If the tests you have had so far point to your water-works (urinary system) as the cause of your trouble, It is necessary to look inside the urinary system to find out what is going on. A special telescope is used to see, or sometimes to take X-rays. At the same time narrow parts can be widened, stones taken out, pieces of the lining taken out, and diseased parts burnt out as needed.
The Operation
You can have a general anaesthetic or you can be numbed from the waist down with an injection in the back. The choice depends partly on which you prefer, and partly on what your surgeon or anaesthetist thinks is best. Having general anaesthetic means that you will be completely asleep during the operation. Having an injection in the back means that you will be awake during the operation, but will not be able to feel any pain from the waist down. If the surgeon believes that he only needs to have a thorough look and take some X-rays or two to three pieces of tissue (biopsies) from the lining of your urinary system to help him to clarify the problem, you might not need a general anaesthetic or an anaesthetic injection in the back.
As an alternative the surgeon can flush some anaesthetic jelly into your urethra (the tube that connects your bladder with you penis or the area in the front of your vagina) so that you will have only minimal discomfort when he passes the telescope up into your bladder. If you are awake for the operation, you will have your legs held up in stirrups. A nurse will chat to you during the operation.
A narrow tube is passed inside the penis in the male, (or into the front passage in the female), up into the bladder. The surgeon then slides a telescope and other instruments up the first tube. He then looks around, or takes X-rays, or operates as planned. Finally all the equipment is taken out. After the operation it is sometimes necessary to pass a tube (a catheter) back up into the bladder. This will allow urine to drain freely into a bag for a time. Usually you can go home the same day. If there are any problems with the operation, you will need to stay longer. The doctors will let you know about this at the time.
Any Alternatives
Doing more X-rays, scans and other tests will not help find out what the trouble is. To find out, at this point, it is necessary to have a look inside the bladder and higher up towards the kidneys. The simplest step is to slide telescopes and other instruments through the front passage into the bladder and beyond. Bigger operations such as passing a telescope through the skin into the kidney are not needed at this stage. In the same way the treatment can be done by this route. Open operations are not needed at this stage.
If there is a growth in the bladder, burning or cutting the diseased lining away by this method is usually all that is needed. Sometimes a drug treatment washed into the bladder is very helpful. X-ray treatment is usually held in reserve. If you do nothing you will not find out what is causing your problem. Also you will not get the benefit of early treatment by this route which in certain situations, such as a developing cancer, it is vital to get a diagnosis and start treatment as early as possible. The problem will steadily get worse.
Before the operation
Stop smoking and try to get your weight down if you are overweight. (See Healthy Living). If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check the hospital's advice about taking the Pill or hormone replacement therapy (HRT). Check that you have a relative or friend who can come with you to the hospital, take you home, and look after you after the operation. Sort out any tablets, medicines, inhalers that you are using. Keep them in their original boxes and packets. Bring them to hospital with you.
On the ward, you may be checked for past illnesses and may have special tests to make sure that you are well prepared and that you can have the operation as safely as possible. Please tell the nurses of any allergies to tablets, medicines or dressings. You will have the operation explained to you and will be asked to fill in an operation consent form. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks.
After - In Hospital
You may have a fine tube (catheter) passing into the bladder through the front passage. This is so that urine can drain into a collecting bag. This can feel uncomfortable. Sometimes the catheter needs to be flushed out to keep the urine flowing properly. You may be given oxygen from a face mask for a few hours if you have had chest problems in the past. There may be some slight discomfort where the instruments have been.
You will not normally need painkillers. The feeling goes away after a day or two. A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. The nurses will help you with everything you need until you are able to do things for yourself. Do not make important decisions, drive a car, use machinery, or even boil a kettle during this time.
If there is no catheter, you should be able to pass urine before you leave hospital. If you cannot pass urine, let the doctors and nurses know. If there is a catheter, the urine drains out automatically. The catheter will be taken out when the urine is clear and when it is safe to do so. After that you will be checked to see that you are passing urine properly. It is a good idea to drink an extra pint of water in addition to what you normally drink each day.
Do this for a week after the operation. This will help to clean the urine. You will be given an appointment for the out-patient department, or you will get a date for any repeat operation. Some hospitals arrange a check up about one month after you leave hospital. Others leave check-ups to the general practitioner. The nurses will advise about sick notes, certificates etc.
After - At Home
You may feel tired for a day or two after the operation. You should not drive for 24 hours after the anaesthetic. You can start sexual relations within two to three days of the operation. You should be able to go back to work within one or two days of leaving hospital.
Possible Complications
If you have this operation under general anaesthetic, there is a very small risk of complications related to your heart and lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.
If you have an anaesthetic injection at the back, there is a very small chance of a blood clot forming on top of your spine which can lead to a feeling of numbness or pins and needles in your legs. Most of the time the clot dissolves on its own and this solves the problem. Extremely rarely, the injections can cause permanent damage to your spine.
Complications are unusual, but are rapidly recognised and dealt with by the surgical and nursing staff. If you think that all is not well, please let the doctors or the nurses know.
Chest infections may arise, particularly in smokers. Do not smoke. Getting out of bed as quickly as possible, being as mobile as possible and co-operating with the physiotherapists to clear the air passages is important in preventing an infection.
Sometimes there is blood in the urine and if the doctors expect this a catheter is usually put in at the time of the operation. It may take some days to clear. You will need to stay in hospital until it gets better.
Sometimes you can have an infection which is either localised in your urine stream or gets into the bloodstream. You will be given antibiotics to treat the infection.
Extremely rarely (especially if many biopsies are taken or there is a lot of burning) the telescope or other instruments used during the operation can create a hole (perforation) or an extensive scratch in the lining of the urethra or the bladder. This problem is usually corrected by putting a catheter back in for one or two weeks to decompress the bladder and drain the urine until the hole or the scratch has healed. Only in extreme circumstances will you need another operation to fix the problem.
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