Bladder Procedures

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. Open bladder surgery may be required for patients who have experienced severe bladder trauma, or who suffer from large bladder stones, bladder fistulas or bladder cancer.

Conditions

Female Incontinence Surgery

Female incontinence is a condition in which urine is released involuntarily during physical activity, such as heavy lifting, coughing and laughing. It occurs when the pelvic muscles that support the bladder and control urination weaken as a result of age, childbirth or injury. There are several surgical options available and Dr Choonara will recommend the most suitable option based on your symptoms. One of the most common surgeries for the treatment of female incontinence is the vaginal sling procedure, during which a supportive structure is made from synthetic materials and placed around the urethra. The sling helps to keep the urethra closed and prevents unwanted leaking.

Diagnostic cystoscopy

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. Choonara 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. Choonara will proceed with a bladder biopsy. The cystoscopy procedure is usually done under general anaesthetic.

Hydro-dilatation

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. Choonara 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. Choonara 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. Choonara 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.

Repair after traumatic rupture / iatrogenic injury

If the patient has experienced severe bladder trauma (for example, if their bladder burst or if they had a ruptured bladder as the result of an injury). Dr. Choonara may then pursue surgical bladder rupture treatment. The recovery time for repair after traumatic rupture of the bladder will be determined on a case by case basis. Bladder surgery might also be required for patients who have experienced iatrogenic trauma. An iatrogenic injury is caused inadvertently by medical practitioners and can often be a side-effect of the need to treat a ureteric injury or other urinary tract problems.

Open cystolithotomy

When a patient requires open surgical bladder stones treatment this is because other, less invasive measures (such as a endoscopic cystolithotripsy or lithalopaxy procedure) have proven ineffective. Open cystolithotomy is a procedure for bladder stone removal that involves Dr. Choonara making a single incision into the patient’s abdomen, and then an incision into the bladder, before physically removing the large (or hard to dislodge) bladder stones. Recovery time from this cystolithotomy procedure will vary according to the severity of the case.

Fistula repair

A bladder fistula is an abnormal connection  between the bladder and another organ or the skin. Most often they form between the bladder and the bowel (enterovesical fistula) or between the bladder and the vagina (vesicovaginal fistula). Dr. Choonara will conduct fistula repair surgery by excising the fistula tract , and then removing the area of the bladder and other organ that formed the fistula. Healthy tissue is then moved in to block the opening between the bladder and the surrounding organ. Recovery time from a fistula repair procedure will vary according to the individual case

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