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Interstitial cystitis, also known as painful bladder syndrome, is a chronic condition that causes bladder pressure, bladder pain, and sometimes pelvic pain. The pain can range from mild discomfort to severe.

Unlike typical cystitis, the discomfort is not caused by a bacterial infection and does not respond to conventional antibiotic therapy. This condition is part of a spectrum of diseases known as bladder pain syndrome.

Symptoms of Interstitial Cystitis

Interstitial cystitis (IC) symptoms can vary widely among people and may fluctuate in intensity over time. Common symptoms include:

• Persistent Pelvic Pain: A chronic, often severe pain that may be experienced in the bladder area, pelvis, or between the vagina and anus in women and between the scrotum and anus in men.
• Increased Urinary Frequency: The need to urinate frequently, often more than the normal 7-8 times per day, and up to 40-60 times a day in severe cases.
• The Urgency to Urinate: A sudden and overwhelming need to urinate immediately, which can be difficult to control.
• Pain During Urination: A painful or burning sensation during urination, which can worsen as the bladder fills or empties.
• Pain During Sexual Activity: Discomfort or pain during sexual intercourse, which is particularly common in women with IC.

Causes and Risk Factors

The exact cause of interstitial cystitis (IC) remains unclear, but it is thought to involve a combination of factors contributing to bladder irritation and inflammation. Key causes and risk factors include:

Defective Bladder Lining

Some theories suggest that IC may be due to a defect in the protective lining of the bladder, allowing toxic substances in urine to irritate the bladder wall.

Autoimmune Response

An autoimmune component where the body’s immune system mistakenly attacks the bladder may be present.

Hereditary Factors

A genetic predisposition to IC has been observed, indicating that it may run in families.

Gender

Women are diagnosed with IC more often than men, suggesting that gender may play a role in susceptibility to the condition.

Chronic Pain Disorders

People with other chronic pain conditions, such as fibromyalgia and irritable bowel syndrome, are more likely to develop IC.

Age

While IC can occur at any age, it is most commonly diagnosed in people in their 30s and older.

Diagnostic Approach

Diagnosing interstitial cystitis (IC) involves ruling out other conditions with similar symptoms, such as urinary tract infections or bladder cancer, through a detailed medical history and symptom review.

Physical examinations are conducted alongside urinalysis to exclude infections. Cystoscopy may be used to inspect the bladder for ulcers or inflammation indicative of IC. Additional tests like potassium sensitivity or urodynamic studies assess bladder sensitivity and function. Ultimately, diagnosing IC often involves excluding other urinary disorders.

Treatment Options

Interstitial cystitis (IC) treatment relieves symptoms and improves quality of life, as there is currently no cure. Here are the main treatment strategies:

Medication

• Pain Relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) or prescription pain medications to manage discomfort.
• Antihistamines: To reduce urinary urgency and frequency by blocking the effect of histamine, which can contribute to irritation and inflammation.
• Antidepressants: Tricyclic antidepressants like amitriptyline can help relieve pain and urinary frequency.

Bladder Instillations

• A medicinal solution is instilled directly into the bladder via a catheter, often containing medications like dimethyl sulfoxide (DMSO) or lidocaine, to relieve pain and reduce inflammation.

Physical Therapy

• Pelvic floor physical therapy to help relieve pelvic pain associated with tight muscles and trigger points.

Lifestyle Modifications

• Dietary changes include avoiding foods and drinks that irritate the bladder, such as caffeine, alcohol, and spicy foods.
• Stress management techniques, including relaxation exercises and biofeedback, to help manage pain and urinary symptoms.

Surgical Procedures

• In severe cases, interventions such as bladder distention, nerve stimulation, or even surgery to increase bladder capacity or relieve pain may be considered.

Conclusion

Given its chronic nature and symptom variability, managing interstitial cystitis requires a comprehensive and adaptive treatment approach. It is important to seek medical attention if you experience persistent symptoms of interstitial cystitis, such as pelvic pain, frequent urination, or an urgent need to urinate, that disrupt your daily life. Early intervention can manage symptoms effectively and prevent complications. Additionally, if you notice that your symptoms worsen or do not respond to initial treatments, it is necessary to seek further medical advice.

