description of procedure: The bladder is inspected with a cystoscope. The bladder neck is injected in several places with a collagen type material which bulks up the peri-urethral tissue and increases the resistance to the flow of urine. The procedure is covered with anti-biotics.

Anaesthetic: This operation is usually carried out under a light general anaesthetic.

Length of stay: The length of stay depends on how quickly bladder function returns to normal but an overnight stay is typical.

Post-operative management: Patients will be encouraged to drink freely and pass urine when the bladder feels full. Provided good volumes of urine are passed a catheter assessment of residual volumes is not required.

Potential complications
Complications at the time of surgery include peri-operative bleeding, and damage to structures such as the bladder or urethra. These complications are rare but require corrective surgery immediately or as soon as a problem is recognised. Venous thrombosis (DVT) can follow any pelvic surgery. Stockings are therefore worn. Early mobilisation and early discharge from hospital reduce the risk of thrombosis. Bladder related complications can occur and include urinary urgency, urge incontinence, incomplete voiding and recurrent urinary tract infections. If incomplete bladder emptying is recognised in the first 48 hours a gentle dilatation of the urethra can be carried out under general anaesthetic to make it easier for urine to flow. This is required in less than 1% of cases. One of the long term complications is the slow recurrence of leakage after an initial good response. A second injection is then sometimes required.

Post-operative consultation
A routine appointment is normally booked for three weeks or three months following surgery to ensure the operation has been successful

Other considerations
Sex is best avoided for three days to allow the injection site to settle. This operation has now been largely replaced by trans-obturator tape insertion and tension free vaginal tape procedures.

Relevant websites

Guidelines on management of urinary incontinence. Requires Adobe acrobat reader.

Good information from the Royal College of Obstetricians and Gynaecologists on surgery for urinary incontinence.