You should allow at least 1 hour 15 minutes for the test. You can eat and drink as normal before the test, but we would like you to come with your bladder comfortably full.

If you are currently taking any of the below tablets for your bladder symptoms you will need to stop taking these 7 days before your test unless you have been told otherwise:

• Vesicare/solifenacin.
• Regurin/trospium chloride.
• Detrusitol/tolterodine.
• Oxybutynin.
• Betmiga/mirabegron.

Please complete the three day bladder diary and the questionnaires sent with your appointment letter. You must bring both of them with you to the clinic.

Before the test, please let us know:

• If you have any allergies, especially to latex.
• If you have any problems with your mobility.
• If you feel you may have a urine infection. We are unable to perform urodynamics if you have a urine infection and have symptoms (for example foul-smelling urine or a burning sensation when you urinate).

If you are prone to urinary tract infections, please ensure you get your urine checked by your GP surgery five working days before the appointment so that it can be treated before your appointment.

What the urodynamics test involves

After you arrive, a healthcare professional will explain the test to you and ask some questions about the symptoms that you have been experiencing. You can ask any questions you have about the test.

You will then be asked to sign a consent form to make sure that you understand the procedure, the reasons why it is being done and any potential side effects.

In privacy, you will be asked to change and remove the lower half of your clothing (trousers/skirt/underwear). You will be given a hospital gown to change into and once you are on the couch you will be covered with a sheet.

The healthcare professional will also ask you to pass urine into a special toilet (flowmeter). This measures how fast the flow of your urine is and allows us to check you don’t have a urine infection.

After you have done this, the healthcare professional may examine you. This will include an internal examination, with a chaperone present.

During the test

You will be lying on a couch before one or two small tubes

(no more than 3mm in diameter) will be passed into your bladder. Another small tube will be placed into your rectum (back passage). If you do not have a rectum because you have had surgery and have a colostomy or stoma then that can be used, or the vagina can also be used as an alternative.

These tubes allow us to take measurements both inside and outside the bladder. You will then be asked to sit or stand and your bladder will be slowly filled with water through the tube until you feel full. If you are unable to sit or stand then you will remain lying down on the couch.

You will be asked to cough several times during the test to check the tubes are working. You will also be asked a series of questions such as your first desire to pass urine or whether you experience any urgency.

Once your bladder is comfortably full, one of the bladder tubes will be removed. The tube in your rectum and the very tiny tube in your bladder will be left in. You will then be asked to pass urine and the healthcare professionals will leave the room during this time.

After the test

You will be given time to get dressed in privacy after the test and the results will be explained to you. At this point, you will have the opportunity to ask any questions you may have.

A report will be written and a copy will be sent to your GP, the person who referred you, and yourself.

After the test, you may experience some discomfort where the tubes have been for a short time, but this should settle down. We suggest that you drink extra water during the 24 hours after the test to decrease the chances of you developing an infection.

Video urodynamics is similar to standard urodynamics (described above please read and follow the ‘before the test’ guidance above), however, we also take X-ray pictures of your bladder. Instead of using salt water to fill your bladder, we use an iodine-based fluid (this allows us to see your bladder on X-ray).

Before the test, please also let us know:

• If there is any possibility that you are pregnant as we are unable to perform the test if you are. We may also perform a pregnancy test on the day of your appointment.
• If you are allergic to Iodine.

What the urodynamics test involves

Unlike standard urodynamics, because we need to X-ray your bladder when you pass urine, we have to remain in the room. We are as discreet as possible and stay behind the curtains when possible.

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Information about how to use your inhalers correctly.

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If you have any concerns about the service that the nurses or doctors cannot resolve, you can contact our Patient Advice and Liaison Service (PALS).

PALS offer support and assistance for patients and their families. You can also share positive comments with them about your care.

• Phone: 0117 414 4569 (09:00 to 16:00)
• Email: PALS@nbt.nhs.uk

Figures from a trial being led by NHS Blood and Transplant and the University of Oxford show one in three expectant mothers will develop anaemia.

It is a condition where the blood produces a lower-than-normal amount of red blood cells and can be linked to stillbirth, postnatal depression and haemorrhages.

The research team is working with maternity wards across the UK to carry out a study by giving pregnant women an iron supplement to see if it helps.

