You should allow at least 1 hour 15 minutes for the test. You can eat and drink as normal before the test, but we would like you to come with your bladder comfortably full.

If you are currently taking any of the below tablets for your bladder symptoms you will need to stop taking these 7 days before your test unless you have been told otherwise:

• Vesicare/solifenacin.
• Regurin/trospium chloride.
• Detrusitol/tolterodine.
• Oxybutynin.
• Betmiga/mirabegron.

Please complete the three day bladder diary and the questionnaires sent with your appointment letter. You must bring both of them with you to the clinic.

Before the test, please let us know:

• If you have any allergies, especially to latex.
• If you have any problems with your mobility.
• If you feel you may have a urine infection. We are unable to perform urodynamics if you have a urine infection and have symptoms (for example foul-smelling urine or a burning sensation when you urinate).

If you are prone to urinary tract infections, please ensure you get your urine checked by your GP surgery five working days before the appointment so that it can be treated before your appointment.

What the urodynamics test involves

After you arrive, a healthcare professional will explain the test to you and ask some questions about the symptoms that you have been experiencing. You can ask any questions you have about the test.

You will then be asked to sign a consent form to make sure that you understand the procedure, the reasons why it is being done and any potential side effects.

In privacy, you will be asked to change and remove the lower half of your clothing (trousers/skirt/underwear). You will be given a hospital gown to change into and once you are on the couch you will be covered with a sheet.

The healthcare professional will also ask you to pass urine into a special toilet (flowmeter). This measures how fast the flow of your urine is and allows us to check you don’t have a urine infection.

After you have done this, the healthcare professional may examine you. This will include an internal examination, with a chaperone present.

During the test

You will be lying on a couch before one or two small tubes

(no more than 3mm in diameter) will be passed into your bladder. Another small tube will be placed into your rectum (back passage). If you do not have a rectum because you have had surgery and have a colostomy or stoma then that can be used, or the vagina can also be used as an alternative.

These tubes allow us to take measurements both inside and outside the bladder. You will then be asked to sit or stand and your bladder will be slowly filled with water through the tube until you feel full. If you are unable to sit or stand then you will remain lying down on the couch.

You will be asked to cough several times during the test to check the tubes are working. You will also be asked a series of questions such as your first desire to pass urine or whether you experience any urgency.

Once your bladder is comfortably full, one of the bladder tubes will be removed. The tube in your rectum and the very tiny tube in your bladder will be left in. You will then be asked to pass urine and the healthcare professionals will leave the room during this time.

After the test

You will be given time to get dressed in privacy after the test and the results will be explained to you. At this point, you will have the opportunity to ask any questions you may have.

A report will be written and a copy will be sent to your GP, the person who referred you, and yourself.

After the test, you may experience some discomfort where the tubes have been for a short time, but this should settle down. We suggest that you drink extra water during the 24 hours after the test to decrease the chances of you developing an infection.

Video urodynamics is similar to standard urodynamics (described above please read and follow the ‘before the test’ guidance above), however, we also take X-ray pictures of your bladder. Instead of using salt water to fill your bladder, we use an iodine-based fluid (this allows us to see your bladder on X-ray).

Before the test, please also let us know:

• If there is any possibility that you are pregnant as we are unable to perform the test if you are. We may also perform a pregnancy test on the day of your appointment.
• If you are allergic to Iodine.

What the urodynamics test involves

Unlike standard urodynamics, because we need to X-ray your bladder when you pass urine, we have to remain in the room. We are as discreet as possible and stay behind the curtains when possible.

NHS website

More information about COPD.

Chronic obstructive pulmonary disease (COPD) - NHS

Asthma and Lung UK

More information about COPD.

Chronic obstructive pulmonary disease (COPD) | Asthma + Lung UK

Right Breathe

Information about how to use your inhalers correctly.

RightBreathe

Support to stop smoking

Try the NHS Quit Smoking app, speak to your local pharmacy or GP, or find out about options for support in your area.

Quit smoking - Better Health - NHS

IAPT Talking Therapies

Get help with your mental health through NHS talking therapies.

