Bladder


Bladder Cancer

What is Bladder Cancer?

Bladder cancer happens when cells in the urinary bladder start growing uncontrollably. As more cancerous cells develop, they will form a tumour and could spread to other areas of the body.

Symptoms of Bladder Cancer

Symptoms of bladder cancer include haematuria (blood in the urine), painful urination, burning sensation while passing urine and frequency in urination.

Diagnosing Bladder Cancer

A cystoscopy is often done to diagnose bladder cancer. It involves inserting a small and narrow tube (cystoscope) through the urethra. The doctor will send tissue sample for biopsy and urine for cytology.

Treatments for Bladder Cancer

Treatment will depend on the stage of cancer, the type of cancer, the side effects, patient’s preferences and overall health. Treatments include Chemotherapy (the use of drugs to destroy cancer cells), Radiation therapy (use of high-energy x-rays or other particles to destroy cancer cells), Immunotherapy (known as Biologic therapy, it is suppose to boost the patient’s immune system using the body’s natural materials), Intravesical therapy (doctor puts a liquid drug directly into the bladder using a catheter to prevent cancer from coming back after surgery) and/or Surgery.

  • TRANSURETHRAL RESECTION OF BLADDER TUMOR (TURBT)
    Transurethral resection of bladder tumour is also known as transurethral resection (TURBT). This is recommended for early-stage or superficial (non-muscle invasive) bladder cancers. An instrument is inserted into the urethra (no cutting into the abdomen). A rigid cystoscope called a resectoscope is placed into the bladder through the urethra. The wire loop at the end of the scope removes any abnormal tissues or tumours. The removed tissue is sent for biopsy.

  • PARTIAL CYSTECTOMY
    This option is for the kind of bladder cancer that has invaded the muscle layer but the affected area is not very large and only in one place. This surgery will remove the cancer along with part of the bladder wall without taking out the whole bladder. The hole in the bladder wall is then closed. Nearby lymph nodes are also removed and examined for spread of cancer.

  • RADICAL CYSTECTOMY
    If the cancer is more aggressive and is larger or in more than one part of the bladder, a radical cystectomy is required. This surgery will remove the entire bladder and nearby lymph nodes. In women, the ovaries, fallopian tubes, uterus, cervix and a samll portion of the vagina are often removed along with the bladder. In men, the prostate and seminal vesicles are also removed. In radical cystectomy, reconstructive surgery is needed as you will need another way to store urine and remove it. There are several types of reconstructive surgery such as incontinent diversion, continent diversion and neobladder. The type of reconstructive surgery done will depend on the medical situation and personal preferences of patient.

Urinary Incontinence

What is Urinary Incontinence?

Urinary incontinence is the loss of bladder control. It occurs more often in women than in men especially after childbirth and menopause. It is also common among elderly. This condition can also be caused by urinary tract infection or an overactive bladder. If urinary incontinence affects your lifestyle and daily activities, get it treated. The situation can improve!

Symptoms/Types of Urinary Incontinence

Symptoms and types of urinary incontinence include stress incontinence (urine leaks when exerting pressure on your bladder by a certain activity like coughing or sneezing), urge incontinence (sudden urge to urinate followed by uncontrollable urine leak), overflow incontinence (frequent and constant dribbling of urine), functional incontinence (a physical or mental impairment that prevents you from making it to the toilet in time) and mixed incontinence (experiencing more than one type of urinary incontinence).

Diagnosing Urinary Incontinence

A urinalysis to check for signs of infection or blood traces is done together with a bladder diary. A bladder diary will record how much you drink, your output of urine and when you urinate. The doctor will also perform a post-void residual measurement using an ultrasound to check if there is leftover urine in your bladder after you urinate. This will enable the doctor to diagnose you accurately.

