Cystoscopy

Cystoscopy is a technique where a thin scope called a cystoscope, is introduced into the bladder via the urethra. This allows the doctor to examine the interior lining of the urethra and bladder for tumours, bleeding, stones and infections.

Very small surgical instruments may be passed through the cystoscope to allow samples of urine or tissue biopsy from each kidney to be taken. An advantage of cystoscopy is that the doctor is able to examine parts of the urethra and bladder that usually do not show up well on X-rays. Cystoscopy may also prevent the need for more extensive surgery by treating some bladder problems. For example, some small growths and bladder stones may be removed using small surgical instruments that pass through the cystoscope.

The procedure is performed under a light anaesthetic and usually takes under 10 minutes. Cystoscopy is normally undertaken as an out patient procedure.

Cystodiathermy

Cystodiathermy is a procedure that uses a high frequency electric current that is produced by surgical instruments passed through a Cystoscope. An instrument called a Diathermy is used to produce heat into the bladder wall to lightly burn away any diseased tissue. Conditions such as superficial bladder cancer may be treated using this technique.

Cystodiathermy can be undertaken as an out patient procedure or an in-patient procedure. If the Cystodiathermy is performed as an in-patient procedure, a hospital stay of up to two days may be necessary. The procedure is performed under a light general anaesthetic and may take up to 30 minutes, depending on the position and amount of diseased tissue in the bladder.

It may be necessary to use a catheter (sterile hollow tube connected to a drainage bag) to drain urine from the bladder. The catheter is passed up the urethra and into the bladder at the end of the operation.

Excision of Epididymal Cyst

Epididymal cysts are a common condition and usually do not require treatment. An epididymal lump may be a small amount of tissue or cyst found on the epididymis of a testicle. It is only necessary to perform surgery if the epididymal cyst is causing pain or discomfort or is large enough to be inconvenient.

The operation usually takes 15 to 20 minutes, is carried out under a light general anaesthetic and is normally undertaken as an out patient procedure.

A small cut is made in the scrotum through which the cyst or lump is removed. The cyst is then easily peeled away from the surrounding tissue. It may be necessary to send a piece of tissue off to a laboratory for analysis.

Men of all ages (but especially between 18 and 35) should perform a monthly check for any lumps or bumps on their testis.

Excision of Hydrocele

A hydrocele is a disease observed only in males, and is usually subclinical or asymptomatic. It is a sac containing watery fluid found along the spermatic cord, which lies within the scrotum.

This condition may develop during normal development, as the testicles descend down a tract from the abdomen into the scrotum. A hydrocele will result if this tube does not close. This allows peritoneal fluid to drain from the abdomen through the open tract and accumulate in the scrotum, where it collects causing a swelling.

Abdominal fluid may then flow through the processus vaginalis in the abdomen and the tunica vaginalis in the scrotum, which causes swelling of the scrotum, on one side or even both sides.

This passage between the abdomen and the testicles usually closes and the fluid is absorbed. But if the fluid remains after the sac closes a non-communicating hydrocele is the result. This is the case if the fluid will not flow back into the abdomen when compressing the scrotal sac. This type of hydrocele is frequently seen in newborn males and normally disappears by the end of the first year of life as the fluid is absorbed. With a communicating hydrocele, the fluid moves slowly back up into the abdomen through the processus vaginalis if the scrotal sac is compressed (or the hydrocele may changes size). A communicating hydrocele is normally smaller when the child wakes up in the morning and becomes larger in the evening as fluid passes into the scrotum after activity.

A hydrocele may also be formed if a testicle is damaged, inflamed or even if there is fluid blocking the sperm duct.

Many hydroceles are congenital and occur in children under 2 years of age. Chronic or secondary hydroceles can occur in men that are over 40 years old and may be secondary to epididymitis or orchitis. Hydrocele may also be caused by infections such as filariasis or tuberculosis.

A doctor may diagnose a hydrocele by feeling the scrotum to see if the swelling is due to a solid mass or a collection of fluid. The swelling may be shown to be a hydrocele by shining a light underneath the scrotum thereby illuminating the fluid-containing sac. The testicles will be seen in outline and the rest of the scrotum will allow the light through. If the diagnosis of hydrocele is still in doubt an ultrasound scan will confirm the diagnosis.

The fluid in the scrotum may be removed with a needle in a procedure called aspiration. Aspiration of a hydrocele is not therapeutic procedure however because the fluid usually builds up once again and there is also a possibility of infection.

After aspiration the injection of thickening or sclerosing substances (e.g. sodium tetradecyl sulfate, urea or tetracycline) may be carried out to help to close the opening through the scrotum and prevent fluid accumulating in the scrotum after the procedure.