NHS Talking Therapy | Vita Health Group

If you have any concerns about the service that the nurses or doctors cannot resolve, you can contact our Patient Advice and Liaison Service (PALS).

PALS offer support and assistance for patients and their families. You can also share positive comments with them about your care.

• Phone: 0117 414 4569 (09:00 to 16:00)
• Email: PALS@nbt.nhs.uk

Figures from a trial being led by NHS Blood and Transplant and the University of Oxford show one in three expectant mothers will develop anaemia.

It is a condition where the blood produces a lower-than-normal amount of red blood cells and can be linked to stillbirth, postnatal depression and haemorrhages.

The research team is working with maternity wards across the UK to carry out a study by giving pregnant women an iron supplement to see if it helps.

The trial is being funded by the National Institute for Health and Care Research (NIHR) and will involve giving half the mothers taking part one iron supplement a day and the other half a placebo.

Researchers are working with up to 50 maternity wards across the country.

PANDA, is open to women who are in the first 16 weeks of pregnancy with a single baby and women can ask their healthcare professional for more information or ask about taking part.

Prof Simon Stanworth is a consultant haematologist at NHS Blood and Transplant in Oxford and is running the trial.

About the programme - Clinical Trials Unit - NHS Blood and Transplant

Principal Investigator – Dr Christy Burden

Start date - 01/03/2024

Planned end date – 30/08/2026

Local Ref – 5707

The Generation Study is a national research study that will sequence the genomes of 100,000 newborn babies to test for more than 200 rare and treatable genetic conditions. 

Identifying these conditions shortly after a baby is born, rather than when symptoms might appear later in childhood, means families can receive support, monitoring, and treatment much earlier. Early, effective intervention can help to prevent longer term health problems associated with certain conditions, keeping children out of hospital, and helping them live healthier lives. 

The Generation Study, led by Genomics England in partnership with NHS England, will see parents offered whole genome sequencing using blood samples taken from the umbilical cord shortly after birth.

In Bristol, Southmead Hospital (North Bristol NHS Trust) and St Michael’s Hospital (University Hospitals Bristol and Weston NHS Foundation Trust) are among more than 20 hospitals nationally taking part.

Women planning to give birth at home may also take part in the study. Expectant parents will be informed about the Generation study during pregnancy, and if interested, a research midwife will have a detailed conversation with them to decide if they want to take part. Taking part is voluntary and free. Soon after birth, an NHS doctor, nurse, or midwife will check with parents that they are still happy for their baby to be tested, and a blood sample will be taken and sent to a laboratory for whole genome sequencing.    

Results are then reviewed by NHS genomic scientists. The aim is to share results with parents within 28 days if a condition is suspected, or within a few months if no conditions are suspected. 

If a newborn baby is identified as having a treatable childhood condition through the genome sequencing, families and carers will be provided with further NHS testing to confirm a diagnosis and will receive ongoing support and treatment from the NHS. 

The study will also gather genomic data for wider research purposes, allowing a better understanding of rare genetic conditions. It will also potentially pave the way for new diagnostic tools and treatments and improvements in existing therapies.

In addition, the Generation Study will explore the risks and benefits of storing an individual’s genome over their lifetime. This could allow it to be reanalysed later in life if needed, enabling access to new developments in genomics.

For further information on the Generation Study, visit: www.generationstudy.co.uk

Principal Investigator – Dr Christy Burden 

Planned end date – Currently 31/12 2026.

Local Ref – 5527

A team of researchers and clinician are conducting a study of the use of a medication called Pravastatin by pregnant women who have been identified as being at higher risk of their babies being born too early (preterm birth).

Preterm birth is birth that happens before 37 weeks of pregnancy. It affects around seven out of every 100 babies born in the UK. We do not fully understand why some babies are born too early and at present there are few effective treatments to prevent this from happening. Research shows it is likely that early labour may occur in some pregnancies because of inflammation in the mother’s body. Taking a medication that reduces inflammation, such as Pravastatin, could therefore reduce the number of babies being born too early. Pravastatin is a statin, and statins are a group of medicines which are commonly taken to help lower the risk of heart disease and stroke. Statins work by protecting blood vessels and lowering inflammation in the body.

