Urethral Bulking

Table of contents

1. Operative Note
2. Postoperative Considerations
3. Patient Education
4. Implants & Devices

Operative Note

_ indicates a section that needs to be reviewed or completed.

I (or a fellow) will do the operative notes for procedures that I perform (and you assist). These notes are included here so that you can read about the procedure before we get to the OR - allowing you to familiarize yourself with both the steps of the procedure and nuances/dogma of my technique compared to another surgeon’s that you may have seen in the past. As you read the note, consider the instruments and anatomy. Consider how we maximize exposure and where the high risk portions of the procedure lie. Bonus points if you can customize the risk to the patients and their anatomy/history.

After informed consent was obtained, the patient was taken to the operating room where she was placed in the dorsal supine position. She was placed under anesthesia and was repositioned in dorsal lithotomy with her legs in yellow fin stirrups. She was prepped and draped in a normal sterile fashion. A surgical timeout was performed. Anaesthetic gel was administered inside the urethra, and the bladder was emptied using a disposable catheter.

Anaesthetic gel was added to the end of the rotatable Bulkamid sheath and the water inflow was adjusted to produce an adequate stream. The Bulkamid Needle was then placed three fourths of the way into the needle channel of the rotatable sheath and the entire Bulkamid system was then advanced into the urethra until the bladder was visualised. Inspection of the bladder revealed the findings as noted above. The Bulkamid needle was then advanced into the needle channel on the rotatable sheath until the tip of the sheath was adjacent to the bladder neck.

The sheath was then rotated to the 7 o’clock position. The needed was then extend into the bladder until the 2cm mark on the needle was visible. The Bulkamid system was then retracted until the tip of the needle was resting on the bladder neck. The needle was then retracted into the sheath and approximately 1.5cm from the bladder neck. The Bulkamid system was pressed parallel against the urethral wall and the needle was advanced into the submucosal tissue ensuring that the bevel of the needle was facing towards the lumen. The needle was advanced approximately 0.5cm, and the Bulkamid hydrogel was then injected until the Bulkamid cushion was visible and reached the midline of the urethral lumen.

The needle was then retracted back into the rotatable sheath, and rotated to the next injection site. Subsequent injections were preformed at 5 o’clock, 2 o’clock and 10 o’clock all along the same plane as the original injection until all (4) cushions met at the midline of the urethral lumen. 2mls Total of Bulkamid Hydrogel was used.

Approximately _500cc of fluid was left in the bladder and upon completion, the patient emptied her bladder without issues. The patient tolerated the procedure well. Instrument counts were correct.

Patient was given instruction to contact the office if she had any difficulty urinating and was consulted about the potential of a “top up” procedure if the desired effect was not achieved. Prophylactic antibiotics were prescribed, and a follow up appointment was scheduled to evaluate improvement.

Postoperative Considerations

Patient Education

Preop

Postop

Implants & Devices

• BULKAMID®