Macroplastique injection for stress urinary incontinence

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1 Macroplastique injection for stress urinary incontinence Information for patients This information sheet answers some of the questions you may have about having a Macroplastique injection. It explains the benefits, the risks and the alternatives of the procedure as well as what you can expect when you come to hospital. If you have any questions or concerns, please do not hesitate to speak to the doctors or nurses caring for you. What is stress urinary incontinence? Stress urinary incontinence is the sudden, accidental loss of urine when you do everyday things such as coughing, sneezing or laughing. It happens when the pressure inside your bladder as it fills with urine becomes greater than the strength of your urethra (the tube through which urine passes out of your body) to stay closed. Your urethra may not be able to stay closed if your pelvic floor muscles are weak or damaged, or the ring of muscle that keeps the urethra closed is damaged. What is Macroplastique? Macroplastique is a type of material called a bulking agent, which is used to treat stress urinary incontinence. It is made up of two parts:

2 water-soluble gel that is absorbed into your body and removed in your urine rubber-like, silicone material that is permanent and stays in your body, and causes the bulking effect around your urethra. It is injected into the tissues surrounding your urethra. The increased bulk allows your urethra to close more effectively and prevents urine from leaking. It does not close your urethra totally so it can still open normally to allow you to urinate. Why do I need this procedure? You have been diagnosed with stress urinary incontinence. Depending on how severe your condition is, we may suggest you first try pelvic floor muscle exercises to improve your symptoms (see under what are the alternatives) If these exercises do not work, we may offer you Macroplastique. What are the benefits? Most women treated with Macroplastique report that it cures or improves their symptoms; many say they feel better as soon as they leave the ward. About 60% say that their condition has been cured or their symptoms have been improved up to two years after the procedure. You do no need to have a general anaesthetic for this procedure you can have it with just a local anaesthetic injection. This means that we can offer it to you if you cannot have other types of stress incontinence surgery. What are the risks? As with any treatment, there are some risks. It is important to discuss these risks and side effects with your doctor before the procedure. Most patients have no problems after a Macroplastique injection. The following complications can sometimes happen after the procedure: 1. Mild stinging or burning feeling when you urinate You should get this for only a day or two. Taking an ordinary painkiller such as paracetamol or ibuprofen will help ease any pain. You may develop a urinary infection and need to take antibiotics. 2. Very small amount of blood in your urine

3 Any bleeding usually stops within 24 hours. Very rarely you may need to come back into hospital for more treatment. If you keep bleeding for more than 48 hours or you have large blood clots which are difficult to pass, contact our Urogynaecology Department or your own GP for advice straight away. 3. Bladder infection (cystitis or urinary tract infection) Symptoms include stinging in your urethra, the need to pass urine more often, pain in the lower part of your tummy or just feeling generally unwell. If these do not go away, please see your GP. 4. Difficulty urinating If you find it difficult to pass urine after the procedure, we may need to put a catheter into your urethra to help you empty your bladder. You will have this in for a few days only. You can go home and then return to hospital to have the catheter taken out. 5. The procedure may not work No operation for stress urinary incontinence works for everyone Are there any alternatives? There are a number of other treatments for stress urinary incontinence. These include: Pelvic floor muscle training Your pelvic floor is a broad sling of muscle which stretches like a hammock from your pubic bone in the front, to the bottom of your spine at the back. These firm, supportive muscles help to hold your bladder, womb, vaginal walls and bowel in place. They close your bladder outlet (urethra) and your back passage (anus) to stop urine, faeces and wind/gas leaking out. When these muscles are weak, you may start to leak urine, or find it difficult to control wind or hold on when you need to open your bowels; in some cases your pelvic organs can drop down. You may leak urine because of a weakness in your pelvic floor muscles which is usually caused by childbirth, heavy lifting or constipation. These muscles can also become weaker during the menopause. It is important to do pelvic floor muscle exercises regularly to build them up and prevent urine from leaking. Depending on how severe your stress incontinence is, you may find pelvic floor muscle exercises are enough to improve your symptoms. Colposuspension This involves having stitches put in to support the neck of your bladder so it cannot move about and cause stress urinary