The trial is being funded by the National Institute for Health and Care Research (NIHR) and will involve giving half the mothers taking part one iron supplement a day and the other half a placebo.

Researchers are working with up to 50 maternity wards across the country.

PANDA, is open to women who are in the first 16 weeks of pregnancy with a single baby and women can ask their healthcare professional for more information or ask about taking part.

Prof Simon Stanworth is a consultant haematologist at NHS Blood and Transplant in Oxford and is running the trial.

About the programme - Clinical Trials Unit - NHS Blood and Transplant

Principal Investigator – Dr Simon Stanworth

Start date - 01/03/2024

Planned end date – 30/08/2026

Local Ref – 5707

The Generation Study is a national research study that will sequence the genomes of 100,000 newborn babies to test for more than 200 rare and treatable genetic conditions. 

Identifying these conditions shortly after a baby is born, rather than when symptoms might appear later in childhood, means families can receive support, monitoring, and treatment much earlier. Early, effective intervention can help to prevent longer term health problems associated with certain conditions, keeping children out of hospital, and helping them live healthier lives. 

The Generation Study, led by Genomics England in partnership with NHS England, will see parents offered whole genome sequencing using blood samples taken from the umbilical cord shortly after birth.

In Bristol, Southmead Hospital (North Bristol NHS Trust) and St Michael’s Hospital (University Hospitals Bristol and Weston NHS Foundation Trust) are among more than 20 hospitals nationally taking part.

Women planning to give birth at home may also take part in the study. Expectant parents will be informed about the Generation study during pregnancy, and if interested, a research midwife will have a detailed conversation with them to decide if they want to take part. Taking part is voluntary and free. Soon after birth, an NHS doctor, nurse, or midwife will check with parents that they are still happy for their baby to be tested, and a blood sample will be taken and sent to a laboratory for whole genome sequencing.    

Results are then reviewed by NHS genomic scientists. The aim is to share results with parents within 28 days if a condition is suspected, or within a few months if no conditions are suspected. 

If a newborn baby is identified as having a treatable childhood condition through the genome sequencing, families and carers will be provided with further NHS testing to confirm a diagnosis and will receive ongoing support and treatment from the NHS. 

The study will also gather genomic data for wider research purposes, allowing a better understanding of rare genetic conditions. It will also potentially pave the way for new diagnostic tools and treatments and improvements in existing therapies.

In addition, the Generation Study will explore the risks and benefits of storing an individual’s genome over their lifetime. This could allow it to be reanalysed later in life if needed, enabling access to new developments in genomics.

For further information on the Generation Study, visit: www.generationstudy.co.uk

Principal Investigator – Dr Christy Burden 

Planned end date – Currently 31/03/2025.

Local Ref – 5527

A team of researchers and clinician are conducting a study of the use of a medication called Pravastatin by pregnant women who have been identified as being at higher risk of their babies being born too early (preterm birth).

Preterm birth is birth that happens before 37 weeks of pregnancy. It affects around seven out of every 100 babies born in the UK. We do not fully understand why some babies are born too early and at present there are few effective treatments to prevent this from happening. Research shows it is likely that early labour may occur in some pregnancies because of inflammation in the mother’s body. Taking a medication that reduces inflammation, such as Pravastatin, could therefore reduce the number of babies being born too early. Pravastatin is a statin, and statins are a group of medicines which are commonly taken to help lower the risk of heart disease and stroke. Statins work by protecting blood vessels and lowering inflammation in the body.

During the past couple of decades, Pravastatin has been used during pregnancy in studies which have investigated whether Pravastatin prevents or treats other problems/complications of pregnancy. In total 1,303 pregnant women took part in these studies, which showed that there were no safety concerns or problems regarding the baby’s development.

In fact, these studies suggested benefits to the baby, as they found evidence that Pravastatin reduced the number of babies born early. This is what PIONEER will now test. Based on this information, we are interested to find out whether treatment with Pravastatin reduces the chance that a woman will give birth early by: 

• extending the length of pregnancy
• reducing the risks associated with babies being born too soon. 

We would also like to find out how Pravastatin might work to reduce early birth by looking at blood samples, vaginal swabs, and stool samples taken from pregnant women who take part in the study.