Overactive bladder (OAB) is a common condition characterised by a sudden, involuntary contraction of the muscle in the bladder wall, leading to a frequent and urgent need to urinate. This condition affects both men and women, though it is more prevalent in older adults. Understanding the causes, symptoms, and treatment options can greatly contribute to managing this condition effectively.

Symptoms of an Overactive Bladder

The primary symptom of overactive bladder (OAB) is a sudden urge to urinate that is difficult to control, which may lead to the involuntary loss of urine (urgency incontinence). People with OAB may also experience the following symptoms:

• Frequency: Urination eight or more times in 24 hours.
• Nocturia: Awakening two or more times in the night to urinate.
• Urgency: The intense and sudden need to urinate immediately.

Causes and Risk Factors

Overactive bladder (OAB) can be caused by several underlying factors and conditions, which may also increase the risk of developing this urinary disorder. Key causes and risk factors include:

Neurological Conditions

Conditions such as stroke, multiple sclerosis, and Parkinson’s disease can interfere with nerve signals involved in bladder control, leading to symptoms of OAB.

Ageing

The bladder muscles can weaken with age, increasing the likelihood of involuntary contractions.

Hormonal Changes

In women, decreased estrogen levels during menopause can lead to deterioration of the bladder and urethra lining, contributing to OAB symptoms.

Obesity

Excess weight can exert more pressure on the bladder, which may trigger OAB symptoms.

Bladder Obstructions

Enlarged prostate, constipation, or previous surgeries that cause obstructions in the bladder can lead to OAB.

Lifestyle Factors

Excessive intake of caffeine or alcohol, both of which can irritate the bladder, may exacerbate OAB symptoms.

Diagnostic Approach

Diagnosing overactive bladder (OAB) typically starts with a detailed review of the patient’s medical history and symptoms, alongside a physical and neurological examination to identify any abnormalities affecting bladder function.

Patients might also be asked to maintain a urinary diary to document urination patterns, fluid intake, and any episodes of urgency or leakage. Additional tests such as urinalysis help rule out infections or other abnormalities, while urodynamic tests measure the bladder’s capacity and functionality.

Treatment Options

Overactive bladder (OAB) treatment can vary based on the severity and underlying causes of the condition. Here are the main treatment options available:

Medication

• Antimuscarinics: Drugs like oxybutynin and tolterodine reduce bladder contractions.
• Beta-3 agonists: Mirabegron relaxes the bladder muscle, helping increase bladder capacity.
• Topical Estrogen: Applied locally to help improve tissue health in and around the vagina and urethra.

Behavioural Interventions

• Bladder Training: Techniques to progressively increase the intervals between voiding.
• Pelvic Floor Muscle Exercises: Strengthening the pelvic muscles that control urination.

Lifestyle Modifications

• Fluid and Diet Management: Reducing irritants like caffeine and alcohol, and managing fluid intake.
• Weight Management: Losing weight to reduce pressure on the bladder.

Nerve Stimulation Techniques

• Sacral Neuromodulation: Electrical impulses to stimulate nerve signals between the brain and bladder.
• Percutaneous Tibial Nerve Stimulation (PTNS): Weekly acupuncture-like needle stimulation sessions.

Surgical Options

• Bladder Augmentation: Surgery to increase the capacity of the bladder.
• Urine Diversion: Creating a new route for urine to exit the body when other treatments fail.

Conclusion

Managing an overactive bladder effectively requires a multifaceted approach that includes medical intervention, lifestyle adjustments, and possibly surgical options. People with OAB can improve their daily life and well-being with proper management.

Consulting a urologist is recommended if symptoms of overactive bladder (OAB) affect your quality of life or if you notice sudden changes in urinary habits. Early consultation can help diagnose the underlying cause of OAB and initiate the appropriate treatment to manage symptoms effectively.

Transurethral resection of a bladder tumour (TURBT) is the primary diagnostic and therapeutic procedure for bladder cancer, particularly non-muscle invasive bladder cancer (NMIBC).

The procedure involves the insertion of a resectoscope through the urethra to access the bladder. The resectoscope is equipped with a camera and surgical tools, allowing the surgeon to remove the tumour without external incisions.