During the past couple of decades, Pravastatin has been used during pregnancy in studies which have investigated whether Pravastatin prevents or treats other problems/complications of pregnancy. In total 1,303 pregnant women took part in these studies, which showed that there were no safety concerns or problems regarding the baby’s development.

In fact, these studies suggested benefits to the baby, as they found evidence that Pravastatin reduced the number of babies born early. This is what PIONEER will now test. Based on this information, we are interested to find out whether treatment with Pravastatin reduces the chance that a woman will give birth early by: 

• extending the length of pregnancy
• reducing the risks associated with babies being born too soon. 

We would also like to find out how Pravastatin might work to reduce early birth by looking at blood samples, vaginal swabs, and stool samples taken from pregnant women who take part in the study.

Everyone who takes part in PIONEER will be randomised into one of two groups: one group will take Pravastatin and the other group will take a placebo (a dummy tablet which looks like Pravastatin but does not contain Pravastatin, only an inactive substance). An equal number of pregnant women will be placed in each group. The aim is to have two groups that are as similar as possible at the start of the study, so that the only thing that differs between the groups is whether they receive the Pravastatin or the placebo. This then allows a fair comparison between the two groups to see if there are differences between the groups in the number of babies born early.

For more information, please visit the study website www.bristol.ac.uk/pioneer

Principal Investigator – Dr Sherif Abdel-Fattah

Planned end date – 31/03/2027.

Local Ref - 5406

Children of the 90s is a group of around 14,500 children born in the Avon area in 1991 and 1992. Scientists have been studying them ever since and are constantly making discoveries that make a difference to lives around the world.

Some now have children of their own, and we want to follow these pregnancies, births and babies. We call this Children of the Children of the 90s, or COCO90s for short. This is the only project we know of that provides scientists with information on three generations, allowing them to study important social and health issues.

If you or your partner are in Children of the 90s and are about to become or are already a parent, we'd love you, your partner and all your children to take part in COCO90s. It doesn’t matter how much or how little you have been involved in Children of the 90s in the past -- this is a new opportunity to be involved in ground-breaking research.

For more information about this study, visit the CoCo90s website.

Project Details
Principal Investigator: Ms Mary Alvarez
Planned end date: Ongoing
Local Ref: 2801

Aim: This research project compares two ways we may adjust a commonly used treatment, called positive end-expiratory pressure (or PEEP), to help premature babies’ lungs in the first few minutes after birth.  

Recruitment:  80 babies born before 29 weeks of pregnancy.

The POLAR Trial is a large clinical trial, being conducted in 25 hospitals around the world, including Australia, Europe, the United Kingdom and the USA.​

​This trial will establish how to best support the fragile lungs of very premature babies born between 23 and 28 weeks of pregnancy immediately after birth.​

We are comparing two approaches to PEEP levels given to preterm babies’ lungs at birth. We will put your baby into one of two groups, static or dynamic PEEP.  

All the babies in the same group receive the same treatment.  The results are later compared to see if one is better. 

For more information, please visit the POLAR study website.                                                                                          

Project Details
Principal Investigator: Dr Charles Roeher
Planned end date: 30/06/2026
Local Ref: 5152

Aim: The WHEAT International trial will compare two different approaches, feeding babies or not feeding babies during blood transfusions, to work out which one is better. 

Recruitment: We are including all babies that are born before 30 weeks of pregnancy. The WHEAT study is an opt-out study.  This means that all babies will take part unless you let a member of the neonatal team that you do not wish your baby to participate. 

Both approaches are standard practice in the UK but we don’t how best to feed babies during blood transfusions – some hospitals and doctors stop feeds while other don’t. 

Some babies who are born early can develop a bowel disease called necrotising enterocolitis (NEC) which can be serious and can have long-term effects on how babies grow and develop. We want to know if feeding babies or not feeding babies while they have a blood transfusion changes the number of babies that get NEC.

WHEAT is taking places in neonatal units across the UK and Canada and will involve about 4,500 babies.

