Flixible Cystoscopy and Urodynamics
The test is performed under a local anaesthetic, and a fine flexible telescope (cystoscope) is passed through the urethra into the bladder to examine the “plumbing”. It will identify obstructing lesions suchas an enlarged prostate or stricture, and also confirm that the bladder lining, or urothelium, looks normal.
A fine tube connected to a pressure monitor is then inserted into the bladder and into the rectum so that pressure measurements can be obtained while the bladder fills slowly. When feel full, urinating into a special toilet measures the volume and flow rate.
This test will confirm if your bladder is stable during filling or whether it “spasms” and contracts when it should quiet. It will also tell if your bladder is able to consistently contract to completely empty your bladder and if there is any obstruction.
Transurethral Resection of Prostate (TURP)
The commonest operation performed for an enlarged prostate causing bladder outflow obstruction is the TURP. Given that the Newcastle region has a lot of mining, it is colloquially called a “re-bore”!
Usually under a spinal or general anaesthetic, a rigid cystoscopy is initially performed to directly visualise the urethra and bladder. Then, a special electric knife is used to shave off the sides of the prostate to widen the tube, or urethra, running through it. An irrigating catheter is then placed into the bladder usually for 1-2 nights before it is taken out in the morning for a trial of void to ensure that you can pass urine comfortably a few times.
There is visible blood in the urine for a few weeks, which may be prolonged if on blood thinners. The flow will be immediately improved when passing a large volume of urine. There is usually burning and stinging when voiding, and irritative symptoms such as frequency, urgency and nocturia for a few weeks to months after the procedure is common while the raw area of the prostate takes time to heal. It almost always settles down with time.
There is a very small risk of stress incontinence and dry orgasms are to be expected due to retrograde ejaculation as semen goes back into the bladder after the prostate is opened. Please tell your doctor if you are on any blood thinners as these may need to be stopped temporarily prior to the operation. It is usually reasonable to remain on low dose aspirin, such as Cartia.