Objectives of TURBT: The main objectives are to remove visible tumours from the bladder wall and to obtain tissue samples for further histopathological analysis.

Process of TURBT: During the procedure, the surgeon uses the resectoscope to shave off the tumour and cauterise the base to control bleeding.

Immediate Postoperative Care

After undergoing TURBT, immediate postoperative care involves:

Monitoring and Pain Management

Patients are closely monitored in the recovery room following the procedure, and pain is typically managed through medications prescribed by the urologist.

Catheter Care

A urinary catheter is often placed post-surgery to help drain the bladder and allow healing at the resection site. The catheter can also be used to irrigate the bladder to prevent clot formation and ensure that any remaining blood is cleared.

Activity Restrictions

Patients are usually advised to avoid strenuous activities, heavy lifting, and vigorous exercise for several weeks after the procedure.

These measures form part of the standard care to ensure effective recovery without severe complications.

Managing Common Post-TURBT Symptoms

Recovery from TURBT can involve several common symptoms, which, while typically mild, require proper management to ensure comfort and reduce the risk of complications.

Haematuria

Description: It is normal to experience some blood in the urine after TURBT. This may appear as pink or red urine.

Management: Patients are advised to increase their fluid intake to help clear the blood. However, they should seek medical attention if the bleeding worsens or does not improve.

Urinary Frequency and Urgency

Description: Some patients may experience increased frequency and urgency of urination. This is usually temporary.

Management: Moderating fluid intake and avoiding irritants such as caffeine and alcohol may alleviate these symptoms. If symptoms persist, a consultation with a urologist is advisable.

Discomfort or Pain While Urinating

Description: Burning or discomfort during urination can occur, especially in the first few days post-procedure.

Management: Drinking plenty of water and, in some cases, the use of prescribed pain relief can alleviate discomfort. If pain persists, it should be discussed with a urologist.

Preventing Infections

Recommendations: To prevent infections, maintain good personal hygiene and ensure regular bladder emptying. Antibiotics may be prescribed if there is a significant risk of infection.

Monitoring: Signs such as severe pain, inability to urinate, or signs of infection (fever, chills, persistent pain) warrant immediate medical attention.

Long-Term Recovery Considerations

Long-term recovery after TURBT involves ongoing monitoring and lifestyle adjustments to manage the health of the bladder and prevent the recurrence of the tumour.

Ongoing Monitoring

Surveillance Cystoscopy: Regular cystoscopy exams are essential after TURBT to monitor for any new tumour growth or recurrence. The frequency of these exams depends on the initial tumour grade and stage but typically occurs every 3 to 6 months for the first few years.

Urine Tests: Urine cytology tests are often recommended as part of follow-up care to detect cancer cells in urine.

Lifestyle Adjustments

Smoking Cessation: Smoking is a major risk factor for bladder cancer. Quitting smoking is crucial to reduce the risk of recurrence and improve overall health.

Diet and Hydration: A diet rich in fruits and vegetables, low in processed meats, and adequate hydration can help maintain bladder health and overall well-being.

Physical Activity: Regular exercise can improve immune function and reduce the risk of cancer recurrence.

Psychological and Emotional Support

Counselling: Many patients benefit from counselling or support groups to cope with the psychological impacts of cancer diagnosis and treatment.

Education: Understanding the disease, its management, and recovery can empower patients and reduce anxiety.

Long-Term Medication and Treatments

Intravesical Therapy: Additional treatments such as intravesical chemotherapy or immunotherapy may be recommended to prevent recurrence depending on the tumour’s characteristics.

Chronic Pain Management: Some patients may experience chronic bladder pain or discomfort post-TURBT, which can be managed through medications or physical therapy.

The aim of long-term recovery is not only to monitor and prevent the recurrence of bladder cancer but also to enhance the patient’s quality of life through comprehensive healthcare and lifestyle management.

Conclusion

Recovery from TURBT is a multi-faceted process that extends beyond the immediate postoperative period. Successful recovery involves adhering to postoperative care guidelines, effectively handling common symptoms, monitoring long-term health, and making lifestyle adjustments.

These steps collectively aim to optimise healing, prevent complications, and reduce the risk of cancer recurrence.