Project Details
Principal Investigator: Dr Daniela Vieten-Kay
Planned end date: 31/12/2026
Local Ref: 5236

Aim: The neoGASTRIC study is looking at whether routinely measuring gastric residual volumes (checking what is in the stomach before feeding) helps babies safely get to full feeds more quickly. We are comparing two ways of caring for babies having tube feeds, both ways are standard care commonly used in neonatal units across the UK.

Recruitment: We are including all babies born 6 or more weeks early (before 34 weeks of pregnancy) who require tube feeding unless there is another medical reason why they should not take part. All babies will be in the study unless you let a member of the neonatal team know that you do not wish your baby to take part.

Some doctors and nurses routinely measure gastric residual volumes because they think it might help tell if the baby is coping with their feeds, and may help identify signs of a serious but rare gut disease called necrotising enterocolitis (NEC). Other doctors and nurses think that routinely measuring gastric residual volumes may not be a good idea because it can be inaccurate and we do not know if it does help to identify necrotising enterocolitis (NEC). It also increases the amount of procedures each baby has, and may be uncomfortable for them. Routinely measuring gastric residual volumes may also lead to feeds being reduced or even stopped, this will delay the time it takes for the baby to reach full feeds and might affect how well they grow. It will also mean a baby will need intravenous nutrition for longer which can lead to potential problems like infections.

In the UK about half of doctors and nurses routinely measure gastric residual volumes and about half don’t – so both approaches are standard treatment. 

The study is being run in more than 30 hospitals in the UK and Australia for about 3 to 4 years. We hope to include over 7000 babies in the study (UK and Australia combined).

Project Details
Principal Investigator: Paula Brock
Planned end date: 31/10/2026
Local Ref: 5298

Have you recently received a letter from the NHS breast screening programme inviting you to come for your first screening mammogram?

The NHS provides a breast screening service because early detection of breast cancer saves lives.

The NHS screening programme has been using mammograms to detect cancer since 1988… But still, 30 women die of breast cancer every day in the UK.

The FAST MRI DYAMOND study is looking to see if a new form of MRI scan, called FAST MRI, can pick up aggressive cancers even earlier than mammograms can. 

The NHS already uses breast MRI to detect cancers, but only for women who have a very high likelihood of having breast cancer. For these women, MRI detects breast cancers earlier than mammograms and saves more lives.

The FAST MRI DYAMOND study will be the first UK study to offer a FAST MRI scan to women at normal or average risk, aged 50-52. People invited for their first screening mammogram can take part at 4 NHS breast screening services in England. (Bristol, Cheltenham, Swindon, Truro, London (St George’s & King’s College).

Everyone’s breasts are different, and in addition to how breasts look and feel in real life, they also look different on mammograms.

At age 50-52, breasts can look completely white on mammograms. They can also look completely dark. Both appearances are normal, as are all the different combinations of white and dark in between. These differences are called mammographic density or breast density.

The problem is that breast density can make a small cancer difficult to spot on a mammogram. Breast cancers tend to show as white on mammograms, so you can see how much easier a cancer would be to spot on the dark mammogram on the left than on the white mammogram on the right.

Fortunately, however, FAST MRI works well at detecting small cancers for women of all breast densities. The pink arrow highlights what a cancer, that was completely invisible on the mammogram, looks like on FAST MRI.

Breast screening with mammograms already saves around 1,300 lives each year in the UK by finding cancers that are too small to feel or see. 

FAST MRI could find cancers even earlier for women and our research is designed to find out which women would benefit from breast screening with FAST MRI through finding breast cancer even earlier than mammograms.

We want to find breast cancers earlier because:

• finding cancer early makes it more likely that treatment will be successful
• finding cancer early makes it less likely that a mastectomy will be needed
• finding cancer early makes it more likely that the cancer will be cured.

The only way to discover your breast density is to have a mammogram.

The FAST MRI DYAMOND study wishes to offer a FAST MRI scan to 1000 people who all have average breast density. At age 50-52, four out of every 10 women will have average breast density and could join the FAST MRI DYAMOND Study to have a FAST MRI scan. 

We can only find out whether you can join the study if you give us your contact details and let us know you are happy for us to use your mammogram to measure your breast density.

