John J. Bauer, M.D.
www.flinturology.com Urology Services, Inc.
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Contents
General information
Pre-operative instructions
Risks and Complications
Detailed Surgery Description
Family waiting instructions
Post-operative instructions
Printing tip: If you want to print only one portion of this entire document, you should be able to do this depending on your software. To print a selection, highlight the section you want to print using your mouse, then click on print, and then in the print menu, choose "selection."
Terminology tip: If you come across words you don't understand, look them up in the On-Line Medical Dictionary.
Contigen is a collagen material that can be injected just under the urethral or bladder neck mucosa (inside lining) to treat incontinence or leakage of urine. Come people can have allergic reactions to this material, so a skin test is required in our office 30-days prior to treatment with Contigen. To get the best results it may take multiple treatments, since some of this material is reabsorbed by the body over time. Even if the treatment is successful after the first injection (usually in females, it may be necessary to do it yearly to enjoy the maximum benefit of complete dryness). Since the procedure may cause you to be obstructed immediately after, we require that a preliminary office visit be scheduled with the nurses to learn how to do self-catheterization. That way if you are unable to void a few hours after the procedure you can relieve yourself rather than come to the emergency room in significant pain.
The procedure is done through a rigid cystoscope in both the male and the female. This is done through a scope that is no larger than a catheter. Very little discomfort is associated with this procedure, except during the injection were you may feel some stinging sensations that resolve as soon as the injection stops. An oral antibiotic is given after the procedure to prevent urinary infection. You will leave with a 12Fr. Red Robbin catheter just in case you have to catheterize yourself later in the day.
Your pre-operative appointments
Before your surgery, you will be seen by the physician and the anesthesiologist, and when applicable, there is a pre-admission appointment with the hospital. Click here to read more details about these appointments, referred to as the Pre-Operative Work-Up.
Change In Health Status
Notify your surgeon if you experience any significant change in your health status: develop a cold, influenza, a bladder infection, diarrhea, or other infection, before your surgery.
Pre-Operative Medication Instructions
Unless specifically instructed otherwise by your surgeon or anesthesiologist, please observe the following guidelines for taking your medicines before surgery:
Pre-Operative Diet Instructions
Unless specifically instructed otherwise by your surgeon or anesthesiologist, patients of all ages must observe the following diet restrictions before surgery:
Patients undergoing operative or diagnostic procedures involving sedation are required to refrain from eating, drinking or taking anything by mouth for a stated period prior to their surgery or procedure. The reason for this is to prevent complications caused by nausea or vomiting while you are unconscious. Should you vomit while in the unconscious state, the risk exists that the vomit may enter into your lungs causing serious complications such as pneumonia. These complications may result in an extension of your hospitalization following your surgical procedure. It is for this reason patients are often instructed to have nothing by mouth after midnight the night prior to your operation unless otherwise instructed by an anesthetist.
Pre-Operative Cleaning Instructions (bathing and showering instructions)
Pre-operative showers are to be taken the night before and the morning of surgery just prior to your arrival. All adults are required to take a shower using either a Betadine or Hibiclens Surgical Scrub antibacterial soap. The reason is to remove as much bacteria from your skin as possible prior to your surgery. If you are allergic to these products please notify your physician or nurse. Perform your shower as follows:
On The Day Of Surgery
The anesthesiologist will discuss with you the anesthetic most appropriate for your medical condition and procedure prior to surgery.
After your surgery you must be escorted/driven home by a responsible adult. You may take a taxi car or shuttle if accompanied by a responsible adult who can stay with you after the driver departs.
Time To Arrive For Your Surgery
During your Pre-Admission Interview, our Registered Nurse will provide you with the correct time to arrive for check-in prior to your surgery.
ARRIVAL TIME:
WHERE TO ARRIVE:
The risks and complications for this surgery are described in the "Counseling and Pre-Op Note" that you will need to sign before the surgery. The main content of that note is listed below.
Indications:
Patient is a male / female with a history of urinary incontinence (stress or mixed). Male patients with stress urinary incontinence secondary to previous prostate surgery for benign and malignant conditions or has an incompetent sphincter secondary to neurological disease are indicated for this procedure. Urodynamic studies have confirmed the presence of Type III stress urinary incontinence or mixed incontinence with a low valsalva leak point pressure.
Alternatives:
Alternatives include watchful waiting, Kegel exercises, behavioral/biofeedback/electrical stimulation therapy, penile clamp/condom catheter/male sling for males, urethral plugs/pubovaginal sling for females and an artificial urinary sphincter (AUS-800).