4 incontinence. It is usually done through a cut in your bikini line. But it is major surgery that means you need to stay in hospital for two three days and it will take about six eight weeks to recover. Intra-vaginal devices You can have a small device called a vaginal pessary, which is similar to a diaphragm or a cervical cap, put in to your vagina to hold prolapsed organ(s) in place. It is also used for stress urinary incontinence. Pessaries must be fitted individually and you may need to try a few different shapes and sizes before you find one that feels comfortable and stays in place. Tension-free vaginal tape This involves putting a synthetic tape through a small cut in your vagina. The tape is looped around the outside of your urethra and the two ends come out through two very small cuts on your pubic area and are then trimmed. The tape does not dissolve and stays inside you forever. You can have this procedure as day surgery. This is a smaller operation than colposuspension and you recover more quickly. Consent We must by law obtain your written consent to any operation and some other procedures beforehand. Staff will explain the risks, benefits and alternatives before they ask you to sign a consent form. If you are unsure of any aspect of the treatment proposed, please do not hesitate to speak with a senior member of the staff again. Do I need to prepare for the procedure? You do not need to prepare for the procedure, but please let us know if you have an infection or any inflammation in your kidneys, bladder, urinary tract or vagina. This must be treated before you have Macroplastique injected. Your doctor or nurse will test your urine before the procedure to make sure you do not have a urinary tract infection. Your doctor will also check the tissue around your urethra. If it does not look healthy you cannot have the procedure. If you are having another procedure at the same time, you may need to come in for a pre-assessment appointment. Where will I have the procedure?

5 You usually have it as an outpatient in the Gynaecology Ambulatory Unit. What happens during the procedure? Your doctor will ask you to lie down on your back. They will clean your genitals with a mild disinfectant and put a paper sheet around the area. Try not to touch the area with your hands. They will lubricate and partly numb your urethra using an anaesthetic gel. This may sting a little for a short time. They inject more anaesthetic into the tissues surrounding your urethra. They then inject the Macroplastique. The extra bulk of the Macroplastique helps your urethra to close more effectively and stops urine from leaking. Will I feel any pain? The procedure is uncomfortable but it should not be painful. The local anaesthetic jelly should partly numb the area. You will be able to speak to your doctor or nurse during the procedure and ask them to stop if it becomes too painful. You do not usually get any pain afterwards. How long will it take? It usually takes about 20 minutes. What happens after the procedure do I stay in hospital or go home? You usually stay in the ambulatory unit until the anaesthetic has worn off and you can urinate normally. If you find it difficult, we may put in a catheter until you can urinate normally. About 80% of patients go home with a urinary catheter. You come back to the ambulatory service after two days to have the catheter removed. We may give you a prescription for antibiotics to prevent infection. It is important to take them to reduce your risk of a urinary tract infection. You can go back to your normal daily activities and return to work within a few days.

6 What happens if I need another procedure at the same time? You may have Macroplastique injected at the same time as you are having another procedure such as a cystoscopy or a prolapse repair under a general anaesthetic. If so, you will have a pre-assessment appointment before your surgery to check you are well enough to have the procedures. What happens at pre-assessment appointment? You may have tests such as blood tests, an electrocardiogram (ECG) to check your heart and a chest x-ray. The pre-assessment nurse will explain what happens during your operation and the care you need afterwards. You will also see the medical team to complete a consent form. You will have the chance to talk to them about the procedure and ask questions. What happens at pre-assessment appointment? If you are a patient of Professor Cardozo or Mr Robinson, we will ask you to come to your pre-assessment appointment on the Monday or Thursday before your surgery. If you live a long way from the hospital or have certain medical problems (such as diabetes), you will stay in overnight and have your planned surgery the next day (Tuesday or Friday). Otherwise you will be admitted on the morning of your surgery. The pre-assessment nurses will give you all the details you need. If you are a patient of Mr Bidmead or Miss Srikrishna, you will have your pre-assessment on the Thursday or Friday before your surgery. You will usually be admitted on the morning of your operation. How long will I need to stay in hospital? This depends on what other procedures you are having. We will discuss this with you at your pre-assessment appointment. What should I do if I cannot attend my appointment? Please contact the gynaecology admissions team. Tel:

7 Who do I contact with queries and concerns? If you have any problems within hours of leaving hospital, please call Katherine Monk ward and ask to speak to the ambulatory nurse or the nurse in charge of the ward. Tel: If you have any problems after 48 hours, please contact your GP. If you need urgent medical attention, go straight to your local Emergency Department (ED/A&E). If you have any other queries or concerns, please phone the Urogynaecology Department. Tel: , 9am 5pm, Monday to Friday. Sharing your information We have teamed up with Guy's and St Thomas' Hospitals in a partnership known as King s Health Partners Academic Health Sciences Centre. We are working together to give our patients the best possible care, so you might find we invite you for appointments at Guy's or St Thomas'. To make sure everyone you meet always has the most up-to-date information about your health, we may share information about you between the hospitals. Care provided by students King s is a teaching hospital where our students get practical experience by treating patients. Please tell your doctor or nurse if you do not want students to be involved in your care. Your treatment will not be affected by your decision. PALS The Patient Advice and Liaison Service (PALS) is a service that offers support, information and assistance to patients, relatives and visitors. They can also provide help and advice if you have a concern or complaint that staff have not been able to resolve for you. The PALS office is located on the ground floor of the Hambleden Wing, near the main entrance on Bessemer Road - staff will be happy to direct you.

8 Tel: Textphone: Fax: If you would like the information in this leaflet in a different language or format, please contact PALS on Corporate Comms: 0657 PL612.1 October 2013 Review date October 2016

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