Research is fundamental to improving treatment and care for patients and the public but it is your choice whether you join the study or not.

If you are having your first screening mammogram and would like to learn more about the FAST MRI DYAMOND study, please fill in a FAST MRI DYAMOND consent to be contacted form, either online or at your mammogram appointment. 

This is the web address of the online form. 

If you would like to ask any questions at all, you will find the telephone number for the nurse from your local research team below this video along with the link to the online form.

Thank you for taking the time to watch this film. Thank you for helping us with this research.

Women with “average” breast density and a clear mammogram may be able to have a FAST MRI. To find this out, we are first inviting women to Stage 1 of the DYAMOND study. 

If you agree to take part in Stage 1, we will send your mammogram to the DYAMOND team at the Royal Surrey NHS Foundation Trust so that they can measure your breast density. We won’t send your mammogram to be measured for 10 working days after we receive your consent. This is in case you change your mind about participating. If you do, please let us know. 

The results will then be sent to Warwick Clinical Trials Unit, to be stored. 

If your mammogram is measured as anything other than average breast density, you will be looked after by the screening service, and you won’t be able to take part in this study. This is because we are only inviting people with “average” breast density to have a FAST MRI. If breast density can't be measured due to having breast implants or for other technical reasons, we will unfortunately not be able to invite you to Stage 2.

If your mammogram measurement is in the “average” breast density group, we will look at your mammogram screening results to check if the screening service says you need any further investigations. This is because in this study, we are only inviting people with clear mammograms to have a FAST MRI.

If you do need some further investigations, the screening service will contact you directly. You won’t be able to have the FAST MRI scan as part of this study. Instead, with your consent, we would like to access your screening and medical records to discover the outcome of your investigations. We will do this for up to 3 years after your first mammogram.

If the screening service says your mammogram needs no further investigations and you are in the average breast density group, we will send you information and an invitation to take part in Stage 2 of the study.

Stage 2 of the FAST MRI DYAMOND study involves having a FAST MRI scan.

Agreeing to take part in Stage 1 does not mean you will automatically have a FAST MRI scan. If the Stage 1 density grading shows you are eligible to take part in Stage 2, you will be invited and can then decide whether to take part or not. 

A member of the research team will contact will contact you to give you information about Stage 2. They will discuss the study with you. If you can have the scan and would like to, they will book you a scan appointment. The scan itself takes just 2-5 minutes, but the whole appointment would last up to 45 minutes. 

No, it’s up to you to decide whether to take part. If you do not want a FAST MRI scan or know you cannot have one, then you can let us know you don’t want to take part. Whether or not you choose to take part, be reassured that your clinical care will not be affected. You will still be offered your routine screening mammograms every 3 years until you turn 71.

In this study we will use information from you and from your medical records. We will only use information that we need for the research study. We will let very few DYAMOND team members know your name or contact details, and only if they really need it for this study. This includes research staff at Royal Surrey Hospital who are providing the Consent Form website. 

Everyone involved in this study will keep your data safe and secure. We will also follow all privacy rules.  At the end of the study, we will save some of the data for up to 5 years after the study closes, in case we need to check it and for future research (if you have given us permission). We will make sure no-one can work out who you are from the reports we write. Please contact us on the details below for more information about this. 

This study is run by Dr Lyn Jones (Consultant Radiologist) at the FAST MRI Programme Team at North Bristol NHS Trust and a Consultant Radiologist at your local Hospital.

FAST MRI DYAMOND Consent Website

If you have read the patient information above, or have previously read a leaflet given to you in your breast screening mammogram appointment, you can sign up via the FAST MRI DYAMOND Consent Form.

Opioids provide pain relief by mimicking the body’s natural pain relief (endorphins). They are used when the pain is moderate to severe after an operation or accident. They are also used at different stages of illness.

Opioid medicines can help manage some, but not all types of pain, and they will be prescribed by your medical team in hospital or your GP if it is felt they are the best treatment for your pain.

Opioid medicines can help manage pain when other medicines are not suitable, or do not provide enough pain relief. They may help reduce your suffering or distress, and may improve your ability to function physically and socially. They may also allow you to sleep and eat better. 

