Urethral Bulking Injection (Bulkamid)

What is urinary stress incontinence?

Urinary Stress Incontinence (USI) is when you leak urine when increased abdominal pressures occurs, such as exercising, coughing, laughing or sneezing.

USI can occur when there are weak muscles in the pelvic floor or a weakened sphincter muscle at the neck of the bladder.

What is Urethral Bulking Injection (Bulkamid)?

Bulkamid is the injection of a smooth, water-based gel into the walls of the urethra at 3 to 4 different sites in order to improve the volume of the neck of the bladder and prevent leakages of urine. This substance remains in the body over time.

In order to inject bulkamid, a small microscope will pass through your urethra into the bladder in order to visualise where the injections should be administered. Sterile water is used to flush this scope which will later be passed by yourself when on the toilet.

What happens at the hospital?

Once your consent has been obtained to proceed with the Bulkamid treatment, you will be placed on a waiting list. Waiting list times can vary depending if you have chosen to have a general anaesthetic, spinal anaesthetic or local anaesthetic.

For general or spinal anaesthetic, you will have your procedure in the theatre setting. This will require you to attend the access lounge on the day of your procedure. This is where you are admitted, see the nurses and doctors and will wait until you are called for your procedure.

Once the procedure is completed in theatre, you will return here to recover and pass urine successfully before going home. In some cases, you may have to stay overnight but this is generally no the case with Bulkamid.

You may have to attend Access Lounge at a required time and have a wait before being called for your procedure.

If you have chosen to have the procedure done with local anaesthetic, you may also have your procedure completed in theatre or in the outpatient setting depending on availability. In the outpatient setting, you will attend at your required appointment time.

There you will have your procedure done under the care of the doctor and nurses. You will need to pass urine before leaving the clinic. This appointment can usually take 1 to 3 hours.

You will have a telephone follow up review with the Urogynaecology specialist nurse. At this appointment you can discuss your recovery, symptoms and any questions that you may have.

What are the advantages of having Bulkamid Injections?

Bulkamid is a minimally invasive procedure which can be done under local anaesthetic and usually takes around 10 to 15 minutes to complete. This can be an advantage for many women who are unable to have general anaesthetics or who need quick recovery times for different reasons.

What are the associated risks?

There is risk that patients who have Bulkamid for treatment of urinary stress incontinence will see some improvement but the benefits will likely wear off. This may require repeat injections.

There is also limited information on complications, especially long term. Women can also have a burning or stinging sensation when passing urine but this was usually for a short period of time after the injections.

As the injections aim to help relieve the symptoms of stress incontinence, there is also a risk that patients are unable to pass urine or fully empty their bladder. This may require self-catheterisation which will be taught to you before your injections if requested, or after if required.

Are there any alternative treatments?

NICE guidelines recommends that patients with urinary stress incontinence undergo conservative measures such as lifestyle changes, weight management and fluid education as well as pelvic floor muscle training for a period of 3 months before proceeding with further treatments. These options can be declined by yourself.

There are also alternative surgical options such as colposuspension and autologous fascial sling. More information on these surgical options can be requested.

Mid-urethral mesh sling operations are currently not being offered due to a national pause.

It is important to remember there is the option of having no treatment and managing your symptoms.

Before proceeding with Bulkamid, you will have a test called Urodynamics, this is completed in the outpatient setting and gives your doctor more information regarding your bladder.

Your case and urodynamic assessment will be discussed at an MDT (multidisciplinary team meeting) to ensure Bulkamid is the best treatment option for you.

Associated leaflets and References

• International Urogynaecology Association (Stress Urinary Incontinence)

• International Urogynaecology Association (Pelvic Floor Exercises)

• International Urogynaecology Association (Intermittent Self Catheterisation)

• International Urogynaecology Association (Cystoscopy)

• British Society of Urogynaecology Association – Urethral Bulking to treat Stress Urinary Incontinence; https://bsug.org.uk/budcms/includes/kcfinder/upload/files/info-leaflets/Urethral-bulking-BSUG-Mar-2018.pdf

• NICE – Surgery for stress urinary incontinence Patient Decision Aid; https://www.nice.org/guidance/ng123/resources/surgery-for-stress-urinary-incontinence-patient-decision-aid-pdf-6725286110

• International Urogynaecology Association – Urethral Bulking for Stress Urinary Incontinence; https://www.yourpelvicfloor.org/conditions/urethral-bulking/

• Bulkamid: A long lasting treatment for stress urinary incontinence; https://bulkamid.com/patients.what-is-bulkamid

Contact numbers

Urogynaecology Secretary

01642 624 216

Tuesday to Thursday; 8am to 4pm

Friday; 8am to 1pm

Gynaecology Secretaries

01642 383 838

Monday to Friday; 8am to 4pm

Urogynaecology Specialist Nurse

07760 554 010

Monday to Friday; 8am to 4pm

Please be aware these are not emergency lines and any urgent medical attention or query should be addressed with 111 or 999.

Further Information

• The British Society of Urogynaecology (BSUG) https://busg.org.uk/

• Home | RCOG https://www.rcog.org.uk/

• www.yourpelvicfloor.org/leaflets

• https://bulkamid.com/patients/what-is-bulkamid

• https://www.nhs.uk/conditions/urinary-incontinence/surgery/

Comments, concerns, compliments or complaints

Patient Experience Team (PET)

We are continually trying to improve the services we provide. We want to know what we’re doing well or if there’s anything which we can improve, that’s why the Patient Experience Team (PET) is here to help. Our Patient Experience Team is here to try to resolve your concerns as quickly as possible. The office is based on the ground floor at the University Hospital of North Tees if you wish to discuss concerns in person. If you would like to contact or request a copy of our PET leaflet, please contact:

Telephone: 01642 624719

Freephone: 0800 092 0084

Opening hours: Monday to Friday, 9:30am to 4:00pm

Email: [email protected]

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Out of hours if you wish to speak to a senior member of Trust staff, please contact the hospital switchboard who will bleep the appropriate person.

Telephone: 01642 617617

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Telephone: 01642 383551

Email: [email protected]

Leaflet feedback

This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:

Email: [email protected]