cystoscopy is a telescopic examination of the bladder. It can be carried out under general anaesthetic (asleep), or under local anaesthetic (awake). If the test is being done to make a diagnosis it is usually done under local anaesthetic (LA), whereas if it is being done as treatment it is usually done under general anaesthetic (GA). If done under LA, there is no need to starve before the operation. A flexible instrument is passed through the urethra into the bladder, and after filling the bladder with salty water the bladder is inspected. The procedure usually takes a few minutes and the results discussed immediately.
…a telescopic examination of the bladder…
After the test is complete the patient is discharged and is free to go back to normal lifestyle, although it is adviseable to increase fluid intake for several days afterwards. The procedure may cause discomfort, bleeding in the urine, or urinary infection. If the procedure is done under GA it usually involves admission to hospital for a day, but not overnight. It is not adviseable for the patient to be alone or drive/operate machinery for 24 hours after a general anaesthetic. The same risks of discomfort, bleeding or infection apply as with a LA procedure, but as with all procedures carried out under general anaesthetic, there are risks of heart, lung or thrombosis problems.
ureteric stent is a long thin plastic tube that is inserted into the ureter (the tube that joins the kidney to the bladder). It is held in position by a curl at the top, which sits inside the kidney, and a curl at the bottom, which sits inside the bladder. It is used to drain the kidney if there is a blockage within the ureter. It may also be used after surgery (such as telescopic examination of the ureter) in which there has be some stretching or damage to the ureter; when it helps to prevent blockage of the tube during healing.
…a long thin plastic tube that is inserted into the ureter…
A stent can cause problems, such as pain in the kidney on passing urine, a feeling of needing to pass urine more often than normal, discomfort, infection or bleeding in the urine. Stents are usually only used for short periods of time and should not be left for more than 6-12 months without removing or changing. Removing a stent usually requires a cystosopcy under local anaesthetic, at which point the stent can be grasped and pulled out, without too much discomfort.
A presentation based on a new way of investigating prostate cancer using MRI won best paper award at the Midlands Urology Club annual meeting at Old Hall, Sutton Coldfield in October 2011. This new pathway for diagnosing prostate cancer in difficult cases has been devised by our surgeons over the last couple of years. Encouraging results, and a good presentation by trainee Urologist Sam Grimsley, led to the judges awarding the work the top prize.
The team were also selected to present their experience of Keyhole removal of part of the kidney (partial nephrectomy), which is a very demanding operation, and one that only a handful of major centres in the United Kingdom regularly perform. The results of this surgery were warmly received and applauded.
On 11th October the Staffordshire Urology group held a GP education evening at the North Staffordshire Nuffield Hospital. Christopher Luscombe gave a lecture on testicular swellings, including cancer, followed by prostate cancer, with particular reference to PSA and screening. Lyndon Gommersall talked on the subject of erectile dysfunction and Samson Liu then chaired a lively “ask the expert” session. It is hoped that this will become a regular event.
On 29th September Christopher Luscombe attended a Men’s Health meeting at the village hall at Madeley. Over 50 patients attended this event to listen to a lecture on subjects such as prostate enlargement and cancer, testicular swellings and erectile dysfunction. Afterwards there was a lively questions and answers session.
Mr Golash and Mr Luscombe are amongst several authors that publish an article in the respected Journal of Endourology. The article entitled “An objective scoring system for laparoscopic nephrectomy” was published in the September 2011 edition of the Journal (pages 1497-502). It discusses a scoring system for assessing trainee surgeon’s surgical skills when learning keyhole kidney surgery.
Mr Gommersall delivered an informative talk to the Moorlands Cancer Support Group in Cheadle on 19th November 2011. This meeting was well attended and the interesting presentation provoked many questions.
Mr Gommersall talked widely about the excellent bladder cancer services available locally, and showed videos on photodynamic diagnosis and keyhole bladder removal. The central focus of Mr Gommersall’s patient care is to give patient information to enhance the patients understanding throughout their cancer journey.
The key message was that if blood is seen in the urine, medical advice should be sought from the GP and a referral to hospital should be made for further investigations, so that the possibility of bladder cancer can be investigated.
Anurag Golash presented his results of ground breaking surgery for polycystic kidney disease to a meeting of renal (kidney) Doctors. Over 100 delegates were enthralled by his presentation including videos, about removing enormously swollen polycystic kidneys, by keyhole surgery. He believes that he is one of only a handful of surgeons worldwide that offer this surgery, with only one other unit in the UK. This procedure offers major surgery that usually requires a very large incision (with all the complications and long recovery associated with such an incision) with the advantages of small skin incisions and much more rapid recovery. The procedure seems to be safe and, he believes, should be considered for all patients requiring this surgery.