The correct dose of any medicine is the lowest dose that produces a noticeable benefit. It is unusual to get complete relief of pain from opioids.

However, it is important to find the most effective dose for you to reduce your pain. The amount needed to control pain varies between people. There is no standard dose of opioid.

It is important to understand that the medication/opioids prescribed for your pain may not completely stop your pain – this is normal. The aim of these opioids is to make pain manageable, so you are able to carry out normal daily activities.

You will usually start with a low dose and gradually build up until you find the dose that helps with your pain. The doses can be changed, and other pain medicines can be trialed so your pain is kept under control. Your doctor may try more than one kind of opioid if one type is not right for you.

It is important to control background pain, which is constant and continuous, so you will take a dose at a regular time each day to prevent the pain building up again.

You may have additional medicine for breakthrough pain, which is a sudden, intense pain in addition to the background pain. This will be a short acting preparation (“immediate release”). This acts quickly but usually wears off within a few hours.

It is important to take your pain medicines as they are prescribed.

If it is almost time for your next dose, skip the missed dose and take your medication as normal (you must leave the prescribed number of hours between doses).

Never take two doses together.

If you are using opioids but are still in pain, the opioids are not effective for your pain control and should be stopped by your doctor. Please seek medical advice on weaning opioids if they are not helping to manage your pain- they should not just be stopped.

• Morphine/morphine equivalent medication doses that are 120mg or above per day (24 hour period) greatly increase the risk of harm caused to your body. Research shows there is no increased benefit to pain control above this 120mg total dose.

If you have significant pain after surgery and are sent home with an opioid prescription, it should be limited to a small amount. If you do take opioids, take them only for a day or two, three days at most. Your pain will improve significantly within a few days whether you take opioids or not.

While opioids can have a positive effect for some people living with long-term pain, research shows that opioids have little to no benefit for nerve pain.

Taking opioids long term can have serious consequences when they are not providing enough benefit or are being taken not as prescribed. It is important to consider the risks and benefits of continued opioid therapy with your prescriber on a regular basis.

Recent medical research suggests that the risks to your health increase significantly when taking prescribed opioids at high doses for a long period of time. Health risks include accidental overdose or even death.

When you first start taking opioids you can experience some side effects, which usually stop after a few days. These include:

• Feeling dizzy.
• Feeling sick (nausea).
• Being sick (vomiting).
• Feeling sleepy.
• Feeling confused.
• Feeling constipated.

Please let your doctors know if you experience any of the above. Some side effects can be helped with other medication or alternative pain medication may need to be changed.

It is important to take pain medicine for the shortest possible time. If you want to try reducing your dose, you should discuss this with your doctor and bring the dose down slowly.

Many people find they can reduce their opioid dose without the pain increasing. As fewer side effects are experienced, quality and enjoyment of life can improve. All of this contributes to greater physical fitness.

Following surgery, many patients go home with an opioid pain medicine prescription, this can sometimes trigger addiction.

It is strongly recommended to only take opioids for the shortest possible length of time. Everyone prescribed any pain medication should have them reviewed by their prescriber at regular intervals.

Remember:

• Opioid medicines should be used as little as possible, if at all, after surgery.
• Nobody should need to take them for more than a week after an operation.
• Addiction can develop after taking just a few of them.

People who are addicted to pain medicine can:

• Feel out of control about how much medicine they take or how often they take it.
• Crave the drug.
• Continue to take the drug even when it has a negative effect on their day-to-day life, physical and/or mental health.

If you have been taking opioid pain medicine for more than a week, your body may have become used to the opioid medicine and you may experience symptoms of withdrawal (sweating, stomach cramps, diarrhoea, aching muscles) and the return of your pain if you:

• Stop taking it too suddenly.
• Lower the dose too quickly.
• Run out of medicine.

You should not suddenly stop taking your opioid medicine but get advice from your doctor who will help you reduce the dose gradually and safely.

