Synopsis

Polyacrylamide Hydrogel (Bulkamid®) Bladder Neck Augmentation for Urodynamic Stress Incontinence of Urine

Urodynamic Stress Incontinence

It is the unwanted loss of urine on effort, exertion or a physical stress, such as coughing, sneezing, laughing, lifting heavy objects or physical exercise. The diagnosis is confirmed by urodynamic testing. There are many causes of stress incontinence, all of which result from a lack of pelvic floor support of the bladder neck.

Polyacrylamide hydrogel (Bulkamid®)

It is a bulking agent (polyacrylamide hydrogel, made of 97.5% water and 2.5% cross-linked polymer), shown to be biocompatible, micro-particle free and migration resistant.

The technique

The bulking agent is injected into the tissue around your urethra or bladder neck making the tissue thicker and therefore closing your usually open bladder neck. The procedure is performed in the operating theatre, usually under general anaesthetic, occasionally under local anaesthetic with sedation.

Before the operation a urine sample must be tested. If any infection is present, it needs to be treated and the procedure rebooked.

You will be given antibiotic cover to minimise the risk of a urine infection.

If a local anaesthetic is to be used you will come to the operating theatre after emptying your bladder and some local anaesthetic gel will be placed into your urethra or injected around the urethra. A small telescope and camera will be used to locate where the agent is needed, and it is injected using a special implantation needle via the telescope.

The procedure takes about 15 minutes.

After your operation

Most patients have no difficulty passing urine immediately after the operation, but it may take 24 to 48 hours until you are emptying your bladder normally.

A small amount of bleeding is usual after the operation. It should settle within 3 days.  Pain killers may be needed after the operation. Please check that you have simple painkillers at home such as paracetamol. The discomfort should settle within 3 days.

Healing

It takes approximately 6 weeks for the implant to fully settle. We suggest not having sexual intercourse until the end of 6 weeks.

Follow up

A clinic appointment will be arranged so that the results of the procedure can be assessed.

 

Complications

 

Complications do occur, but not very commonly and include:

• A small amount of bleeding is usual after the operation. It should settle within 3 days.
• Pain or discomfort. Please check before you come into hospital that you have some paracetamol (or equivalent) at home.
• Difficulty emptying the bladder – a few patients will have a temporary difficulty and may require a catheter on the ward. If you cannot empty your bladder properly you may have to go home with a catheter draining the bladder.

Please don’t be alarmed by this, it is very unusual and the requirement for a catheter is usually for few days only.

• Urgency – where the bladder feels irritated: this is usually a temporary problem: prolonged urgency is unusual.
• Urinary infection – may occur in up to 6% of patients and is treated by antibiotics and an adequate fluid intake.
• Improvement rather than cure. It is often possible to inject a bit more polyacrylamide hydrogel (Bulkamid®) after few months.
• Treatment failure – you may need to be investigated with fresh Urodynamic tests and treatment decided on the basis of these.