A cystoscopy can be used to examine and treat symptoms and conditions inside your bladder and urinary system using an instrument called a cystoscope. A cystoscope is a thin tube with a light and a camera at one end. It's inserted into your urethra (the tube that carries urine out of your body) and passed into your bladder.
There are two types of cystoscope:
- flexible cystoscope – uses a flexible tube to look inside your bladder
- rigid cystoscope – uses a thin, straight metal tube to pass small surgical instruments down to obtain a tissue sample or carry out treatment
Symptoms a cystoscopy is used to investigate include: urinary incontinence, blood in your urine, persistent pelvic pain, pain or a burning sensation when you pass urine, frequently needing to urinate, not being able to urinate or only intermittently and, a feeling that your bladder isn't completely empty after going to the toilet.
Conditions that your urologist may detect or monitor during a cystoscopy include: narrowed or blocked urethra, urinary tract infections, polyps (non-cancerous growths), enlarged prostate gland, bladder stones, ureter problems and cancers of the urinary tract.
Transurethral resection of a bladder tumour (TURBT) is used to investigate the type of tumour you may have and treat any tumours present in your bladder. It normally follows a cystoscopy that has flagged up a tumour in your bladder. Bladder tumours can be benign (non-cancerous) or malignant (cancerous). During a TURBT the tumour or tumours will be cut away from the bladder wall and sent for examination to see if they are cancerous and if they are, how advanced the cancer is.
Benign bladder tumours often grow very slowly but if they aren’t treated, they could become very large and cause problems by taking up too much space in your bladder or pressing on other organs in your body.
Malignant tumours continue to grow unless they’re removed. They can invade surrounding issue and spread to other areas of the body causing further problems.
The information gained from a TURBT will help your consultant decide on any future treatment required.
Adult circumcision is a simple operation that removes the foreskin from the penis. The foreskin is the retractable sleeve of skin which covers the delicate end of the penis.
Adult circumcision is most often carried out for medical reasons but it can be performed for religious and cultural reasons.
Medical reasons include:
- tight foreskin, called phimosis - the foreskin is too tight and unable to retract over the head of penis
- recurrent balanitis – the foreskin and head of the penis become inflamed and infected
- paraphimosis – the foreskin can't be returned to its original position after being pulled back and causes the head of the penis to become swollen and painful
- balanitis xerotica obliterans – a condition that causes phimosis and may also affect the head of the penis which can become scarred and inflamed
- cancer of the penis
Adult circumcision is performed under general anaesthetic and involves trimming the narrow sleeve of the foreskin and stitching together the remaining skin edges. There are restrictions and waiting lists on the NHS for circumcisions. Here at Berkshire Independent Hospital we will perform an adult circumcision without restrictions or waiting.
Penile straightening is a procedure to correct curvature of the penis during erection when the penis is too bent to permit penetration. The operation is performed under general or spinal anaesthetic. It involves straightening the penis curvature using a plication procedure whereby the long side is shortened.
Prostate biopsy removes tiny samples of prostate tissue for examination, looking for signs of prostate cancer. The prostate is a small, walnut-sized gland just under the bladder and makes semen. A prostate biopsy is done to determine if a lump found in the prostate gland is cancerous or to find the cause of a high level of prostate-specific antigen (PSA) in the blood.
The three main ways to perform a prostate biopsy include:
- Transrectal prostate biopsy - through the rectum. This is the most common method.
- Transurethral - through the urethra
- Perineal - through perineum (the skin between the anus and the scrotum)
Your urologist will discuss with you the most appropriate biopsy for your needs.
Treatment of bladder cancers
Bladder cancer is a disease in which malignant cells form in the tissues of the bladder. If you’ve been diagnosed with bladder cancer, your cancer care team will discuss your treatment options with you.
Treatment options depend on the stage of the cancer and other factors. Sometimes, the best option might include more than one of type of treatment. They include:
- Surgery – this is part of the treatment for most bladder cancers. It can often remove early-stage bladder tumours however new cancers can form in other parts of the bladder over time. Sometimes the entire bladder is removed, known as radical cystectomy. Other treatments can be given to try and reduce the risk of new cancers if an entire bladder removal is not performed.
- Intravesical therapy - a liquid drug put directly into the bladder through a catheter rather than giving it by mouth or injecting it into a vein.
- Chemotherapy – use of drugs to treat cancer.
- Radiation therapy – use of high-energy radiation to kill cancer cells.
- Immunotherapy - use of medicines to help a person’s own immune system recognise and destroy cancer cells.
Close follow-up is needed to check for signs of new cancers in the bladder.
Treatment for stress incontinence
Stress urinary incontinence (SUI) occurs when your bladder leaks urine during physical activity or exertion. It occurs when the pressure inside your bladder as it fills with urine becomes greater than the strength of your urethra to stay closed and any extra pressure such as sneezing or moving position can cause a leak.
Conservative treatments include: lifestyle changes, pelvic floor muscle and bladder training. If these don’t work, then surgery will be recommended. Surgeries for SUI include:
- Tape procedures – plastic tape is used to hold up the urethra in the correct position.
- Colposuspension - to lift up the neck of the bladder and stitch in this lifted position.
- Sling procedures – to place a sling around the neck of the bladder to support it.
- Bulking injections – to make the area around the urethra thicker.
- Artificial urinary sphincter - to keep urine from leaking.
Your consultant urologist will discuss with you the best treatment for your stress incontinence.
A transurethral resection of the prostate (TURP) involves cutting away a section of the prostate. It’s usually recommended if the prostate has become enlarged and is placing pressure on the bladder and urethra, affecting urination.
A thin metal tube containing a light, camera and loop of wire, known as a resectoscope, is passed along your urethra until it reaches your prostate. The loop of wire is then heated with an electric current and cuts away a section of your prostate. General or spinal anaesthesia is used during the procedure.
Vasectomy is a surgical procedure for male sterilisation or permanent contraception. It’s a minor operation that involves cutting, blocking or sealing the tubes (vas deferens) that carry sperm from a man's testicles to the penis and so stops sperm getting into a man’s semen.
Vasectomy is a quick procedure carried out under local anaesthetic. Vasectomy often has a long waiting list on the NHS. At Berkshire Independent Hospital we can perform a vasectomy without waiting.
A vasectomy is considered a permanent method of birth control. Vasectomy reversal, also known as vasovasostomy, reconnects the tubes that were cut during a vasectomy. It’s most successful if it’s done soon after the vasectomy.
A vasectomy reversal isn’t available on the NHS. We can perform vasectomy reversals if required.