• If you are allergic to any medications.
• If you are taking any other medication, including over the counter or herbal medication (sometimes different medications can interact with each other).
• If you are pregnant or breastfeeding, or if you are planning to become pregnant in the near future.
• If you have kidney and/or liver problems.
• If you have or have previously had a history of excessive alcohol use, recreational drug use, or addiction to prescribed or over-the-counter medication.
• If you have a condition called obstructive sleep apnoea - it may not be safe to take opioids with this condition.

It is important that you read the drug information leaflet provided with your medication on discharge. This includes more advice on driving and alcohol use along with your medicines.

Taking alcohol and opioids together will cause sleepiness and reduce your ability to concentrate. When you first start taking opioids or when your dose is increased you should be more careful. When you are on a steady dose of opioid, you should be able to drink safe and modest amounts of alcohol without getting any extra unusual effects.

When you are taking opioids, you should not drink alcohol if you are going to drive or operate machinery.

UK law allows you to drive if you are taking opioid medicines. However, you are responsible for making sure you are safe to drive.

Because opioid medicines can make you feel sleepy, you should not drive or operate machinery until you see how it affects you. Your reactions and alertness will be affected. You should only consider driving regularly if you are confident that your concentration is not impaired. You should not drive if your dose has changed or if you feel unsafe. You do not have to inform the DVLA that you are starting an opioid. However, there may be other information about your illness that the DVLA needs to know.

If you have a history of chronic/long term pain and you are taking pain medicines for this at home before coming into hospital, your analgesia/pain relief will be discussed with your doctors/anaesthetist, and/or (if required) the acute pain team. 

It is important that only you take the opioids prescribed for your pain.

Opioid medicines should be kept in their original containers and clearly labelled. They should be stored as the information leaflet given with the medication suggests, usually at room temperature in a dry place.

As with all medicines they should be stored safely out of the reach and sight of children.

• Return them to the pharmacist/pharmacy for safe disposal.
• Do not share these medications with anyone, they are prescribed for you only.
• Do not flush them down the toilet or throw them away.

Resus is for the most critically unwell patients with life or limb-threatening conditions.
 

Majors is for acutely unwell patients who require regular monitoring.

See and Treat is our Minor Injuries Unit (MIU), and where most injuries get seen. 

The minor injury unit can see both children and adults. 

It can treat patients with minor injuries such as cuts, sprains, minor burns and suspected broken bones. 

We do not have a dedicated Minor Injuries team overnight, and all patients will be seen in the ED, along with the Majors and Resus patients. 

This means that after 1 am, patients with minor injuries may wait considerably longer than they would normally.

If you have a minor injury or illness overnight, you will be seen in order of clinical need alongside ambulance arrivals and emergency patients. 

At present, waiting times are much longer overnight, and you may be asked to come back the following morning, or to attend another suitable service instead. 

Other Minor Injuries units are at Yate MIU, Clevedon MIU and South Bristol Community Hospital.

The ED Observation Unit is a seated assessment area for ambulatory patients who are well, but may need further observation and treatment.

If you are unlikely to require admission to hospital, and are waiting for results, need further treatment and/or observation, you will be transferred to our seated monitored waiting area (EDOU).

Occasionally, depending on the results of certain investigations, patients may need admission to a specialised ward from the EDOU.  

The EDOU also has capacity for two surgically expected patients, this means you may be referred directly by your GP to the EDOU, depending on your GP assessment.

In the current climate, waiting times in the Emergency Department can be very long, and for many people, an emergency department is not the best place to be seen. 

The Senior Streaming Nurse may decide your condition does not need to be seen in the Emergency Department and may direct you elsewhere. 

This may happen if our team thinks your condition is not an emergency, or you have certain symptoms which mean you need to be seen by another healthcare provider.

You may be redirected to 111 (link to phoning 111 in the Emergency Department), local Minor Injuries Units (Yate and Clevedon), your GP, local pharmacies, Same Day Emergency Clinic (SDEC) (based at Gate 36, Level 1 of the hospital) or Bristol Children’s Hospital Emergency Department.

Around 10,000 people are diagnosed with bladder cancer each year. It often happens because harmful things like cigarette smoke can damage the bladder lining.   

The most common symptom is blood in the urine. If you have this see your GP immediately.  

