Your urologist may recommend a cystoscopy to examines and treat bladder and urinary system problems. A cystoscope is a thin tube with a light and camera source that’s inserted through your urethra (the tube that carries urine out of your body) and into your bladder.
A cystoscope can be flexible (looks inside your bladder) or rigid (used to pass small surgical instruments into your bladder to obtain a tissue sample or to perform treatment).
A cystoscopy can investigate the reason for many symptoms including: urinary incontinence, frequently needing to urinate, feeling that your bladder isn't fully empty after going to the toilet, intermittent urination or inability to urinate, pain or a burning feeling as you pass urine, blood in your urine and pelvic pain.
It can detect and monitor conditions such as: urinary tract infections, narrowed or blocked urethra, ureter problems, urinary tract cancers, polyps, enlarged prostate gland and bladder stones.
If you’ve had a cystoscopy that indicates you may have a tumour in your bladder, then a TURBT (transurethral resection of a bladder tumour) is often recommended to investigate and treat the tumour. Bladder tumours can be benign (non-cancerous) or malignant (cancerous).
During a TURBT, the tumour or tumours are cut away from your bladder wall. They’re then sent off to find out if they’re cancerous or not, and if so, how advanced the cancer is. With this information your urologist can advise on the most appropriate treatment for your needs.
Untreated benign bladder tumours will continue to grow slowly and may become very large. This could then cause them to take up too much space in your bladder or press on other organs.
Malignant tumours will grow unless they’re removed. They can also attack surrounding tissue and spread into other areas of the body.
Adult circumcision is the removal of the foreskin from the penis.
It can be performed for medical, religious and cultural reasons. Medical reasons include: tight foreskin (phimosis), recurrent infected and inflamed foreskin and penis head (balanitis), foreskin won’t return to its original position resulting in swelling and pain at the penis head (paraphimosis) and penile cancer.
Adult circumcision is performed under general anaesthetic and involves trimming and stitching the foreskin.
There are restrictions and waiting lists to have a circumcision on the NHS. Winfield Hospital offers adult circumcision surgery without restrictions or waiting.
Penile straightening corrects the curvature of a penis when it’s too bent during erection and causes penetration problems during sexual intercourse.
General or spinal anaesthetic may be offered as pain relief for surgery. A plication procedure is used to shorten the longer side of the penis, causing it to straighten.
The prostate is a walnut sized gland found under the bladder. It produces a thick, white fluid that mixes with the sperm from the testicles to make semen. It also creates a protein called prostate-specific antigen (PSA) that turns the semen into liquid.
A prostate biopsy is advised if you’ve a lump in your prostate gland or high levels of PSA in your blood. The biopsy involves removing prostate tissue samples so that they can be examined for signs of prostate cancer.
The most common method of performing a prostate biopsy is through the rectum, called trans-rectal prostate biopsy. Alternatively, it can be carried out through the urethra (transurethral prostate biopsy) or the space between the anus and either the scrotum or the bottom of the vaginal opening, called the perineum (perineal prostate biopsy).
Treatment of bladder cancers
Bladder cancer occurs in the lining of your bladder, an organ in your lower abdomen that stores urine. Treatment of bladder cancers depends on the stage of the cancer, its size and grade and a patient’s health. Treatment may involve just one treatment or a combination of treatments and include:
· Surgery to remove the cancerous cells. It forms part of the treatment for most bladder cancers. Early-stage bladder tumours can be removed or the whole bladder (radical cystectomy).
· BCG treatment or intravesical therapy whereby the BCG vaccine is given directly into the bladder using a catheter.
· Chemotherapy – use of drugs to destroy the cancer cells.
· Radiation therapy – use of high-energy rays to destroy cancer cells.
· Immunotherapy - medicines used to encourage your immune system to recognise and destroy cancer cells.
Close follow-up is required to check if any new cancers have appeared in the bladder.
Treatment for stress incontinence
When you exercise or exert yourself your bladder may leak urine. This is called stress urinary incontinence (SUI) and occurs when the pelvic tissues and muscles become weak and allow your urethra to open when there’s an increase in abdominal pressure such as sneezing or moving causing a leak. SUI can also occur when the sphincter muscle that controls the urethra weakens.
Initially conservative treatments will normally be advised such as: pelvic floor muscle exercises, bladder training, avoiding activities that trigger leakage and bulking injections to thicken the area around your urethra. If these aren’t successful, then surgery will be recommended.
There are a number of different surgeries for SUI and your urologist will advise on the most suitable for your needs. They include:
- tape procedures (plastic tape used to hold up the urethra in the correct position)
- colposuspension (lift up and stitch the neck of the bladder)
- sling procedures (place a sling around the bladder neck to support it)
- artificial urinary sphincter (replacement of sphincter with a mechanical device).
A transurethral resection of the prostate (TURP) involves cutting away a section of your prostate. It’s normally performed if your prostate’s become enlarged and is putting pressure on your bladder and urethra and affecting urination.
A TURP is carried out under general or spinal anaesthesia. It passes a thin metal tube with a light source, camera and loop of wire, called a resectoscope, along your urethra to your prostate. The loop of wire is then heated to cut away a section of your prostate.
A vasectomy is a minor operation performed to offer permanent contraception. This male sterilisation procedure cuts and seals the vas deferens tubes to stop sperm getting into a man’s semen.
Vasectomy is carried out under local anaesthetic. Often you’ll have to wait if you want to have this procedure through the NHS. Here at Winfield Hospital we can perform a vasectomy without waiting.
Vasectomy reversal, also known as vasovasostomy aims to reconnect the vas deferens tubes that were cut during a vasectomy. It’s the best chance of success if done shortly after the vasectomy.
You can’t have a vasectomy reversal through the NHS as it’s seen as a permanent contraceptive option. Winfield Hospital performs vasectomy reversals if required.