Surgery is usually preferred, but aspiration may be the safest option for patients that may have surgical risks.

A hydrocele is easily corrected with a hydrocelectomy. This is a minor surgical procedure performed on an outpatient basis using a general anesthetic. An incision is made in the scrotum and the procedure may require a drainage tube and a large dressing to be applied the scrotum.

Urethrotomy

Urine passes out of the body from the bladder via the urethra. Occasionally the urethra may become scarred in one part of the tube forming a stricture. The stricture in the urethra may be caused by an untreated infection, scar tissue, surgery or even a trauma to the penis. This stricture may impede the flow of urine leading to more frequent urination and the possibility of repeated urinary tract infections.

A urethrotomy is a procedure that is carried out under a general anaesthetic to correct this stricture, where the urethra is narrowed which causing problems with the flow of urine.

The urethrotomy corrects the urethral stricture using a rigid endoscope with a fine instrument passed up through the urethra to the narrowed area. The stricture is gently slit open to allow the widening of the urethra. A catheter is inserted into the urethra to allow urine to drain from the bladder for a few days during healing of the uretha.

PUJ (pelviureteric junction) obstruction

The kidneys filter the blood and remove waste materials, salts and water producing urine. Urine is then drained from the kidneys through a funnel-shaped structure called the renal pelvis and into a tube called the ureter. Urine passes through the ureter into the bladder.

PUJ (pelviureteric junction) obstruction is due to a blockage in the area where the ureter leaves the kidney at the renal pelvis. There are two types of PUJ - a Primary PUJ is when the blockage is the source of the disorder and a Secondary PUJ is where the blockage that occurs is a result of another disorder. The PUJ obstruction may be caused by scar tissue or a congenital defect.

PUJ occurs in around one in 1,500 children and is most commonly caused by a congenital obstruction at the pelviureteric junction (PUJ), which is the point where the ureter joins the renal pelvis. When a PUJ is present there is an accumulation of urine within the kidney because urine is produced faster than it is possible to drain out of the renal pelvis into the ureter.

The use of ultrasound to screen unborn children means that a doctor may easily detect this accumulation of urine (hydronephrosis), which makes it possible to predict the presence of PUJ obstruction before a baby is born. Once a baby is born the symptoms of PUJ obstruction may present as a urinary tract infection with a fever, increased fluid intake, bloody urine with pain in the flank and even stones.

Sufferers of PUJ obstruction may not have an infection but will still experience localised pain. The PUJ obstruction may irregular in nature with sporadic pain as urine may drain normally sometimes and be obstructed at other times.

To correctly diagnose a PUJ obstruction a procedure known as intravenous pyelogram (IVP) is used. During an IVP a dye is injected into the patient's blood stream, which the kidneys will then remove from the blood. The dye then passes into the urine and out through the bladder. The doctor will able to see the shape of the kidneys, renal pelvis and ureters using X-ray examination as the dye is visible under X-rays.

PUJ obstruction is seen much less frequently in adults and may occur as a result of kidney stones, previous surgery or disorders that can cause inflammation of the upper urinary tract.

PUJ in infants and young children less than 18 months of age may be a temporary condition and surgery may not be necessary. If a diagnosis of PUJ obstruction is made and it is believed that there will be no improvement, then surgical treatment will be required.

PUJ obstruction is traditionally treated by pyeloplasty, which is an operation to remove the PUJ and to rejoin the ureter to the pelvis of the kidney giving a wider junction between the two areas. Pyeloplasty eases the symptoms and reduces the risk of infection, because urine produced by the kidney may now be drained faster and more easily.

The latest treatment of PUJ obstruction uses minimally invasive surgery. This type of surgery may be Laparoscopic pyeloplasty or internal incision of the PUJ.

Laparoscopic surgery uses several small instruments passed through the abdominal wall to carry out the surgical procedure. This is normally carried out through the abdominal cavity but may possibly cause slight scarring within the abdomen. But this type of surgery is a less painful technique especially for adults and older children.

The other major option is to cut the tight and narrow PUJ from the inside by inserting a wire through the ureter. A drain in the ureter is left in place for several weeks and then removed. This allows the PUJ to heal in a more open manner in most patients but the treatment may need to be repeated and there is less pain and nausea with this procedure.

After repair of the PUJ obstruction there may be swelling of the ureter and there may continue to be poor drainage of the kidney for a period of time. But this changes when the area heals. After several weeks the doctor will arrange a functional kidney test to check how well the kidney is working after the procedure.