A cystoscopy is used to investigate and treat bladder and urinary system problems including: urinary incontinence, frequent or intermittent urination, inability to urinate, urinary retention, pain or burning feeling when urinating, blood in your urine and pelvic pain.
Cystoscopy uses a thin tube with a light and camera at one end called a cystoscope. It’s inserted into your urethra and then into your bladder.
A flexible cystoscope is used to look inside your bladder. A rigid cystoscope is used if your urologist needs to pass small surgical instruments into your bladder, for example to obtain a biopsy or perform treatment.
Conditions that may be detected and monitored using a colonoscopy are: urinary tract infections, narrowed or blocked urethra, ureter problems, polyps, enlarged prostate gland, bladder stones and urinary tract cancers.
Transurethral resection of a bladder tumour (TURBT) is used to investigate and treat bladder tumours. Often it’s recommended if a cystoscopy has indicated a bladder tumour. These can be benign (non-cancerous) or malignant (cancerous).
A TURBT involves cutting away the tumour or tumours from the bladder wall and sending them for cancer examination. Once your urologist knows if the tumour is cancerous, and if so how far it’s advanced, then they can advise on the most suitable treatment.
Untreated benign bladder tumours continue to grow slowly. They can become very large and occupy too much space in your bladder and press on other organs in your body.
Malignant tumours will also grow unless they’re removed. Surrounding tissue can also be attacked by a malignant tumour or the cancer can spread into other areas of the body.
Adult circumcision involves the surgical removal of the foreskin from the penis under general anaesthetic.
It can be carried out for religious and cultural reasons or for medical reasons such as: tight foreskin (phimosis), recurrent inflamed/infected foreskin and penis head (balanitis), foreskin won’t return to its original position (paraphimosis), a dermatological condition of the penis head (balanitis xerotica obliterans) and penile cancer.
Circumcision surgery is available on the NHS but with restrictions and waiting lists. Adult circumcision is available at New Hall Hospital without restrictions or waiting.
If a penis is too bent during erection to allow penetration during sexual intercourse, then surgery to correct the curvature can be performed. This is known as penile straightening.
Penile straightening surgery is performed under general or spinal anaesthetic using a plication procedure to shorten the longer side of the penis and straighten it.
A prostate biopsy is the removal of prostate tissue samples so that they can be investigated further for signs of prostate cancer.
The prostate is a small gland found beneath the bladder that makes semen. A prostate biopsy aims to find out more about symptoms such as a lump in the prostate gland or high levels of prostate-specific antigen (PSA) in the blood.
You can have a prostate biopsy by one of three ways:
- trans-rectal (through the rectum, most frequently performed)
- transurethral (through the urethra)
- perineal (through the perineum - skin between the anus and the scrotum).
Treatment of bladder cancers
Bladder cancer means that malignant cancerous cells have been found in your bladder. Its treatment depends on the stage of cancer and other factors. Treatment options for bladder cancers include:
- Surgery - to remove the cancer cells. Your surgeon takes away early-stage bladder tumours or the whole bladder (radical cystectomy). It forms part of the treatment for most bladder cancers.
- Intravesical therapy - a liquid drug is introduced through a catheter directly into the bladder.
- Chemotherapy – drugs to treat cancer.
- Radiation therapy – high-energy radiation to kill the cancer cells.
- Immunotherapy - medicines given to encourage the immune system to recognise and destroy cancer cells.
Treatments are sometimes combined. Follow-up is needed to check for new cancers in the bladder.
Urinary incontinence is the unintentional passing of urine.
There are several types of urinary incontinence, including:
- stress incontinence – when urine leaks out at times when your bladder is under pressure; for example, when you cough or laugh
- urge incontinence – when urine leaks as you feel a sudden, intense urge to pee, or soon afterwards
- overflow incontinence (chronic urinary retention) – when you're unable to fully empty your bladder, which causes frequent leaking
It's also possible to have a mixture of both stress and urge urinary incontinence.
Causes of Stress Incontinence
Stress incontinence is usually the result of the weakening of, or damage to the muscles used to prevent urination, such as the pelvic floor muscles and the urethral sphincter. Conservative treatments, which do not involve medicines or surgery are usually tried in the first instance and include pelvic floor physiotherapy and lifestyle changes. If these are not successful surgery may be considered.
Procedures for Stress Incontinence
Mesh-free Sling Procedure
A sling procedure is used to reduce pressure on the bladder or strengthen the muscles that control urination. Sling surgery involves making a cut in your lower abdomen and vagina so a sling can be placed around the neck of the bladder to support it and prevent urine leaking. The sling is made from tissue taken from another part of your body (autologous sling).These slings are generally preferred because more is known about their long-term safety and effectiveness.
Urethral bulking agents
A urethral bulking agent is a substance that's injected into the walls of the urethra in women with stress incontinence. This increases the size of the urethral walls and allows the urethra to stay closed with more force. This is less invasive than surgical treatments for stress incontinence, as it does not usually require any cuts. The substance is usually injected through a cystoscope (a thin camera) inserted into the urethra .The effectiveness of a urethral bulking agent does reduce with time and you may need the injection to be repeated.
Colposuspension involves making a cut in your lower tummy (abdomen), lifting the neck of your bladder, and stitching it in this lifted position. Colposuspension offers an effective long-term treatment for stress incontinence.
Causes of Urge Incontinence
The urgent and frequent need to pass urine can be caused by a problem with the detrusor muscles in the walls of your bladder. The detrusor muscles relax to allow the bladder to fill with urine, then contract when you go to the toilet to let the urine out. In the first instance this condition is always treated with oral medications, and these are effective in the majority of patients. Those patients who do not respond adequately to oral medication may wish to consider more invasive treatment options.
Procedures for Urge Incontinence
Botulinum toxin can be injected into the walls of your bladder to treat urge incontinence and overactive bladder syndrome. This medicine can sometimes help relieve these problems by relaxing your bladder. This effect can last for several months and the injections can be repeated if they help.
A transurethral resection of the prostate (TURP) removes part of the prostate. It’s carried out if the prostate is enlarged and is putting pressure on your bladder and urethra affecting urination.
Performed under general or spinal anaesthesia, a TUPR passes a resectoscope (thin metal tube with a light source, camera and loop of wire) along your urethra to your prostate. The loop of wire is then heated to cut a section of your prostate.
A vasectomy is a method of male sterilisation or permanent contraception. It’s a minor procedure carried out under local anaesthetic. Your urologist will cut, block and seal the vas deferens tubes so that your sperm are stopped from entering your semen.
Often to have a vasectomy on the NHS you’ll have to wait. Here at New Hall Hospital we can offer a vasectomy without waiting.
Vasectomy reversal aims to reverse male sterilisation. It’s most successful if it’s performed soon after a vasectomy. Also known as a vasovasostomy, the procedure involves reconnecting the vas deferens tubes that were cut during a vasectomy.
You cannot have a vasectomy reversal through the NHS as it’s considered a permanent method of birth control. New Hall Hospital can perform a vasectomy reversal if required.