Treatment and Surgery Restoration of Urinary Bladder Diseases

• Cystoscopy
  Cystostopy is an endoscopic technique which is considered one of the most important “diagnostic urological tests”, for the examination of the lower urinary system. The test takes a short time, is carried out with local anaesthesia and can be performed in the urologist’s private office, provided it is equipped with the proper endoscopic equipment. The test uses a flexible cystoscope with a diameter of a few millimeters, and can check the urethra for damage in the sphincter or narrowing, the urinary bladder walls, the ureter mouths, the prostate size in men, or whether there are stones, a tumor or growth in the urinary bladder. During the cystoscopy, tissue samples can be collected for biopsy, and some pathological damages can be cauterized. After cystoscopy, the patient may experience mild nuisance (burning sensation) during urination, as well as frequent urge to urinate. These problems do not last more than 2-4 hours and are treated with common pain killers. video

  
  

• Urethroscopy
  Urethroscopy is an endoscopic technique which is considered one of the most important “diagnostic urological tests”. The test takes a short time, is carried out with local anaesthesia and can be performed in the urologist’s private office, provided it is equipped with the proper endoscopic equipment. The test uses a flexible cystoscope with a diameter of a few millimeters, and can check the urethra for damage in the sphincter or narrowing, inflammation or exophytic lesion. During the urethroscopy, tissue samples can be collected for biopsy, and some pathological damages can be cauterized. After urethroscopy, the patient may experience mild nuisance (burning sensation) during urination, as well as frequent urge to urinate. These problems do not last more than 2-4 hours and are treated with common painkillers.

   

  Cystocele – Vaginal Mesh Suspension Placement
  The methods for the restoration of damages in the vaginal wall due to prolapse of the internal pelvic organs, after a major surgery or due to old age are a great challenge, as regression and reappearance of symptoms is frequent.
  A new method for the treatment of cystocele is the placement of a special support – suspension mesh, which reinforces the support capability of the pelvic ground at the vaginal area, which, when weakened, allows the urinary bladder to prolapse through the vagina. The tape consists of a thin polypropylene mesh. It is surgically inserted through a small (4cm) incision in the vagina underneath the urethra, thus lifting the posterior bladder wall which prolapses and is supported in four spots at the side walls of the pelvic ground, providing steady support and improving the involuntary prolapse of the urinary bladder. The procedure lasts approximately 1 hour, is carried out with local or epidural anaesthesia. After insertion of the vaginal mesh suspension, the patient may experience mild nuisance (burning sensation) during urination, as well as frequent urge to urinate. These problems do not last more than 2-4 hours and are treated with common painkillers. The patient must remain in hospital for one day, while morbidity is minimal. The patient may return to her normal sexual activity in a month’s period.

  
  

• Urinary Bladder Stone – Open Surgery
  The open surgery for the treatment of urinary bladder stones has been significantly limited to cases of coral-like stones or failure to face the problem with the modern methods. The operation is carried out with general anaesthesia. The area of the lithiasis is approached surgically and a cystolithotomy is performed. The stone is removed and then a urinary bladder catheter is placed. In case there co-exists a benign prostatic hyperplasia, the prostatic gland is removed surgically. The surgical trauma is stitched and drainage is placed for 1-2 days. The patient must remain in hospital for observation for 2-4 days, while morbidity is minimal.

  
  

• Urinary Bladder Stone – Endoscopic Removal
  Nowadays, the treatment of urinary bladder lithiases demands minimally invasive approach. The most common intervention is the endoscopic removal of a urinary bladder stone. With a special instrument, the cystoscope, the stone that causes the blockage is identified and with a special technique and proper handling is immediately crushed with the use of ultrasounds, electrohydraulic waves or laser, depending on the position, shape and composition of the stone. The operation is carried out with light sedation or epidural anaesthesia and its duration depends on the size, position and composition of the stone. In some cases it is advisable that a urinary bladder catheter be placed. The patient must remain one day in hospital for observation, while morbidity of the operation is minimal.

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  Urinary Bladder Tumor – Endoscopic removal
  Nowadays, the treatment of urinary bladder cancer demands minimally invasive approach. The most common intervention is the endoscopic removal of the tumor and the collection of random biopsies from the entire bladder walls for better evaluation of the findings – staging. With a special instrument, the resectoscope, which consists of a cold light lense system, faucets for the liquid flow control, and an electric loop which cuts and cauterizes the tissues, or a laser which vaporizes. The tumor is identified and with a special technique and proper handling is immediately removed or vaporized, depending on its position, shape and composition. The operation is carried out with light sedation or epidural anaesthesia and its duration depends on the size, position and composition of the tumor. In some cases it is advisable that a urinary bladder catheter be placed for 24 hours. The patient must remain one day in hospital for observation, while morbidity of the operation is minimal. Immediately after surgery, the surgical product is tested to define whether further additional treatment is required. video

  
  Urinary Bladder Tumor – Total (Radical) Cystectomy
  With the Total, also known as Radical, Cystectomy, further to the total removal of the urinary bladder, there is also removal of the nearby lymph nodes and the genitalia. More specifically, in men, the organs that are removed are the prostate and the seminal vesicles and in women the uterus, the ovaries and part of the anterior vaginal wall. In cases of proved cancer invasion in the urethra, and urethrectomy is also performed in parallel. There are three ways to perform this operation: a) the traditional open surgery, making a whole in the abdominal area, b) laparoscopically, which, however limits the surgeon’s control and range of vision and c) with the robotic Da Vinci method. After removal of the bladder, the surgeon creates a new way for the urine to be stored in the body (neobladder) and a new conduit for the release of the urine, either through the urethra or in an external urine collection sack. The operation is carried out with general anaesthesia and the duration of the patient’s hospitalization ranges from 5-9 days, depending on the selected surgical option and the general post-operative condition of the patient.

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