A cystoscopy examines and treats bladder and urinary system problems. A cystoscope is a thin tube with a light and a camera at one end that’s inserted into your urethra (the tube that carries urine out of your body) and then into your bladder.
A flexible cystoscope is used to look inside your bladder and a rigid cystoscope is used to pass small surgical instruments into your bladder to obtain a tissue sample or carry out treatment.
A cystoscopy is used to investigate many symptoms including: urinary incontinence, frequently needing to urinate, intermittent urination or inability to urinate, feeling that your bladder isn't fully empty after going to the toilet, pain or a burning sensation when you pass urine, blood in your urine and pelvic pain.
This investigative procedure may detect and monitor conditions including: urinary tract infections, narrowed or blocked urethra, ureter problems and urinary tract cancers, polyps, enlarged prostate gland and bladder stones.
Transurethral resection of a bladder tumour (TURBT) investigates and treats bladder tumours. Typically, it follows on from a cystoscopy that has indicated a tumour in your bladder. Bladder tumours can be benign (non-cancerous) or malignant (cancerous).
During a TURBT, your urologist cuts away the tumour or tumours from the bladder wall. They will then send them away for examination to find out if they’re cancerous and if so, how advanced the cancer is. Once they have this information they will decide on the best course of treatment.
If benign bladder tumours aren’t treated they will continue to grow slowly and could become very large. They could then take up too much space in your bladder or press on other organs in your body.
Malignant tumours will grow unless they’re removed. They can also attack surrounding tissue and spread into other areas of the body.
Adult circumcision removes the foreskin (the retractable sleeve of skin which covers the end of the penis) from the penis. It’s performed under general anaesthetic and the foreskin is trimmed and stitched.
It’s often carried out for medical reasons including: tight foreskin (phimosis), recurrent inflamed /infected foreskin and penis head (balanitis), foreskin won’t return to its original position after being pulled back and causes swelling and pain to the head of the penis (paraphimosis), a condition that causes phimosis and inflammation of the penis head (balanitis xerotica obliterans) and penile cancer. It can also be performed for religious and cultural reasons.
There are restrictions and waiting lists for circumcisions on the NHS. Ashtead Hospital offers adult circumcision surgery without restrictions or waiting.
Penile straightening is performed to correct the curvature of a penis when a penis is too bent during erection to allow penetration during sexual intercourse.
Surgery is performed under general or spinal anaesthetic. The penis is straightened using a plication procedure that shortens the longer side of the penis.
A prostate biopsy removes prostate tissue samples to investigate for signs of prostate cancer. The prostate is a small gland located under the bladder that makes semen. If you have a lump in your prostate gland or high levels of prostate-specific antigen (PSA) in your blood, a prostate biopsy will be recommended to find out more about these symptoms.
A prostate biopsy can be performed three ways: trans-rectal prostate biopsy (through the rectum and is the most common method), transurethral (through the urethra) and perineal (through the perineum, the skin between the anus and the scrotum).
Treatment of bladder cancers
If you’ve been diagnosed with bladder cancer, malignant cells will have been found in your bladder.
Treatment is decided based on the stage of the cancer and other factors and your cancer care team will discuss this with you. Sometimes more than one treatment is combined to offer the best course of treatment. Close follow-up is also needed to check for new cancers in the bladder.
Treatment options for bladder cancers include:
- Surgery to take away the cancer cells. It can remove early-stage bladder tumours or the whole bladder, known as radical cystectomy. It forms part of the treatment for most bladder cancers.
- Intravesical therapy whereby a liquid drug is placed directly into the bladder through a catheter as opposed to taking 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 the cancer cells.
- Immunotherapy - use of medicines to encourage the immune system to recognise and destroy cancer cells.
Treatment for stress incontinence
Stress urinary incontinence (SUI) is a condition whereby your bladder leaks urine when you partake in physical activity or exert yourself. It can happen due to the pressure inside your bladder as it fills with urine becomes greater than the strength of your urethra to stay closed. Extra pressure such as sneezing or moving can then cause a leak.
Conservative treatments may be recommended first including: lifestyle changes, pelvic floor muscle exercises and bladder training. Surgery is usually performed If these don’t work. Your urologist will advise on the most suitable treatment for your stress incontinence.
Surgeries for SUI include: tape procedures (use of plastic tape to hold up the urethra in the correct position), colposuspension (lifts up the neck of the bladder and stitch in this lifted position), sling procedures (a sling is placed around the neck of the bladder to support it), bulking injections (thickens the area around the urethra) and artificial urinary sphincter (to keep urine from leaking).
A transurethral resection of the prostate (TURP) cuts away a section of the prostate. If your prostate has become enlarged and is putting pressure on your bladder and urethra so that urination is affected, then your consultant urologist may recommend a TURP.
A TUPR procedure is performed under general or spinal anaesthesia and involves passing a thin metal tube with a light source, camera and loop of wire, known as a resectoscope, along your urethra to your prostate. The loop of wire is heated and used to cut a section of your prostate. General or spinal anaesthesia is the pain relief used during the procedure.
A vasectomy is performed for male sterilisation or permanent contraception. It’s a minor procedure that cuts, blocks and seals the vas deferens tubes and stops sperm getting into a man’s semen.
Vasectomy is a relatively simple procedure, carried out under local anaesthetic. There are often long waiting lists to have a vasectomy on the NHS. Ashtead Hospital can perform a vasectomy without waiting.
Vasectomy reversal, is also called vasovasostomy. It reconnects the vas deferens tubes that were cut during a vasectomy. It has the best chance of success if it’s done soon after the vasectomy.
The NHS does not offer a vasectomy reversal. It’s seen as a permanent method of birth control. Ashtead Hospital offers vasectomy reversals if required.