Parson’s cocktail bladder instillation for painful bladder syndrome (interstitial cystitis)

Q 1. What does the procedure involve?

A. This procedure involves instilling a combination of drugs into the bladder to help treat painful bladder syndrome or cystitis type symptoms, such as bladder pain, urinary urgency and frequency.

It works by aiming to reduce inflammation and discomfort in the bladder.

It is also called Parson’s cocktail and consists of lignocaine (a local anaesthetic), sodium bicarbonate and heparin (a naturally occurring compound in the bladder lining).

Q 2. What are the alternatives to this procedure?

A. The alternatives include:

• Bladder distension
• Commercial intra-vesical instillations
• Pain clinic
• Removal of the bladder
• Diversion of urine away from the bladder

Q 3. What should I expect before the procedure?

A. If you are taking blood thinning medication on a regular basis, you must discuss this with your urologist because these drugs can cause increased bleeding after surgery. There may be a balance of risk where stopping them will reduce the chances of bleeding but this can result in increased clotting, which may also carry a risk to your health. This will, therefore, need careful discussion with regard to risks and benefits. Aspirin does not usually need to be stopped but will be the decision of your surgeon.

You will usually be admitted on the same day as your surgery, or a day before. You will normally undergo pre assessment on the day of your clinic. After admission, you will be seen by members of the medical team which may include the consultant, junior urology doctors and nurse.

You will be asked not to eat or drink for six hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.

Please be sure to inform your urologist in advance of your surgery if you have any of the following:

• Co-morbidities like Diabetes, Hypertension, Coronary artery disease or, stroke, epilepsy
• Any transmissible disease like HIV/AIDS, Hepatitis B or C etc
• Presence of implants, pacemakers, graft etc
• You are taking prescription drugs like-
  • Blood thinners/ anti-platelets i.e. Warfarin, ecosprin, clopidogrel etc
  • Anti-epileptics like phenytoin, valproate etc

Q 4. What happens during the procedure?

A. You will need to lie down throughout your treatment.

A fine plastic tube (catheter) will be passed into the bladder and the medication (50mls) will be given slowly through it. The catheter will then be removed.

You will be asked to hold the urine in your bladder for a minimum of 15 minutes and a maximum of 30 minutes.

You will then be asked to empty your bladder.

Q 5. What is the frequency of instillations?

A. The instillations are planned for once a week for six weeks, then once per month for six months. You will be reviewed after six to eight weeks of treatment.

Q 6. What happens immediately after the procedure?

A. Once your treatment has been completed, you will be able to go home. You will be asked to complete questionnaires assessing your symptoms and response to treatment.

Q 7. What are the side effects or complications?

A. Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.

Common (greater than one in 10)

• Temporary discomfort on passing urine (this should settle after 1-2 days, a hot water bottle or painkillers such as Paracetamol should help)
• Frequency or urgency

Occasional (between one in 10 and one in 50)

• Nil

Rare (less than one in 50)

• Nil

Q 8. What should I expect when I get home?

A. If you think you have a urine infection or if you develop a high temperature with backache, it is important to contact your urologist and get treatment with antibiotics.