Everyone who takes part in PIONEER will be randomised into one of two groups: one group will take Pravastatin and the other group will take a placebo (a dummy tablet which looks like Pravastatin but does not contain Pravastatin, only an inactive substance). An equal number of pregnant women will be placed in each group. The aim is to have two groups that are as similar as possible at the start of the study, so that the only thing that differs between the groups is whether they receive the Pravastatin or the placebo. This then allows a fair comparison between the two groups to see if there are differences between the groups in the number of babies born early.

For more information, please visit the study website www.bristol.ac.uk/pioneer

Principal Investigator – Dr Sherif Abdel-Fattah

Planned end date – 31/03/2027.

Local Ref - 5406

Children of the 90s is a group of around 14,500 children born in the Avon area in 1991 and 1992. Scientists have been studying them ever since and are constantly making discoveries that make a difference to lives around the world.

Some now have children of their own, and we want to follow these pregnancies, births and babies. We call this Children of the Children of the 90s, or COCO90s for short. This is the only project we know of that provides scientists with information on three generations, allowing them to study important social and health issues.

If you or your partner are in Children of the 90s and are about to become or are already a parent, we'd love you, your partner and all your children to take part in COCO90s. It doesn’t matter how much or how little you have been involved in Children of the 90s in the past -- this is a new opportunity to be involved in ground-breaking research.

For more information about this study, visit the CoCo90s website.

Project Details
Principal Investigator: Ms Mary Alvarez
Planned end date: Ongoing
Local Ref: 2801

Aim: The DOLFIN trial is a research study looking at whether giving a specially developed nutritional supplement via breast or formula milk for the first year of life helps with brain development. If your baby was born less than 28 weeks old or is receiving cooling therapy, you may be approached about the study.

Recruitment: 30 babies born at less than 28 weeks or receiving cooling therapy.

A small UK study has been carried out and the results were promising, but we need to find out more.  About 500 babies nationally will take part in the study so that we can find out whether the supplement improves neurological child development. Half will receive the nutrient supplement and half will a get a dummy (placebo). You will not know which treatment your baby will receive.  Joining the study involves you giving the supplement daily to your baby until the date they would have turned one.

For more information, please visit the DOLFIN trial website.

Project Details
Principal Investigator: Dr Amiel Billietop
Planned end date: 31/05/2024
Local Ref: 5131

Aim: This research project compares two ways we may adjust a commonly used treatment, called positive end-expiratory pressure (or PEEP), to help premature babies’ lungs in the first few minutes after birth.  

Recruitment:  80 babies born before 29 weeks of pregnancy.

The POLAR Trial is a large clinical trial, being conducted in 25 hospitals around the world, including Australia, Europe, the United Kingdom and the USA.​

​This trial will establish how to best support the fragile lungs of very premature babies born between 23 and 28 weeks of pregnancy immediately after birth.​

We are comparing two approaches to PEEP levels given to preterm babies’ lungs at birth. We will put your baby into one of two groups, static or dynamic PEEP.  

All the babies in the same group receive the same treatment.  The results are later compared to see if one is better. 

For more information, please visit the POLAR study website.                                                                                          

Project Details
Principal Investigator: Dr Charles Roeher
Planned end date: 30/06/2026
Local Ref: 5152

Aim: To investigate whether in late preterm and early term infants with respiratory distress the early use of surfactant versus expectant management results in a shorter duration of hospital stay and fewer infants who fail to respond to treatment.

Recruiting: Infants born between 34+0- and 28+6-weeks’ gestation admitted to a Neonatal Unit (NNU) with respiratory distress and for whom a clinical decision has been made to provide non-invasive respiratory support.

For more information, please visit the SurfOn website.

Project Details
Principal Investigator: Dr Amiel Billietop
Planned end date: 28/02/2025
Local Ref: 4949

Aim: The WHEAT International trial will compare two different approaches, feeding babies or not feeding babies during blood transfusions, to work out which one is better. 

Recruitment: We are including all babies that are born before 30 weeks of pregnancy. The WHEAT study is an opt-out study.  This means that all babies will take part unless you let a member of the neonatal team that you do not wish your baby to participate. 

Both approaches are standard practice in the UK but we don’t how best to feed babies during blood transfusions – some hospitals and doctors stop feeds while other don’t. 

Some babies who are born early can develop a bowel disease called necrotising enterocolitis (NEC) which can be serious and can have long-term effects on how babies grow and develop. We want to know if feeding babies or not feeding babies while they have a blood transfusion changes the number of babies that get NEC.

