Bladder problems are common and can disrupt the normal functioning of the entire urinary tract system. Patients with urinary tract symptoms should seek a diagnosis to determine whether they have a bladder infection, or perhaps be referred for a diagnostic cystoscopy to check for example for bladder stones or evidence of cancer in the bladder.
Diagnostic cystoscopy ± biopsy of bladder mucosa/tumour
A diagnostic cystoscopy procedure is undertaken in cases where it might be necessary to perform a biopsy of a bladder mucosa or tumour, or in preparation for bladder tumour removal. Dr. Hayden will conduct the cystoscopic examination by inserting a thin tube with a camera attached to it via the urethra. Depending on the findings, it might be necessary to follow up the cystoscopy with a bladder biopsy procedure. If there is a bladder tumour or suspicious mucosa present, Dr. Hayden will proceed with a bladder biopsy. The cystoscopy procedure is usually done under general anaesthetic.
Hydrodilatation of the bladder is a procedure that involves the gentle stretching of the bladder using fluid, in order to diagnose and treat interstitial cystitis. Also known as hydro distention, Dr. Hayden will in all likelihood perform this procedure in conjunction with a cystoscopy. Hydrodilatation usually proceeds under general anaesthetic.
Transurethral resection of a bladder tumour
A transurethral resection of a bladder tumour (TURBT) procedure is surgery performed to diagnose bladder cancer and the process of bladder tumour removal. Dr. Hayden will perform a cystoscopy (visual examination) under general anaesthetic, and if a bladder tumour resection is necessary, he will then insert a resectoscope via the urethra, and use this combination visual/surgical instrument to proceed with bladder tumour resection. Note that even after successful bladder tumour removal, bladder cancer can return, and so repeat TURBT procedures might be required for some patients.
Insertion of suprapubic catheter
In cases where a urinary catheter is either an unsuccessful or inappropriate method of treatment, a suprapubic catheter can be used to drain urine from the bladder. Suprapubic catheter insertion often involves a cystoscopic examination, before a small incision is made in the lower abdomen,and a suprapubic tube is inserted to drain urine directly from the bladder, without it passing through the urethra. The insertion of a suprapubic catheter might be necessary in some cases, and there is evidence to suggest that, with long-term use, suprapubic catheters may be more effective than transurethral catheters in controlling bladder infections.
Treatment of a bladder stone
Prolonged periods of urinary stasis or foreign bodies in the bladder can lead to calcium crystals (‘stones’) forming in the bladder. The procedure of bladder stone disintegration (lithotripsy) and removal is safe and generally pain-free. Laser lithotripsy is used most commonly and sometimes an electrohydrolic lithotripter is used. Lithalopaxy (or ‘crushing’) is also an effective form of bladder stones treatment, however, this technique has mostly fallen out of favour. Treatment of bladder stones is performed under general or spinal anaesthetic, and involves disintegration and removing the stone fragments with the use of a cystoscope (a tube with a camera attached to it that is inserted via the urethra). In some cases, Dr. Hayden might elect to use a percutaneous route (keyhole procedure through the skin of the lower front of the abdomen) to gain access to the bladder stone.