Treatments
Here at The London Bladder Clinic we all work together to ensure every patient that comes to us can feel rest assured they are in safe hands.
What We Can Treat
We bring medical expertise and innovation together.
We are phasing in the following treatments:
Indepth
Treatments Explained.
01.
Bladder Botox Therapy
Bladder Botox has revolutionised the medical treatment for patients with overactive bladder. This is for patients who have not responded to standard initial medical or behavioural measures and still find their symptoms of urinary frequency, urinary urgency, night time urination and for some urge urinary incontinence unbearable. Botox is a muscle relaxant, the same compound that is injected elsewhere in the body for different licensed indications. It has been used in the bladder for over 20 years now, with excellent results for the majority (70-80%) of patients, restoring bladder control, confidence and freedom. It is delivered through cystoscopy and several small injections into the bladder with a small needle and is very well tolerated. The whole procedure lasts less than 10 minutes, and is performed under local
anaesthesia.
The caveat to Botox therapy is that the beneficial effect does wear off and the treatment does need to be repeated once or twice a year (every 6-12 months) if the patient wishes to sustain the efficacy. Other considerations are that there is a small risk of urinary infections which may require a treatment course with antibiotic medication, and a small number of patients 15% will require to assist their bladder emptying with clean intermittent self catheterisation for a temporary period. Our nursing team constantly provides specialised training and education around this. Please ask for further details to see if you would be eligible.
02.
Nursing led services
Our nursing specialists can support you with a variety of urological complaints from female and male lower urinary tract symptoms, recurrent urinary tract infections and incontinence. We offer specialist skills in the assessment of bladder dysfunction, education and teaching around catheters, catheter care and management, discussion of a range of available products, teach clean intermittent self-catheterisation, perform urodynamics and percutaneous tibial nerve stimulation.
03.
Clean Intermittent Self-Catheterisation
If you’re required to perform the intermittent self catheterisation procedure our specialist nursing team will be able to provide you with the confidence and knowledge you’ll need to perform this procedure with ease. This involves inserting a catheter into your bladder via your urethra (waterpipe) at different intervals throughout the day to ensure the bladder is completely empty and once the urine is drained the catheter is removed. In a private room you will be provided with a model demonstration on how the procedure needs to be performed whilst answering any questions or concerns you may have. Initially people can be apprehensive about performing the procedure and it may feel awkward to start with, but our specialist team are here to gain your confidence to manage this procedure alone at home. You will be sent home with adequate supplies and a management plan clearly outlined for you.
04.
Bladder Instillation
Clients with symptoms such as cystitis (inflammation of the bladder), recurrent urinary tract infections and painful bladder may require bladder instillation as part of their management plan. Here a bladder medication is placed directly into the bladder, to apply topical relief to the lining of the bladder.
Our specialist nursing team will be able to counsel you on what the procedure involves including possible side effects prior to commencing the treatment. A urine sample will be obtained and if there are no signs of infection, a catheter will be passed into the bladder via your urethra (water pipe). Once all the urine is drained, a liquid medication is administered into your bladder through the catheter, and once all the medication has been instilled the catheter is removed and the medication shall remain in the bladder. Several treatments are usually required meaning you will need to return for this treatment in clinic, once a week for 6 weeks. A detailed plan will be explained on how long to hold the medication for, and a management plan clearly outlined.
05.
Catheter Care
If you have a long-term urethral catheter (a catheter in your water pipe) or a suprapubic catheter (a catheter inserted in your lower abdomen) you will require regular care to reduce the risk of catheter associated urinary tract infections and displacement of the catheter. The catheter itself must be changed at least every 12 weeks. Some clients may require more frequent changes if there are issues such as blockages, but blockages can be managed by our specialist nurses through a maintenance flushing regime. Equipment attached to the catheter such as valves and drainage bags need to be changed every 7 days. In clinic, our team will be able to confidently change your catheter and arrange further dates for subsequent changes. We will also provide you adequate time to learn how to effectively care for your own catheter and our team will be at hand to answer any concerns you may encounter. If you are having issues with catheter blockages or urinary leakages around the catheter, or recurring infections, we can swiftly perform the necessary testing to identify the cause, exclude any bladder stones and provide an ongoing management plan.
06.
Trial Without Catheter (TWOC)
Following any episode of urinary retention, you may have had a urethral catheter placed, and will subsequently need an assessment on the cause of the retention. This will require our specialist team obtaining a full medical history and an external examination.
Further tests involving a blood sample and an ultrasound scan of your kidneys, pelvis (female clients) and prostate (male clients) will be completed prior to removing the catheter. Throughout your 4-6 hour appointment, the volume of urine you pass will be monitored as well as the volume remaining in your bladder using a bladder ultrasound scan. For those who are unable to completely empty their bladder our team may require teaching you how to perform the procedure of intermittent self-catheterisation and provide you with a tailored regime to follow. In cases where you are unable to pass urine at all a catheter may need to be re-inserted and a clear management plan set out with an aim of removing your urethral catheter urgently.
07.
Percutaneous Tibial Nerve Stimulation
Our specialist team may offer you percutaneous posterior tibial nerve stimulation if first line treatments for overactive bladder have not improved your symptoms. During the procedure our specialist nurse will insert a small acupuncture type needle just above your ankle and an electrode is placed on your foot, both are then connected to a low voltage stimulator. Stimulation of the posterior tibial nerve produces a typical motor (plantar flexion or fanning of the toes) and sensory (tingling in the ankle, foot, and toes) response. Treatment typically lasts for 30 minutes and consists of 12 sessions, a week apart. If you require longer relief treatment our specialist team can arrange further top-up sessions.