Bladder & Urinary Symptoms
Performed by Dr. David Wetherell
Bladder and urinary symptoms are common and can significantly affect comfort, confidence, and daily life. This page outlines key investigations and treatments for bladder conditions and urinary symptoms, with clear information about what each procedure involves, when it may be recommended, and what to expect before and after treatment.
Cystoscopy
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Cystoscopy and Intravesical Botox Injection
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Transurethral Resection of Bladder Tumour (TURBT)
Cystoscopy • Cystoscopy and Intravesical Botox Injection • Transurethral Resection of Bladder Tumour (TURBT)
Cystoscopy
The Key Things to Know:
Cystoscopy is a procedure that allows your urologist to look inside the bladder and urethra using a thin telescope (cystoscope). It helps diagnose urinary problems such as blood in the urine, recurrent infections, or difficulty passing urine. It can also be used for simple treatments such as removing small stones or biopsies.
What It Is
During cystoscopy, a small telescope with a light and camera is gently passed through the urethra into the bladder. The procedure is usually done under local anaesthetic in the clinic or under sedation in theatre, depending on the indication and patient comfort.
When It's Needed
Cystoscopy may be recommended if you have: - Blood in the urine (visible or microscopic) - Recurrent urinary tract infections - Bladder pain or irritation - Difficulty passing urine or suspected obstruction - Surveillance after bladder cancer or other procedures
Surgery Diagram
Benefits
Quick and accurate visual diagnosis
Minimal recovery time
Can be diagnostic and therapeutic (e.g. remove small stones, stents, or biopsies)
Often performed as a day procedure
Risks
Temporary burning or blood in urine
Mild discomfort for 24-48 hours
Small risk of urinary infection
Rarely, injury to the urethra or bleeding requiring further care
What to Expect After Surgery
You can usually go home shortly after cystoscopy. Mild stinging or frequency is common for a day or two. Drink extra fluids and avoid heavy exercise for 24 hours. If you develop fever, chills, or difficulty passing urine, contact your doctor.
FAQs
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Local anaesthetic gel makes it well tolerated. Some mild discomfort is common but short-lived.
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Yes - cystoscopy is the gold standard test for diagnosing bladder tumours.
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The procedure usually takes 5-10 minutes, slightly longer if biopsies are taken.
Cystoscopy and Intravesical Botox Injection
The Key Things to Know:
Cystoscopy with intravesical Botox injection is a minimally invasive procedure used to treat overactive bladder (OAB) or urinary urgency incontinence that has not responded to medications. Botox helps relax the bladder muscle, reducing urgency, frequency, and leakage episodes.
What It Is
The procedure involves passing a cystoscope (a thin telescope) through the urethra into the bladder under local or general anaesthesia. Small doses of Botulinum toxin (Botox®) are injected
into the bladder wall using a fine needle. The treatment usually takes about 10-20 minutes and is performed as a day procedure.
When It's Needed
This treatment is recommended when: - You have an overactive bladder not controlled by oral medications - You experience frequent urgency, frequency, or urinary leakage - You are seeking an alternative to long-term drug therapy - You have neurogenic detrusor overactivity (e.g., spinal cord injury, multiple sclerosis)
Surgery Diagram
Benefits
Reduces urinary urgency, frequency, and leakage
Short, minimally invasive procedure
Can significantly improve quality of life
Repeatable every 6-12 months as needed
Risks
Temporary blood in urine or burning with urination
Urinary retention (difficulty emptying the bladder) - may require temporary self-catheterisation
Urinary tract infection (UTI)
Rare allergy or temporary general weakness from toxin spread
What to Expect After the Procedure
You can usually go home within a few hours. You may have mild burning or blood in the urine for a day or two. The effect begins within 1-2 weeks and lasts 6-12 months. Follow-up includes a bladder scan to ensure you are emptying well. Repeat injections can be performed when symptoms return.
FAQs
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Typically 6-12 months, after which the treatment can be safely repeated.
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A small number of patients may have difficulty emptying the bladder temporarily and may need to self-catheterise.
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Discomfort is minimal; local anaesthetic or light sedation is used.