The first step to treatment is finding out what stage your cancer is at. This is usually done with an operation called TURBT to remove the growth from the bladder to see how deep in the bladder wall it is (Day case TURBT (Transurethral Resection of the Bladder Tumour).  You may also have a scan of the rest of the body. 

Treatment for bladder cancer depends on how deep it is in the bladder wall. If it is just inside the bladder it is called intravesical.  

If it involves the lining and muscles of the bladder this is called invasive. This is a serious diagnosis and often you will need both chemotherapy and surgery to treat it. 

Find out more about treatments for bladder cancer: 

• Treatment for bladder cancer | Macmillan Cancer Support
• Action Bladder Cancer UK
• Fight Bladder Cancer 

Treatment for bladder can include surgery. Bristol Urological Institute has the most experienced surgeons in the country who provide robotic surgery for bladder cancer. Robotic assisted surgery allows smaller incisions (cuts), less blood loss, and less anaesthesia needed. This means patients recover far more quickly.

Our consultants Mr Koupparis and Mr Rowe were the first in the country to remove a patient’s bladder due to cancer and reconstruct a new bladder out of bowel using the Da Vinci robotic surgical platform. 

Kidney cancer is also known as renal cancer and is most common in people over 60.  

Find out more about kidney cancer, symptoms, treatment, and recovery:

• Home - Kidney Cancer UK
• Kidney cancer | Macmillan Cancer Support 

Cancer of the penis is quite rare. If you have any symptoms you will need further tests like a biopsy, lymph node aspiration, and scans like a CT scan.  

Once we have the results of your tests, we will work out the right treatment with you. This may be a combination of treatments that could include: 

• Surgery to remove the cancer, and possibly to reconstruct the penis.
• Radiotherapy.
• Chemotherapy.  

Find out more about penile cancer, symptoms, treatment, and recovery: 

• Penile cancer | Macmillan Cancer Support.
• Orchid Fighting Male Cancer 

Prostate cancer is the most common cancer in men in the UK. Slow-growing prostate cancer is more common and does not always cause symptoms or shorten life. It is often found on a routine blood screening. More aggressive prostate cancer can cause problems urinating (peeing) and can spread to other parts of the body like bones. 

At Bristol Urological Institute we have some of the most experienced prostate cancer specialists in the country. We work with our oncology colleagues and a team of specialist nurses. 

Find out more about treatments you may have for prostate cancer:

• Brachytherapy
• External radiotherapy
• Active surveillance
• High intensity focused ultrasound (HIFU)
• Robotic Assisted Laparoscopic Prostatectomy   

Find out more about prostate cancer, treatments, and support on the websites below:

• Prostate Cancer UK | Prostate Cancer UK
• Prostate cancer | Macmillan Cancer Support
• Prostate cancer - NHS

Testicular cancer is most common in males aged 15-40. The risk of testicular cancer over your lifetime is roughly 1 in 250 (0.4%).

It has one of the highest cure rates of all cancers. More than 90% will be cured.  

Testicular cancer is often suspected if you find a lump. Not all lumps on the testicles are tumours, and not all tumours are malignant (cancerous).  If you find a lump, get it checked by your GP. Find out more about testicle swellings and lumps: Testicle lumps and swellings - NHS.

If your GP suspects your lump is a cancer, they will refer you for scans and blood tests. You may then meet a surgeon at Bristol Urological Institute to discuss removal of the testicle – this is called an orchidectomy.

Some important things to discuss with your surgeon

• Your blood test results (tumour markers) before your operation
• Prosthesis insertion.
• Pre-operative sperm banking.

Most people will have surgery within the next 2 weeks, and you will usually go home on the same day (day case). You will be given all the information you need including when and where to go, and when to stop eating and drinking.

It is usually done under general anaesthetic (you will be asleep). When you wake up you will have a dressing on the wound on your groin. The stitches in the incision (cut) are usually dissolvable so don’t need to be removed.

Find out more about testicular cancer, symptoms, treatment, and recovery:

• Testicular cancer | Macmillan Cancer Support
• Testicular Cancer Charity | It's in the Bag