Through proactive management and support, people recovering from TURBT can achieve a quality of life and long-term health that supports their personal and medical needs.

Cystoscopy is a diagnostic procedure that examines the inside of the bladder and urethra. This examination aids in diagnosing, monitoring, and treating conditions affecting the urinary tract.

During a cystoscopy, a cystoscope—a thin, flexible instrument with a light and a camera at the end—is carefully inserted into the urethra and advanced into the bladder. The camera displays images on a screen, allowing the urologist to observe the bladder wall and urethra in detail.

Preparing for a Cystoscopy

Preparation for a cystoscopy ensures that the procedure goes smoothly and with minimal discomfort. Below are key steps and considerations for patients scheduled to undergo this diagnostic test:

Dietary and Medication Adjustments

Fasting: Depending on the anaesthesia used, you may need to refrain from eating or drinking for several hours before the cystoscopy.

Medication Management: Inform your urologist about all your medications and supplements. Certain medications, especially blood thinners, may need to be paused or adjusted to reduce the risk of bleeding during the procedure.

Preparing at Home

Hygiene: Shower or bathe on the day of your cystoscopy to reduce the risk of infection. Give particular attention to the cleanliness of your genital area.

Clothing: Wear comfortable, loose-fitting clothing to your appointment to ease the changing process and accommodate any post-procedure discomfort.

What to Bring

Documentation: Bring any required documents, such as your ID, insurance information, and medical records.

Support: Consider bringing a family member or friend who can help you with transportation and provide support after the procedure.

The Cystoscopy Procedure

Anaesthesia

For a simple cystoscopy, local anaesthesia may be applied directly to the urethra. In more complex cases, or if you are particularly anxious, sedation or general anaesthesia may be used.

Insertion of the Cystoscope

The cystoscope is lubricated and gently inserted into the urethra, then slowly advanced into the bladder. If you are awake, you may feel a sensation similar to needing to urinate.

Bladder Inspection

The camera on the cystoscope transmits images to a screen, allowing the urologist to examine the walls of the urethra and bladder. The procedure typically takes 15-30 minutes, depending on what is found and whether any samples are taken.

Possible Interventions

If necessary, instruments can be passed through the cystoscope to remove tissue samples (biopsies) or treat certain conditions.

Withdrawal of the Cystoscope

Once the examination is complete, the cystoscope is carefully withdrawn.

Recovery

You will be taken to a recovery area where you will be monitored until the effects of the anaesthesia wear off. Most patients can go home the same day.

What to Expect After a Cystoscopy

Recovery from a cystoscopy is generally quick, with most patients able to resume normal activities within a few days. However, it is important to be aware of the common sensations and potential signs of complications post-procedure.

Immediate Post-Procedure Effects

Discomfort and Pain: It is common to experience some discomfort or a burning sensation during urination for a few days after the procedure.

Bleeding: You might notice a small amount of blood in your urine or light spotting. This typically resolves within 24 to 48 hours.

Care Instructions

Hydration: Drinking plenty of fluids helps to flush out the bladder and reduce the risk of urinary tract infections.

Activity Level: Avoid strenuous activities and heavy lifting for at least 24 hours. You can gradually return to your usual activities as comfort permits.

Monitoring: Keep an eye on your urine output and the presence of blood or signs of infection, such as fever, chills, or pain that worsens or does not improve.

When to Seek Medical Advice

Persistent Bleeding: If bleeding becomes heavy or does not decrease after a couple of days, contact your urologist.

Signs of Infection: Symptoms such as fever, persistent pain, or cloudy urine could indicate an infection, necessitating prompt medical attention.

Conclusion

Cystoscopy is a valuable diagnostic tool that provides essential insights into the health of the bladder and urethra. It plays an important role in diagnosing, monitoring, and sometimes treating urinary system conditions.

If you have symptoms that may require a cystoscopy, we encourage you to contact our clinic to book a consultation. Our experienced urologist is committed to providing you with the highest standard of care, ensuring your comfort and safety throughout the diagnostic process.

A cystectomy is a surgical procedure for the removal of the urinary bladder. In some cases, surrounding tissues and organs in the pelvis are also removed, depending on the underlying health condition being treated.