Non-Muscle Invasive Bladder Cancer (NMIBC)
The Key Things to Know:
Non-muscle invasive bladder cancer (NMIBC) affects the inner lining of the bladder and has not invaded the bladder muscle. It is often treatable with local (bladder-preserving) therapies, and long-term outcomes are excellent with proper surveillance and follow-up.
What It Is
Bladder cancer begins when abnormal cells grow in the bladder lining. NMIBC includes three main types:
Ta:** Confined to the inner layer
T1:** Grown into the connective tissue beneath the lining but not the muscle
CIS (carcinoma in situ):** Flat, high‑grade, and more aggressive in behaviour
Initial treatment involves **Transurethral Resection of Bladder Tumour (TURBT)**, followed by intravesical (into the bladder) therapy to reduce recurrence.
When It's Needed
Treatment is tailored based on risk category:
**Low risk:** Single, small, low‑grade tumour – TURBT plus single dose intravesical chemotherapy (e.g. mitomycin)
**Intermediate risk:** Multiple or recurrent low‑grade tumours – induction and maintenance intravesical therapy
**High risk:** High‑grade or CIS – induction and maintenance Bacillus Calmette‑Guérin (BCG) therapy, or in selected cases, early cystectomy
Surgery Diagram
Benefits
Organ-preserving treatment in most cases
High survival rates (>95% for low-risk NMIBC)
Outpatient, minimally invasive treatment
BCG therapy reduces recurrence by ≈60%
Risks
Tumour recurrence - 30-70% depending on risk group
Progression to muscle-invasive disease (≈10-20% overall, higher for high-grade tumours)
Irritative urinary symptoms during intravesical therapy
Rare bladder contraction or systemic infection from BCG (<1%)
What to Expect After Treatment
You will have regular cystoscopies (usually every 3-6 months initially) to check for recurrence. Some patients receive a short course of intravesical chemotherapy or immunotherapy after surgery. Mild discomfort and urgency are common after treatments but settle quickly.
FAQs
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Yes - most NMIBC cases are curable with endoscopic and intravesical treatments.
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Because recurrence is common, ongoing cystoscopic surveillance ensures early detection and treatment.
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Recurrences are usually treated with repeat TURBT and/or further bladder instillations.
Transurethral Resection of Bladder Tumour (TURBT)
The Key Things to Know:
Transurethral Resection of Bladder Tumour (TURBT) is the first-line procedure used to diagnose and treat bladder cancer. It is performed through the urethra without any external cuts. The tumour is removed and sent for laboratory analysis to determine the type, grade, and stage of cancer.
What It Is
TURBT is performed under general or spinal anaesthetic using a thin telescope (resectoscope) passed through the urethra. The surgeon removes visible tumours using an electric loop or laser and cauterises the area to control bleeding. The tissue is sent for histopathology to confirm whether the cancer is superficial (non-muscle invasive) or invasive. A single dose of intravesical chemotherapy may be given at the end of the procedure to reduce recurrence risk.
When It's Needed
TURBT is recommended for: - Diagnosis of suspected bladder cancer seen on cystoscopy or imaging - Removal of visible bladder tumours - Restaging when previous biopsies are incomplete - Monitoring recurrence during follow-up of known bladder cancer
Surgery Diagram
Benefits
No external incision - performed through natural urinary passage
Both diagnostic and therapeutic in one procedure
Rapid recovery (usually day surgery)
Can be repeated safely for recurrences
Risks
Blood in urine for several days (common)
Urinary infection (≈5-10%)
Temporary burning or frequency when passing urine
Perforation of the bladder wall (≈1-3%, usually managed conservatively)
Recurrence of bladder cancer (≈30-70%, depending on tumour grade and type)
What to Expect After Surgery
You’ll usually stay in hospital for a few hours or overnight. A catheter may be placed for 1-2 days to allow urine to drain freely. Blood-stained urine is normal early on. Avoid heavy lifting for 1 week and drink plenty of fluids. You’ll receive follow-up results within 1-2 weeks and may be advised on further intravesical therapy or repeat TURBT based on findings.
FAQs
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It can cure low-grade, small, non-invasive tumours, but ongoing surveillance is required.
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For high-grade or large tumours, a second TURBT ensures complete removal and accurate staging.
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Typically cystoscopy every 3-6 months, depending on your risk category.
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