Risks/Complications:
The risks and complications of the procedure where extensively discussed with the patient. The general risks of this procedure include, but are not limited to bleeding, transfusion, infection, wound infection/dehiscence, pain, scaring of tissues, failure of the procedure, potential injury to other surrounding structures, deep venous thrombosis, pulmonary embolus, myocardial infarction, heart failure, stroke, death or a long-term stay in the Intensive Care Unit (ICU). Additionally, mentioned were the possible serious complications of the anesthesia to include cracked teeth, airway damage, aspiration, pneumonia, spinal head-ache, nerve damage, spinal canal bleeding and malignant hyperthermia. Your anesthesiologist will discuss the risks and complications in more depth separately. Additional procedures may be necessary.
The specific risks of this procedure include, but are not limited to: urinary tract infection, blood in the urine, clot retention, urinary retention, possible need for short term clean intermittent catheterization (CIC), multiple injects may be necessary to obtain an improvement. Results suggest that 25% of males with mild incontinence will be dry after an average of 5 injections, 88% will be improved, females with pure type III SUI have greater than 85% chance of being dry after multiple injections, females with Type I and II hypermobility incontinence have nearly a 50% dry rate.
You understand the procedure, general and specific risks as discussed and agree to proceed with the procedure. You also understand that not every possible complication can be listed in this counseling note and additional risks are possible, although unlikely.
To view the actual printable form for this surgery, click here: Counseling Note for Cysto-Bulking Agent Injection. To print the document, simply select print after you have opened the page. You can use that copy to sign before your surgery.
Terminology tip: If you come across words you don't understand, look them up in the On-Line Medical Dictionary.
Indications: Patient with Stress Urinary Incontinence. The patient was skin tested with Contigen and was found to have no reaction to 30 days.Sample Procedure Dictation:
The patient was given spinal/general anesthesia, placed in the Lithotomy position and then prepped and draped in the usual standard sterile manner. External pressure on the bladder produced obvious stress urinary incontinence. A cystoscope was then gently placed into the urethral meatus and the length of the urethra inspected. The urethra was open with easy passage of the cystoscope to the bladder neck.
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The bladder neck was open and the bladder was inspected without any lesion noted. The ureteral orifices were noted bilaterally with clear efflux.
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The cystoscope was removed and a Wolf Contigen scope was placed to the level of the bladder neck and three syringes of Contigen were placed just under the mucosa to cause complete coaptation of the bladder neck. Direct pressure on the bladder produced no obvious leakage. The bladder was drained and the scope was removed under direct vision. Patient was then awaken from anesthesia without complications and transferred to the Recovery Room (RR). The patient arrived to the RR in stable condition and without complications.
To the family and friends of patients undergoing surgery.
SCHEDULED STARTING TIME OF SURGERY:ESTIMATED LENGTH OF SURGERY:
You should plan to check in at the waiting area information desk as soon as your family member or friend has left for the Operating Room. This is the only way we can talk to you afterwards, or on occasion; reach you to give you updates on the operation's progress. If the surgery is scheduled for many hours, you can leave to eat or do other things, but you should let the information desk know that you are going to leave the area, where you are going, and how long you might be gone so that we might reach you if need be. You should be in the area before the elected time of the end of the operation.
The information deck will overhead page you or the "family of" when they receive the recovery call to let you know that the surgery has been completed. The overhead page system works ONLY on the Surgical Waiting Area and not throughout the hospital or the cafeteria.
We will plan to see you in the surgical waiting area after we have safely completed the early phases of the post-anesthesia recovery in the "Recovery Room" or PAR (Post Anesthesia Recovery). This may take up to an hour after the initial call. Sometimes, especially if another case is ready to start, we will call and talk to you. If for some reason, we have not come or called within 30 minutes, please ask the information desk to page us.
Your family member will be in the Recovery Room for 1-2 hours. This is standard recovery time, although the times vary with each individual. For example, spinal anesthetics take longer to "wear off," local anesthetics are much shorter acting. Under no circumstances are family members or friends allowed in the recovery room. The information deck will inform you of the patient's return to the room as soon as they receive the information that the patient has left recovery. At that time, they will give you the room number and direct you to the correct wing and floor.
Activity
Diet
Medication
Catheter and Wound Care
Bowel Movements
When to Contact your Doctor
Contacting Your Physician
Dr. Bauer can be contacted by calling the number listed at the top of the page. You may also call the hospital to have them contact us. Please do not hesitate to call with any questions or concerns.
Frequently Asked Questions after surgery
This section is under construction.