Mrs C case study – bladder neck fillers to resolve stress incontinence

Posted by Patricia Wakeford on

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Mrs C began to develop symptoms of urinary stress incontinence following the birth of her second child. She had some physiotherapy sessions but unfortunately these did not work as well as she had hoped. She was eventually referred to a consultant in her local Trust and she asked for a minimally invasive procedure. She was recommended a product called Deflux which is a filler injected into the bladder neck. She agreed to this procedure and had this shortly thereafter.

Within a few days of having this procedure she was getting symptoms of an overactive bladder; experiencing sensations of frequency but finding it difficult to pass urine. It was felt that she might have a urinary tract infection and she was referred back to the Trust for follow up. In the months to follow it became more and more difficult for her to pass urine; having to go to the toilet 3-4 times an hour to relieve the discomfort.

It appeared that a wait and see approach was considered appropriate. Mrs C was not happy with this.

Complications with Deflux

She was referred to the same consultant who had performed the Deflux procedure to see him privately. Further testing revealed a cyst which had built up in the area of the bladder neck where the Deflux was injected. This was thought to be a rare complication but easily treated. Prior to waiting for this surgery she attempted to self-catheterise which she found very difficult as she worked in an office and had two young children to care for.

Shortly thereafter she underwent incision and drainage of the cyst and she hoped that this matter was now resolved. However, a few weeks later symptoms began again and she was diagnosed with a reformation of the cyst which caused her even more discomfort.

Mrs C was in a lot of pain whilst she was awaiting her surgery and had symptoms which caused her significant embarrassment and trauma both at work and at home. She was still struggling to self-catheterise. Her situation was much worse than before her initial surgery.

A few weeks later Mrs C did eventually have further surgery. The cyst had increased to more than double the size. She was advised to keep a catheter in for two weeks post procedure. Unfortunately, this became blocked after 10 days and after several emergency visits to have it flushed, the only option was to have the catheter removed.

Incontinence caused by removal of the cyst

Shortly after its removal it became apparent that Mrs C was completely incontinent and leaking urine constantly. Even worse, a further investigation under anaesthetic proved that a ‘vaginal fistula’ had formed which meant that she was leaking through both the urethra and vagina. Mrs C was becoming very distressed by the situation. It was impacting on her home life and also her work life.

Mrs C in desperation asked for a private referral to another consultant who advised that she would need further surgeries as a result of a known complication of Deflux that Mrs C had not been advised about initially. If she had been told about this complication she would have asked for an alternative filler of which there are two other well-known brands on the market that have less of a risk than the Deflux.

A year after having the Deflux procedure Mrs C finally had surgery which resolved the issue following the injection of the Deflux. The surgery was complex and required her to be bed-bound for two weeks. Fortunately, she was fully recovered and fully continent after six weeks.

Physically she is now recovered. However, psychologically she still feels traumatised by what she went through. Not only was she in considerable pain throughout this period, but she had to put up with leakage on a regular basis and this made her feel very uncomfortable and embarrassed.

Support from BL Claims

Mrs C contacted BL Claims Solicitors and Patricia Wakeford managed her claim to conclusion. The Trust admitted failures in the consent process. They had not advised her of the risks of developing a cyst after Deflux which was as much as 10% in the literature. They admitted to there being a delay in dealing with the cyst when initially diagnosed. The Trust did however say that the subsequent events would have happened in any event.

Mrs C tried to settle her claim. However, the Trust rejected her offer. Proceedings were then issued and at that point the Trust made an offer of settlement. Mrs C was happy to negotiate and accept settlement of a five figure sum to bring an end to her claim. She now intends to have CBT to help her to come to terms with what she had been through, especially the impact on her family life.

If you have any questions or have suffered a similar issue; please contact Patricia Wakeford in our Clinical negligence Team on 02380 857310 or email patricia.wakeford@blclaims.co.uk

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If you would like to talk to someone and discuss a potential claim please call us on 0344 620 6600 anytime between 8am and 6pm Monday to Friday, or if you would prefer you can email us at info@blclaims.co.uk

About the Author

Patricia is a Senior Associate, in our Clinical Negligence team, and is also a qualified midwife with many years of experience working in the NHS.

Patricia Wakeford
Email Patricia
023 8085 7310

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