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Operations linked with
bladder problems

Cystoscopy


This is an investigation of the bladder, while you are under anaesthetic; the doctor inserts a telescope in to the urethra. By looking into the telescope, he or she can see inside your bladder and detect any problems. It is done to help in the diagnosis of lower urinary tract (bladder and urethra) symptoms.

Biopsies can also be taken from any abnormal looking areas.

It is also used as a part treatment for bladder tumours and stones, and in gynaecology as part of operations such as TVT- (i.e. tension free vaginal tape) and collagen bladder neck injections

Types of cystoscopes:

Rigid cystoscope : this a straight solid metal tube with a high intensity light source and a separate channel to allow other instruments to be attached.

Flexible cystoscope: this is a fibre optic instrument, which bends easily and has a manoeuvrable tip.

The procedure

The cystoscopy may be done under local anaesthetic, but if it is a planned surgery it may be better to have a general anaesthetic.

A flexible cystoscope can be passed along the urethra with just a lubricating jelly and manoeuvring the tip helps to view all the corners of the bladder.

A rigid cystoscope is used with a general or local anaesthetic. A much wider range of instrument can be employed with this instrument.

Normal saline solution will be sent down the scope to fill the bladder and allow the surgeon to look all around inside the bladder.

An attached camera will allow a view of the bladder to be projected on to a TV monitor.

The information obtained:

As the instrument is passed inside the urethra it is carefully examined for a narrowing or obstruction.

Once inside the bladder the following are carefully looked at:
  • The lining (mucous membrane)- for any polyps (usually simple growths) diverticulea (bulges) tumours, calculi (stones), inflammation(irritation) and the capacity of the bladder and any deformities.
  •  The opening of the urinary passage from the kidneys to the bladder.
  • The link to the urethra (bladder neck).
Biopsies may be taken and bladder stones removed.

In procedures like pubovaginal sling to note whether the introducer needle has passed through the bladder.

Following the procedure:

After a short stay in the recovery room, you will return to the ward, your nurse will take your observations, and make sure that you are comfortable, if you have any discomfort you should be able to have some pain-killers.

2-4 hours after your return to the ward, and as long as you don’t have any anaesthetic sickness, you can start eating and drinking.

When you first pass some urine after the procedure it may be slightly blood stained, this does not always happen, but if it does it is nothing to worry about.

Occasionally a patient may get a water infection after a cystoscopy.

If temperature, pain, or continuous burning is noted the doctor should be contacted.

What about driving?

We recommend that you have a few days off work to get over the anaesthetic, if you have a difficult job then see your GP and he/she will advise you.
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TOT

The Transobturator Tape (TOT)


A transobturator tape is a synthetic tape inserted through a small cut at the top of the groin area to support the urethra and helps improve stress incontinence. It s guided in to position by a small cut in the front wall of the vagina. The TOT is a surgical treatment option for stress incontinence.

What are the benefits of a TOT?

In supporting the urethra, when stress is put on the bladder (coughing, sneezing, lifting) the urethra squeezes against the tape to prevent leakage. 85 – 90% of women with a TOT are completely dry or their symptoms have significantly improved.

What are the risks of the operation?

Bleeding - 2 in 100 (2%) women will experience bleeding from the wound site.

Infection – there is a 2% risk of infection in the surgical wounds or bladder itself. These can be easily treated with antibiotics. You should not use tampons etc until the area is fully healed (4- 6 weeks).

Urinary Retention –
this means an inability to empty the bladder. It is usually temporary. A small number of women have to go home with a catheter in place and return 1 – 2 weeks later for its removal. This occurs about 15% of the time. We will perform a bladder scan before you go home to make sure you are emptying the bladder adequately. Very rarely the tape needs to be loosened or removed. Some women prefer to self catheterise rather than be incontinent again.

Bladder irritation –
5/100 (5%) of women will develop the sensation that the bladder is full and need to empty it often. This often settles spontaneously but sometimes needs physiotherapy and/or medication. If these symptoms are present prior to tape insertion the symptoms may worsen.

Pain/numbness in the groin –
5% will experience this where the cuts are made.

Damage to the bladder, urethra or vagina –
The risks are 1% for any of these and do not usually present a problem so long as they are recognised and repaired. Sometime a catheter is left in place for a few days afterwards.

Tape erosion –
this is where the tape wears through the tissue of the urethra (<1%) or vagina (4%). The latter is more common in older women.

The procedure

Two small cuts are made to the groin area and on the anterior wall of the vagina. The bladder is catheterised and the neck of the bladder identified. A small vaginal cut is made to guide the needle and tape in to position. A needle is inserted through the groin cut and mesh attached vaginally. It is then removed back out through the vaginal opening and back out through the groin cut. The second needle is passed through on the other side and the synthetic mesh is brought under the urethra and back out to the groin. The tape lies just in front of the urethra and under the opening of the bladder. Each cut is then closed with dissolvable stitches.

After the operation

You may have light vaginal bleeding. When you pass urine the nurse will measure how much you have passed and how much is in your bladder. When the volume left is under 150mls you will be allowed home. Some women will need a catheter for a few days so do not be unduly concerned if this happens to you. The stitches all dissolve.

Going Home

Most normal activities can be resumed within a few weeks of surgery. Avoid heavy lifting, exercise or sexual intercourse for four weeks after the operation.

Further Information

Bladder and Bowel Foundation – www. bladderand bowelfoundation .org

 

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Preparing for surgery