WHEAT is taking places in neonatal units across the UK and Canada and will involve about 4,500 babies.

Project Details
Principal Investigator: Dr Daniela Vieten-Kay
Planned end date: 31/12/2025
Local Ref: 5236

Aim: The neoGASTRIC study is looking at whether routinely measuring gastric residual volumes (checking what is in the stomach before feeding) helps babies safely get to full feeds more quickly. We are comparing two ways of caring for babies having tube feeds, both ways are standard care commonly used in neonatal units across the UK.

Recruitment: We are including all babies born 6 or more weeks early (before 34 weeks of pregnancy) who require tube feeding unless there is another medical reason why they should not take part. All babies will be in the study unless you let a member of the neonatal team know that you do not wish your baby to take part.

Some doctors and nurses routinely measure gastric residual volumes because they think it might help tell if the baby is coping with their feeds, and may help identify signs of a serious but rare gut disease called necrotising enterocolitis (NEC). Other doctors and nurses think that routinely measuring gastric residual volumes may not be a good idea because it can be inaccurate and we do not know if it does help to identify necrotising enterocolitis (NEC). It also increases the amount of procedures each baby has, and may be uncomfortable for them. Routinely measuring gastric residual volumes may also lead to feeds being reduced or even stopped, this will delay the time it takes for the baby to reach full feeds and might affect how well they grow. It will also mean a baby will need intravenous nutrition for longer which can lead to potential problems like infections.

In the UK about half of doctors and nurses routinely measure gastric residual volumes and about half don’t – so both approaches are standard treatment. 

The study is being run in more than 30 hospitals in the UK and Australia for about 3 to 4 years. We hope to include over 7000 babies in the study (UK and Australia combined).

Project Details
Principal Investigator: Paula Brock
Planned end date: 31/06/2026
Local Ref: 5298

Women with “average” breast density and a clear mammogram may be able to have a FAST MRI. To find this out, we are first inviting women to Stage 1 of the DYAMOND study. 

If you agree to take part in Stage 1, we will send your mammogram to the DYAMOND team at the Royal Surrey NHS Foundation Trust so that they can measure your breast density. We won’t send your mammogram to be measured for 10 working days after we receive your consent. This is in case you change your mind about participating. If you do, please let us know. 

The results will then be sent to Warwick Clinical Trials Unit, to be stored. 

If your mammogram is measured as anything other than average breast density, you will be looked after by the screening service, and you won’t be able to take part in this study. This is because we are only inviting people with “average” breast density to have a FAST MRI.

If your mammogram measurement is in the “average” breast density group, we will look at your mammogram screening results to check if the screening service says you need any further investigations. This is because in this study, we are only inviting people with clear mammograms to have a FAST MRI.

If you do need some further investigations, the screening service will contact you directly. You won’t be able to have the FAST MRI scan as part of this study. Instead, with your consent, we would like to access your screening and medical records to discover the outcome of your investigations. We will do this for up to 3 years after your first mammogram.

If the screening service says your mammogram needs no further investigations and you are in the average breast density group, we will send you information and an invitation to take part in Stage 2 of the study.

Agreeing to take part in Stage 1 does not mean you will automatically have a FAST MRI scan. If the Stage 1 density grading shows you are eligible to take part in Stage 2, you will be invited and can then decide whether to take part or not. 

No, it’s up to you to decide whether to take part. If you do not want a FAST MRI scan or know you cannot have one, then you can let us know you don’t want to take part. Whether or not you choose to take part, be reassured that your clinical care will not be affected. You will still be offered your routine screening mammograms every 3 years until you turn 71.

Following your first mammogram, we invited you to take part in Stage 1 of the DYAMOND study: to measure your breast density and to check your breast screening results. Your images have now been checked and we think you could be eligible to join Stage 2 of the study to have a FAST MRI scan. 

No, it’s up to you to decide whether to take part. If you choose not to, be reassured that your clinical care will not be affected. You will still be offered your routine screening mammograms every 3 years until you turn 71. 

We have designed the study to be as convenient as it can be, so that as many people can be involved as possible. If you decide to take part, we will:

• Ask you some questions about your health
• Check that you can have a FAST MRI scan
• Book a FAST MRI scan at a time convenient to you
• Ask you to complete a survey about your experience

Some people may also be invited to take part in an interview about their experience.