This surgery is most commonly performed to treat bladder cancer but may also be indicated for other severe bladder conditions, such as significant bladder dysfunction.

Types of Cystectomy

Cystectomy procedures vary mainly by the extent of bladder removal and the surgical method used. Here are the main types of cystectomy:

Partial Cystectomy

In a partial cystectomy, only a portion of the bladder is removed. This procedure is suitable for patients whose cancer is located in one area of the bladder and has not spread to the muscle layer.

Radical Cystectomy

Radical cystectomy involves the removal of the entire bladder along with nearby lymph nodes, part of the urethra, and, depending on the patient’s sex, potentially the prostate and seminal vesicles in men, or the uterus, ovaries, and part of the vagina in women.

Robotic Cystectomy

Robotic cystectomy is a minimally invasive approach to radical cystectomy, performed using robotic surgical systems. This method offers the surgeon enhanced precision, flexibility, and control.

Reasons for Cystectomy

Here are the common reasons for undergoing a cystectomy:

Bladder Cancer: Bladder cancer is the most common indication for a cystectomy.

Cystectomy may also be considered for certain severe non-cancerous conditions when other treatments have failed, including:

Interstitial cystitis: A chronic condition causing bladder pressure, bladder pain and sometimes pelvic pain.

Neurogenic bladder: Dysfunction of the urinary bladder due to disease of the central nervous system or peripheral nerves involved in the control of urination.

Bladder trauma: Severe injuries to the bladder that cannot be repaired by other surgical means.

The Cystectomy Procedure

The cystectomy procedure involves several steps, such as:

Preoperative Preparation

Patients undergoing cystectomy typically undergo a thorough preoperative assessment, including blood tests, imaging studies, and sometimes cardiac and pulmonary evaluations, to ensure they are fit for surgery.

Surgical Procedure

1. Anaesthesia: Cystectomy is performed under general anaesthesia.
2. Incision: For a traditional open cystectomy, a single large incision is made across the abdomen to access the bladder. For robotic and laparoscopic cystectomies, several small incisions are made to accommodate surgical instruments and a camera.
3. Removal of the Bladder: The bladder, and often surrounding lymph nodes and other tissues, are removed. The extent of tissue removal depends on the underlying condition and the type of cystectomy.
4. Urinary Diversion: After removing the bladder, surgeons must create a new way for urine to exit the body. Options include:

• Ileal conduit urinary diversion: Using a piece of the intestine to create a conduit outside the abdomen.
• Continent urinary reservoir: Creating a reservoir that can be emptied by inserting a catheter through the abdomen.

Postoperative Care

Postoperative care involves monitoring for signs of infection, managing pain, and ensuring proper surgical site healing. Patients may need to stay in the hospital for several days to a few weeks, depending on the surgery’s complexity and overall health.

Potential Risks and Complications

Cystectomy, like any major surgery, carries potential risks and complications, including:

Immediate Postoperative Risks

Bleeding: Significant blood loss can occur during or after the surgery, sometimes necessitating blood transfusions.

Infection: Surgical sites, urinary diversions, or the bloodstream can become infected.

Anaesthetic Complications: Reactions to anaesthesia can affect cardiac and respiratory functions.

Long-term Complications

Urinary Tract Infections (UTIs): Patients with any form of urinary diversion are at increased risk of UTIs.

Bowel Obstruction: Scar tissue from surgery can cause obstructions in the intestines.

Ureteral Stricture: Narrowing of the ureters, which can lead to kidney problems.

Surgical Failure or Recurrence of Disease

Cancer Recurrence: There is always a risk that cancer can recur, even after the removal of the bladder and surrounding tissues.

Complications from Urinary Diversion: Complications arising from urinary diversions, such as issues with the constructed urinary pathways, may require additional surgeries.

Conclusion

Cystectomy is a surgical procedure to manage and treat bladder cancer or other severe bladder conditions. The decision to undergo a cystectomy involves careful consideration of the benefits and risks associated with the procedure. Choosing the right surgical option and understanding the potential outcomes are important for managing one’s health effectively.

For more detailed information about cystectomy, or to discuss whether this surgical option might be appropriate for your condition, consider scheduling a consultation with our clinic. Our team is ready to provide you with comprehensive advice and support tailored to your health needs.