Treatments for Urinary Incontinence

Treatments for urinary incontinence will depend on the cause of urinary incontinence and the type of urinary incontinence. There are many ways to treat urinary incontience. They include: Bladder training, Fluid and diet management, Pelvic floor training, Medications such as anticholinergics, mirabegron (myrbetriq) and alpha blockers, Interventional therapies such as botulinum toxin type A (botox) injections and Surgery.

  • SLING PROCEDURES
    A pelvic sling is created around the urethra and the area of thickened muscle where the bladder connects to the urethra. The sling is made of your body’s tissue, synthetic material or mesh. The sling helps to keep the urethra closed. This procedure is used to treat stress incontinence.

  • BLADDER NECK SUSPENSION
    This procedure where an abdominal incision is made provides support to the urethra and bladder neck.

  • PROLAPSE SURGERY
    Prolapse surgery may be done in combination with a sling procedure if the female patient presents with mixed incontience and pelvic organ prolapse.

  • ARTIFICIAL URINARY SPHINCTER
    In men, a small, fluid-filled ring is implanted around the bladder neck to keep the urinary sphincter closed until the patient has the urge to urinate. In order to urinate, patient will need to press a valve implanted under the skin that causes the ring to deflate and allowing urine from the bladder to flow.

Urinary Tract Infection (UTI)

What is Urinary Tract Infection?

Urinary tract infection is an infection in any part of the urinary system. When it affects the lower urinary tract, it is known as cystitis, a bladder infection. When it affects the upper urinary tract, it is known as pyelonephritis, a kidney infection.

Symptoms of Urinary Tract Infection

Symptoms of urinary tract infection include painful urination, frequency in urination, feeling the need to urinate even though the bladder is empty, fever and pain in the flank.

Diagnosing Urinary Tract Infection

A urinalysis and urine culture test are done to diagnose urinary tract infection. It will look for white blood cells, red blood cells or bacteria. If you have recurrent urinary tract infections, the doctor may perfrom a cystoscopy using a small and narrow tube (cystoscope) to see inside the urethra and bladder.

Treatments for Urinary Tract Infection

Treatment for urinary tract infection includes Medication which is usually antibiotics. Patients are advised to drink plenty of water.


Overactive Bladder

What is an Overactive Bladder?

An overactive bladder is a condition which causes a sudden urge to urinate and may even lead to involuntary loss of urine.

Symptoms of Overactive Bladder

Symptoms of overactive bladder include a sudden urge to urinate that is hard to control, the involuntary loss of urine (urge incontinence), frequency in urination (more than 8 times in a day) and nocturia (waking up 2 or more times in the night to urinate).

Diagnosing Overactive Bladder

Urine sample may be sent for testing to exclude infection, traces of blood in urine or other abnormalities. The doctor may perform a post-void residual measurement using an ultrasound to check if there is leftover urine in your bladder after you urinate. A uroflow test to measure urine flow rate may also be required.

Treatments for Overactive Bladder

Treatments for overactive bladder include Medications to relax the bladder and Interventional therapies such as botulinum toxin type A (botox) injections and Surgery.

Surgery can be done to increase the bladder capacity. This involves using pieces of the bowel to replace a portion of your bladder. However, this surgery is only recommended in cases of severe urge incontinence that has failed to respond to other conservative treatments.


Nocturia

What is Nocturia?

Nocturia is the excessive urination at night. Waking up 2 or more times at night to urinate is indicative of nocturia.

Symptoms of Nocturia

People who have nocturia wakes up 2 or more times at night to urinate causing disruptions in a normal sleep cycle.

Diagnosing Nocturia

A bladder diary may be required by the doctor to diagnose nocturia. A bladder diary will record how much you drink, your output of urine and when you urinate.

Treatments for Nocturia

Treatments for nocturia include Medications such as anticholinergics drugs and diuretic drugs and Surgery.

Surgery can be done to treat an overactive bladder by increasing the bladder capacity. This involves using pieces of the bowel to replace a portion of your bladder. However, this surgery is only recommended if patient has failed to respond to other conservative treatments.

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