We expect a small proportion of people having a FAST MRI scan to be invited for another scan after a year or be referred for further investigations.

A Research Nurse will contact you to discuss this part of the study and answer any questions you may have. If you would like to join the study, they will ask you some questions about your health to make sure that you are safe to have the FAST MRI scan. They will help you complete an online consent form and book you in for your scan at a time convenient to you. This will need to be between day 6 and 16 of your cycle if you are still having regular periods.

Please let the Research Nurse know if you are affected by any of the below as these things may prevent you having an MRI scan:

• If you are or may be pregnant or if you are breast feeding
• If you have ever had a penetrating eye injury
• If you have ever had brain surgery
• If you have a pacemaker or defibrillator
• If you have an implanted neurostimulator
• If you have a cochlear implant
• If you have ever had a shrapnel injury
• If you are claustrophobic
• If you have had conditions associated with your kidneys
• If you wear a sensor to measure your blood sugars (e.g. a “continuous glucose monitor”), this will need to be removed for the scan. We will try to arrange your scan around the time when you are due to change your sensor.

We encourage you to watch this video to see what it is like to have a FAST MRI scan. 

Your FAST MRI scan appointment will take up to 45 minutes.

When you arrive, the radiographer will ask some questions to confirm that it’s safe for you to have the scan and ask you to sign a standard safety checklist. 

You will be asked to change into a hospital gown. 

You will have a cannula (a small, soft plastic tube) placed into a vein in your arm. This is necessary so that the radiographer can inject dye during your scan, which makes a cancer show up clearly if it’s there. The injection of dye is not painful. 

The radiographer will explain what is going to happen during the scan, which we expect to take between 3 and 5 minutes.

Once you have had the scan and your cannula has been removed, you will be free to go. Your scans will be sent to specialists who look at them in detail and check the findings. This means we can’t give you the results on the day of your scan.  

We will let you know the results of your FAST MRI scan 3-4 weeks after your scan date. 

If your scan is clear, you will receive your scan results by letter. 

Some people with a clear FAST MRI scan may be invited to have another scan in a year's time. This is because their scan is most likely normal but we would like to see if it has changed over time, as we are still learning which appearances on FAST MRI we can confidently call “clear”. We expect that all the people invited to have this second scan will then have a clear result.

If your scan shows that further investigations are needed, a Research Nurse will contact you by telephone to explain the results and what will happen next. The Research Nurse will arrange an appointment at the Breast Care Clinic. Appointments are usually offered within about 2 weeks of referral. This does not necessarily mean that you have a breast cancer, just that you need to have additional tests. You will receive a letter confirming the FAST MRI scan results.   

At these appointments a healthcare professional will look at your mammogram and FAST MRI scan results and will ask for more tests to be done, including another scan and possibly a biopsy. If you have a biopsy, we may ask you if we can collect an extra sample to donate to a tissue bank to help support future research. Information about this option will only be sent to you if you need further investigations following your FAST MRI.

They may also discuss your case with a team of other professionals after your appointment to help decide if more investigations are needed, which could include deciding to perform a full MRI. If you do need further tests, your care team will explain why each test is important and what having the test would involve for you. Any extra tests you may have will help the team decide if what was seen on the FAST MRI is a cancer or not.

We expect that if 100 people have a FAST MRI scan, 5 of those people will be called back for further investigations. Of those 5 people, we expect that only around 1 participant will be diagnosed with a cancer.

Taking part in the FAST MRI DYAMOND Study gives you access to a new test (a FAST MRI scan).

We do not know if your FAST MRI scan will pick up a cancer that was not found on your first mammogram. If it does, it is possible that you will have a better outcome, because the cancer will have been found earlier than it would have been if you had not taken part in the study. 

By taking part in this important study, you will be making a difference by helping us plan more research to improve breast screening for everyone in the future.

We expect that the potential advantages of taking part will outweigh any disadvantages or risks.

Having an MRI scan is painless, and it’s one of the safest medical procedures available, but there are some risks. For example, there are increased risks to people with certain implants or foreign bodies. The Research Nurse and Radiographer will ask you questions about your medical history to check that you can have the scan. 

Some patients occasionally experience a tingling sensation or feel hot from being in the MRI scanner. These effects only last a short while and should ease as soon as the scan is over.

