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

Have you recently received a letter from the NHS breast screening programme inviting you to come for your first screening mammogram?

The NHS provides a breast screening service because early detection of breast cancer saves lives.

The NHS screening programme has been using mammograms to detect cancer since 1988… But still, 30 women die of breast cancer every day in the UK.

The FAST MRI DYAMOND study is looking to see if a new form of MRI scan, called FAST MRI, can pick up aggressive cancers even earlier than mammograms can. 

The NHS already uses breast MRI to detect cancers, but only for women who have a very high likelihood of having breast cancer. For these women, MRI detects breast cancers earlier than mammograms and saves more lives.

The FAST MRI DYAMOND study will be the first UK study to offer a FAST MRI scan to women at normal or average risk, aged 50-52. People invited for their first screening mammogram can take part at 4 NHS breast screening services in England. (Bristol, Cheltenham, Swindon, Truro, London (St George’s & King’s College).

Everyone’s breasts are different, and in addition to how breasts look and feel in real life, they also look different on mammograms.

At age 50-52, breasts can look completely white on mammograms. They can also look completely dark. Both appearances are normal, as are all the different combinations of white and dark in between. These differences are called mammographic density or breast density.

The problem is that breast density can make a small cancer difficult to spot on a mammogram. Breast cancers tend to show as white on mammograms, so you can see how much easier a cancer would be to spot on the dark mammogram on the left than on the white mammogram on the right.

Fortunately, however, FAST MRI works well at detecting small cancers for women of all breast densities. The pink arrow highlights what a cancer, that was completely invisible on the mammogram, looks like on FAST MRI.

Breast screening with mammograms already saves around 1,300 lives each year in the UK by finding cancers that are too small to feel or see. 

FAST MRI could find cancers even earlier for women and our research is designed to find out which women would benefit from breast screening with FAST MRI through finding breast cancer even earlier than mammograms.

We want to find breast cancers earlier because:

• finding cancer early makes it more likely that treatment will be successful
• finding cancer early makes it less likely that a mastectomy will be needed
• finding cancer early makes it more likely that the cancer will be cured.

The only way to discover your breast density is to have a mammogram.

The FAST MRI DYAMOND study wishes to offer a FAST MRI scan to 1000 people who all have average breast density. At age 50-52, four out of every 10 women will have average breast density and could join the FAST MRI DYAMOND Study to have a FAST MRI scan. 

We can only find out whether you can join the study if you give us your contact details and let us know you are happy for us to use your mammogram to measure your breast density.

Research is fundamental to improving treatment and care for patients and the public but it is your choice whether you join the study or not.

If you are having your first screening mammogram and would like to learn more about the FAST MRI DYAMOND study, please fill in a FAST MRI DYAMOND consent to be contacted form, either online or at your mammogram appointment. 

This is the web address of the online form. 

If you would like to ask any questions at all, you will find the telephone number for the nurse from your local research team below this video along with the link to the online form.

Thank you for taking the time to watch this film. Thank you for helping us with this research.

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 breast density can't be measured due to having breast implants or for other technical reasons, we will unfortunately not be able to invite you to Stage 2.

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.

If you have read the patient information above, or have previously read a leaflet given to you in your breast screening mammogram appointment, you can sign up via the FAST MRI DYAMOND Consent Form.

• 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

Opioids provide pain relief by mimicking the body’s natural pain relief (endorphins). They are used when the pain is moderate to severe after an operation or accident. They are also used at different stages of illness.

Opioid medicines can help manage some, but not all types of pain, and they will be prescribed by your medical team in hospital or your GP if it is felt they are the best treatment for your pain.

Opioid medicines can help manage pain when other medicines are not suitable, or do not provide enough pain relief. They may help reduce your suffering or distress, and may improve your ability to function physically and socially. They may also allow you to sleep and eat better. 

The correct dose of any medicine is the lowest dose that produces a noticeable benefit. It is unusual to get complete relief of pain from opioids.

However, it is important to find the most effective dose for you to reduce your pain. The amount needed to control pain varies between people. There is no standard dose of opioid.

It is important to understand that the medication/opioids prescribed for your pain may not completely stop your pain – this is normal. The aim of these opioids is to make pain manageable, so you are able to carry out normal daily activities.

You will usually start with a low dose and gradually build up until you find the dose that helps with your pain. The doses can be changed, and other pain medicines can be trialed so your pain is kept under control. Your doctor may try more than one kind of opioid if one type is not right for you.

It is important to control background pain, which is constant and continuous, so you will take a dose at a regular time each day to prevent the pain building up again.

You may have additional medicine for breakthrough pain, which is a sudden, intense pain in addition to the background pain. This will be a short acting preparation (“immediate release”). This acts quickly but usually wears off within a few hours.

It is important to take your pain medicines as they are prescribed.

If it is almost time for your next dose, skip the missed dose and take your medication as normal (you must leave the prescribed number of hours between doses).

Never take two doses together.

If you are using opioids but are still in pain, the opioids are not effective for your pain control and should be stopped by your doctor. Please seek medical advice on weaning opioids if they are not helping to manage your pain- they should not just be stopped.

• Morphine/morphine equivalent medication doses that are 120mg or above per day (24 hour period) greatly increase the risk of harm caused to your body. Research shows there is no increased benefit to pain control above this 120mg total dose.

If you have significant pain after surgery and are sent home with an opioid prescription, it should be limited to a small amount. If you do take opioids, take them only for a day or two, three days at most. Your pain will improve significantly within a few days whether you take opioids or not.