What is the evidence base for this information?
This leaflet includes advice from consensus panels, the British Association of Urological Surgeons, the Department of Health and evidence based sources; it is, therefore, a reflection of best practice in the UK. It is intended to supplement any advice you may already have been given by your urologist or nurse specialist as well as the surgical team at Addenbrooke’s. Alternative treatments are outlined below and can be discussed in more detail with your urologist or specialist nurse.
What does the procedure involve?
This is a procedure to stop the effects of an overactive bladder using a toxin injected into the wall of the bladder under local anaesthetic.
What are the alternatives to this procedure
Drug treatment, bladder training, physiotherapy, bladder enlargement with a segment of bowel, sacral nerve stimulation, urinary diversion into a stoma.
What should I expect before the procedure?
You will usually be admitted on the day of your surgery. After admission, you will be seen by members of the medical team which may include the consultant, specialist registrar, junior doctors and your named nurse.
Please be sure to inform your urologist in advance of your surgery if you have any of the following:
- an artificial heart valve
- a coronary artery stent
- a heart pacemaker or defibrillator
- an artificial joint
- an artificial blood vessel graft
- a neurosurgical shunt
- any other implanted foreign body
- a prescription for Warfarin, Aspirin, Rivaroxaban, Dabigatran, Apixaban, Edoxaban or Clopidogrel, Ticagrelor or blood thinning medication
- a previous or current MRSA infection
- high risk of variant CJD (if you have received a corneal transplant, a neurosurgical dural transplant or previous injections of human derived growth hormone)
What happens during the procedure?
The procedure is performed under local anaesthetic and you will be given antibiotics to prevent infection in the urine. Some patients do not tolerate the procedure. If you get too much discomfort, we will stop the procedure and discuss the option of repeating it on a different day with a general anaesthetic.
The botulinum toxin is injected with the aid of a flexible telescope (cystoscope) passed into the bladder via the urethra (water pipe).
What happens immediately after the procedure?
You may experience some discomfort for a few days after the procedure but painkillers may be given to you to take home.
The procedure is done on a day case basis.
Are there any side effects?
Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.
Please use the check boxes to tick off individual items when you are happy that they have been discussed to your satisfaction:
Common (greater than one in 10)
- Blood in the urine
- Discomfort or infection in the urine
- Difficulty in emptying the bladder adequately, requiring the use of intermittent self-catheterisation
Occasional (between one in 10 and one in 50)
- Inability to pass urine at all, requiring passage of a catheter
Rare (less than one in 50)
- Generalised weakness due to the effect of the toxin on the muscles of the body, requiring admission to hospital
What should I expect when I get home?
When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.
It is likely that you will have some blood in your urine and slight discomfort in passing urine.
What else should I look out for?
Difficulty emptying your bladder; if this occurs, please contact your named nurse. The original symptoms may return after about six to nine months, requiring retreatment.
Are there any other important points?
Driving after surgery
It is your responsibility to ensure that you are fit to drive following your surgery.
You do not normally need to notify the DVLA unless you have a medical condition that will last for longer than three months after your surgery and may affect your ability to drive. You should, however, check with your insurance company before returning to driving. Your doctors will be happy to provide you with advice on request.
Privacy and dignity
Same sex bays and bathrooms are offered in all wards except critical care and theatre recovery areas where the use of high tech equipment and/or specialist one to one care is required.
Hair removal and operation
For most operations, you do not need to have the hair around the site of the operation removed. However, sometimes the healthcare team need to see or reach your skin and if this is necessary they will use an electric hair clipper with a single-use disposable head, on the day of the surgery.
Please do not shave the hair yourself or use a razor to remove hair, as this can increase the risk of infection. Your healthcare team will be happy to discuss this with you.
NICE clinical guideline No 74: Surgical site infection (October 2008); Department of Health: High Impact Intervention No 4: Care bundle to preventing surgical site infection (August 2007)
Is there any research being carried out in this field at CUH?
There is no specific research in this area at the moment but all operative procedures performed in the department are subject to rigorous audit at a monthly audit and clinical governance meeting.
Who can I contact for more help or information?
Uro-oncology nurse specialist
Bladder cancer nurse practitioner (haematuria, chemotherapy and BCG)
Prostate cancer nurse practitioner
01223 274608 or 216897 or bleep 154-548
Surgical care practitioner
01223 348590 or 256157 or bleep 154-351
Urology nurse practitioner (incontinence, urodynamics, catheter patients)
01223 274608 or 586748 or bleep 157-237
Urology nurse practitioner (stoma care)
Urology nurse practitioner (stone disease)
01223 349800 or bleep 152-879
Patient advice and liaison service (PALS)
+44 (0)1223 216756
PatientLine: *801 (from patient bedside telephones only)
E mail: email@example.com
Mail: PALS, Box No 53
Hills Road, Cambridge, CB2 2QQ
Chaplaincy and multi faith community
Telephone: +44 (0)1223 217769
E mail: firstname.lastname@example.org
Mail: The Chaplaincy, Box No 105
Hills Road, Cambridge, CB2 2QQ
MINICOM System ("type" system for the hard of hearing)
Telephone: +44 (0)1223 217589
Access office (travel, parking and security information)
Telephone: +44 (0)1223 596060
What should I do with this leaflet?
Thank you for taking the trouble to read this patient information leaflet. If you wish to sign it and retain a copy for your own records, please download the print copy below.
We are smoke-free
Smoking is not allowed anywhere on the hospital campus. For advice and support in quitting, contact your GP or the free NHS stop smoking helpline on 0800 169 0 169.
Help accessing this information in other formats is available. To find out more about the services we provide, please visit our patient information help page (see link below) or telephone 01223 256998. www.cuh.nhs.uk/contact-us/accessible-information/
Cambridge University Hospitals
NHS Foundation Trust
Hills Road, Cambridge
Telephone +44 (0)1223 245151