The scan involves having an injection of dye which is used to highlight any cancer cells (if a cancer is there). The risks associated with this injection are small and are well known: 

• About 1 in every 100 people may have a mild reaction to this dye (such as pain at the injection site, nausea or headache)
• About 1 in 1000 people may experience vomiting and/or an itchy rash   
• A more severe allergic rection is very rare, affecting about 1 in 10,000 people.  The radiographers who will be looking after you during your FAST MRI scan are trained to support individuals if this happens, and appropriate medical care will be given.  The dye is not recommended for people who are pregnant or breast feeding.
• Tiny amounts of dye can stay in the body for a long time after the scan but this has never been shown to cause any problems.   

If you decide to take part in the study, we will let your GP know and we will tell them the results of your scan when they are available.

You will not be paid for taking part in the FAST MRI DYAMOND study but reasonable expenses (up to £10) to attend your FAST MRI scan will be covered. Your Research Nurse will give you this information.

• Botox injections are effective in about 7 in 10 patients (70%), meaning that the urgency and/or urgency incontinence are either significantly better or improved.
• The effects of the injections can last for around 6 to 9 months.
• When your symptoms start to return, you can have further injections.
• There is no limit to how many times you can have your Botox repeated, but you cannot have a repeat within 4 months of each injection.
• Most people find that having repeat injections works well over many years.
• There are no obvious long-term negative effects of having repeated Botox injections into the bladder.

The procedure involves passing a small telescope (cystoscope) into your bladder, through your urethra (water pipe), and giving several injections of Botox into your bladder wall with a needle passed through the cystoscope. Botox paralyses the muscle of the bladder wall and prevents your bladder muscle from contracting and giving you the urgency symptoms.

The aim of the injections is to reduce urinary symptoms such as frequency (passing urine often), urgency and urgency incontinence. It is unlikely that you will see immediate improvement in symptoms and it may take between 2 to 6 weeks to gain maximum benefit. 

The effects of the injections usually last between 6 and 9 months, although this can be variable. Repeat injections will be required each time the effects wear off. This can be offered no more than every 4 months due to the risk of build-up of the toxin in your body.

You are being offered invasive treatment on the basis that you have not had a good response to conservative and medical therapy for your symptoms. 

Overactive bladder may be a lifelong condition and we currently have no cure. All treatments are aimed at helping you cope with the symptoms (see ‘overactive bladder syndrome’ leaflet NBT002734). We recommend that all patients try conservative and medical treatments initially before having invasive procedures. Alternative, conservative measures include:

• Incontinence pads – you may choose not to have any invasive procedures and use incontinence pads to contain your urinary leakage.
• Conservative measures – including weight loss, improving fluid intake and reducing caffeine.
• Bladder training – learning techniques to hold on and override your urgency to pass urine.
• Medicines – these may help if conservative treatment does not work.

Botox injections are usually only tried if the above treatments are not effective. Other treatments that can be used instead of Botox injections include:

• Posterior tibial nerve stimulation (PTNS) – electrical stimulation of the tibial nerve via your ankle can be used, but is not available here in Bristol and not widely available on the NHS as it is not highly recommended by NICE (National Institute for Health and Clinical Excellence).
• Sacral neuromodulation – a device (battery and wire) is implanted in your lower back that sends electrical signals that modulates/stimulates the bladder nerves – a ‘pacemaker’ to the bladder. This is offered here in Bristol and we could make an appointment for you to discuss this in more detail (see NBT003133 leaflet).
• Enterocystoplasty – a major operation that enlarges your bladder using a piece of bowel.
• Urinary diversion (ursotomy) – creating a stoma using a piece of bowel to divert the urine into a bag.

• Botox is not given to patients who have signs or symptoms of urinary tract infection, in individuals with known hypersensitivity to any botulinum toxin preparation or to any of the components in the formulation.
• It is also contraindicated in patients who cannot perform clean and intermittent self-catheterisation or accept a long-term indwelling catheter if they go into urinary retention.
• Botox must be used with caution in patients with neuromuscular disorders, such as myasthenia gravis, as it may affect the muscles involved in breathing.

This treatment improves the bladder symptoms by essentially paralysing the bladder. This can also mean that the bladder does not empty properly and you may need to self-catheterise. Therefore, prior to your appointment for Botox treatment, if you don’t already know how to self-catheterise, you will be seen by one of the specialist nurses and taught how to perform clean intermittent self-catheterisation (CISC). 

This involves you learning how to pass a small plastic tube into your bladder in order to drain urine. This tube is thrown away once the bladder is drained and the procedure may be repeated several (usually 1-4) times a day. If you are unable to perform self-catheterisation, the alternative would be using a long term urethral or suprapubic catheter, and this can be discussed further with the specialist nurses. CISC may be required until the effect of the Botox wears off.

You will be invited to an appointment either in theatres or the outpatient’s clinic where the procedure can be performed under general, or local, anaesthetic. You will be telephoned by one of the admin team and they will ask you some very important questions and it is important to be honest in your answers or you may be cancelled on the day of the procedure.

On the phone, you will be asked questions such as:

• Do you have a catheter or can you perform CISC?
• Do you have recurrent urinary tract infections? If you suffer with recurrent urinary infections, or in the days prior to the procedure you have symptoms of a urinary tract infection, then you should attend your GP surgery to have your urine checked for an infection and a sample of urine sent to the lab to be analysed by Microscopy, Culture and Sensitivity (MC&S). If you do have an infection, please complete your treatment before coming in for the Botox injections. If your urine test taken in the hospital prior to the procedure is negative for infection and you feel well, we will go ahead with the procedure. If you have an untreated urinary infection on the day of the procedure, it will be cancelled.
• Have you had any other Botox injections anywhere else in the body in the last 3 months? If you had botulinum toxin of any formulation anywhere else in the body within the last 3 months, you will not be able to have it in your bladder unless they are 3 months apart.
• Do you have any mobility issues? We can prepare the appropriate equipment to help you.
• Are you on any medications that thin the blood? These medications may include Anticoagulants such as Clopidogrel, Warfarin, Rivaroxaban, Apixaban, Dabigatran, Edoxaban and a dose of Asprin higher than 75mg. If you are on such medications, then a preoperative assessment will need to be arranged to stop the medication safely prior to the procedure.

• If your procedure is being completed in outpatients under local anaesthesia then you may eat and drink as normal and take your usual medications.
• You will be invited to attend Gate 36 in the urology department.
• On arrival to the department, the nursing team will ask you for a urine specimen. It is important that you do this in the department so it is fresh. The procedure will not be able to go ahead if you are not able to produce a urine sample to rule out infection. If you do have an infection, the procedure will be abandoned and you will be rebooked with appropriate antibiotics beforehand.

If your procedure is being completed in theatres under local or general anaesthesia

• You will be invited to attend the theatres department.
• You may be asked not to eat and drink and not to take your medication. If you have any questions regarding this, please contact the department beforehand.
• On arrival to the department, the nursing team will ask you for a urine specimen. It is important that you do this in the department so it is fresh. The procedure will not be able to go ahead if we don’t have a sample to rule out a urine infection. If you do have an infection, the procedure will be abandoned and you will be rebooked with appropriate antibiotics beforehand.
• Wherever you have the procedure, you will be seen by the specialist nurse or doctor who will go through the plans of your procedure and ask you questions regarding your medications, allergies, previous Botox injection, and how you empty your bladder.
• Once you have answered the questions and had the opportunity to ask your own questions, you will be asked to sign a consent form which clearly states the potential risks and side effects of the procedure you are having.

What are the potential risks and side effects?

• Urinary tract infection (15%-20%) - see your GP if you have symptoms of burning/stinging when passing urine as you may require a course of antibiotics. We will give you oral antibiotics to go home with for 5 days.
• Blood in the urine (8%-20%) - this is usually minor and settles down without any treatment. If you however continue to bleed then you would need to seek medical advice and you may need a surgical procedure under general anaesthetic to stop the bleeding.
• Urinary retention (7-10%) – some patients will have difficulty emptying their bladder fully after Botox. This is helped by beginning intermittent self-catheterisation which is taught prior to the procedure, for as long as is needed. If you are unable to do self-catheterisation then you would be offered a suprapubic catheter (small permanent indwelling tube through the lower part of the ‘tummy’) to help drain the urine until the Botox wears off. We would not recommend having a permanent indwelling catheter going through the urethra for a long time due to the damage it causes to the soft tissues in the genitals.
• Bladder Pain (5%) – very occasionally, some patients develop a pain in the bladder following injections. This pain is usually controlled with simple painkillers such as paracetamol and typically resolves quickly following the injections. If this continues please attend your GP surgery.
• Generalised muscle weakness (less than 3%) – this is very rare. Some patients have reported weakness in muscles of the arms and the legs at other hospitals across the world. They have been reported to be mild and usually do not require a stay in hospital. The condition resolves with time although it can take several months. There is no specific treatment for this if it occurs.
• Allergic reaction – this is rare, however, get emergency medical help if you have any of these signs of an allergic reaction: hives, difficulty breathing, feeling like you might pass out, or swelling of your face, lips, tongue, or throat.
• Temporary ‘flu-like’ symptoms are experienced rarely – some patients who have had Botox have reported these symptoms for a week or two after the injections.

If you are happy to go ahead you will be asked to undress in privacy. You will be provided with a hospital gown to wear to cover yourself; this will avoid any water from the cystoscopy coming in contact with your clothes. If you wish to stay in your own clothing on the upper half of your body then please let the doctor or nurse know. If you wish to keep your socks on then please bring a spare pair with you in case they get wet. If you feel cold in the hospital gown, then please let one of the staff members know and they will help cover you with blankets.

In the urology department there is usually a specialist nurse or doctor and at least one other staff member in the room available to help you. There may also be visitors to the unit as we are a national and international training centre. Please let your doctor know if you do not wish to have any visitors in the room during your procedure. This is your right.

If the procedure is completed in theatres there will be a specialist nurse or doctor and a number of theatre staff to look after you and assist with the procedure. An anaesthetist will also be there if you have a general anaesthesia.

You will be asked to lie down on a couch. The specialist will then clean your genitalia with warm cleaning fluid and cover you with sterile drapes. This is important to protect you from infection after the procedure. A small amount of lubricating jelly is injected into the urethra, lubricating the area so you feel less discomfort. This may sting a little. A small telescope is then passed into your bladder. Your bladder is filled with salt-water (normal saline) through the telescope which may make you feel like you need to go to the toilet to pass urine. Sometimes there is leakage of water around the telescope but this is normal and the doctors and nurses expect it to happen. The nurse or doctor then passes a small needle down the telescope and injects between 10 and 20 injections of Botox into your bladder. The telescope and needle are then removed. You can then go and empty your bladder as normal.

The procedure may be uncomfortable but should not be painful. As the Botox is being injected, it can sting for a few seconds. If the procedure becomes uncomfortable you can ask the doctor or nurse to stop. The actual injection process may take about 10 to 15 minutes but expect to be in the department between one and two hours. In theatres however, you may expect to be there for some hours.

If this is your first time, you will receive a telephone follow up from one of our specialist nurses at around 6 weeks to check up on your progress. 

You may also be seen in the outpatient department 6-9 months after you have received your Botox if you request this. 

Following this, you will simply need to contact us once the Botox wears off to book your next session. 

You may also be approached regarding involvement in research and taking part in trials. If you are involved in a trial, your follow up plan may vary according to the trial protocol.

Your risk of getting an infection in hospital is approximately 8 in 100 (8%): this includes getting MRSA and Clostridium Difficile bowel infection. This figure is higher if you are in a ‘high-risk’ group of patients.

It is your responsibility to make sure that you are fit to drive after any surgical procedure. You only need to contact the DVLA if your ability to drive is likely to be affected for more than 3 months. If it is, you should check with your insurance company before driving again.

Thank you for taking the time to read this information sheet. 

Please make note of the link for your own records. You may be asked to sign a form saying you understand the information. 

If you do decide to proceed with the scheduled procedure, you will be asked to sign a separate consent form which will be filed in your hospital notes and you will, in addition, be provided with a copy of the form if you wish.

BAUS Botox leaflet 

Kuo HC, Liao CH, Chung SD. Adverse events of intravesical botulinum toxin a injections for idiopathic detrusor overactivity: Risk factors and influence on treatment outcome. Eur Urol. 2010;58:919–26 

Orasanu B, Mahajan ST. The use of botulinum toxin for the treatment of overactive bladder syndrome. Indian Journal of Urology : IJU : Journal of the Urological Society of India. 2013;29(1):2-11. doi:10.4103/0970- 1591.109975. 

Idiopathic overactive bladder syndrome: botulinum toxin A | Advice | NICE