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Prof. Dr. Tahir Karadeniz, Üroloji Uzmanı

Bladder Diseases

We would like to inform about all urological diseases for you to find out the solution of your problems easily. You will find the diagnosis and the treatments of urological diseases briefly. In this section you will find bladder diseases.

ACUTE CYSTITIS: It is the inflammation of the bladder and mostly seen in young and middle-aged women very frequently.

A sudden burning sensation when urinating, passing frequent small amounts of urine ,blood in the urine,  passing cloudy or strong smelling urine and low-grade fever are the mostly seen symptoms of acute cystitis.

Urinary sytem ultrasound and urine anlaysis (such as urine sample and urine bacterial culture if needed)  are the methods of diagnosis.  If the inflammation is caused by a bacterial infection it is called a Urinary Tract Infection (UTI) and can be effectively treated with antibiotics.

If you have such symptoms you should consult an Urologist not a Gynecologist.

CHRONIC CYSTITIS: This is a chronic condition  mostly affecting  young and middle aged women.It is the long lasting inflammation of the bladder.

These patients are the ones who had used antibiotics but could not be treated. Even they used the appropriate antibiotic for the bacteria seen in their urine bacterial culture,the bacteria occurs again and causes strong and unending burning sensation during urination. When no evidence of infection is found we use imaging tests such as Urinary system ultrasound or Lower abdomen MRI to discover other potential causes of the inflammation. If we get no result with the imaging we perform cystoscopy.Using this method we examine the bladder and urethra by a camera under general anesthesia.

Performing cystoscopy we can observe the leukoplakia widespread in their bladder. As the bacterias are hidden inside these plaques, antibiotics can not be a treatment. During cystoscope we clean the leukoplakia. Our patients always benefits  from this method. 

RADIATION CYSTITIS: Less commonly seen cystitis. It may occur as a reaction to radiation therapy. Especially the radiation used for the treatment of gynocological cancers (such as Cervical and Uterine  and Prostate cancer) may cause radiation cystitis. It can happen in 6 months to 10 years following the radiation therapy. Hematuria (blood in urine) is the symptom. We examine the bladder by lower abdomen MRI. If we can not find out the problem then we perform Cystoscopy under anesthesia. During cystoscopy we burn the bleeding areas. If this treatment does not bring a solution then the only alternative is hyperbaric oxygen therapy.

PAINFUL BLADDER SYNDROME: What is painful bladder syndrome?

It is a chronic condition rarely seen in men mostly  diagnosed in young and mid-aged women.  It is not a life  threatening disease but it affects the quality of life in severe cases.

What is the reason? The exact causes are not known but there are some theories such as Allergy and Autoimmune conditions.

What are the symptoms?

  • Bladder pain.
  • Sometimes pain in other areas such as urethra pelvic and perineal area. In women behind the vagina, in men behind the scrotum.
  • If the case becomes more severe bladder pain gets worse as the bladder fills.
  • Frequent urination often with small amounts.
  • Sometimes urinating 60-70 times per day

How to diagnose? There is no medical test or imaging technique to diagnose. Cystoscopy is the  most commonly used method to diagnose. It should be performed by an experienced urologist under anesthesia. Using a special tool, the doctor looks inside the bladder. By using this test other problems such as cancer are ruled out. This test helps to see the capacity of the bladder.Gives info about the amount of loss of the capacty of bladder. During cystosopy a well experienced doctor can detect Ulcer which is called Hunner Ulcer in ¼ of the patients and can be treated endoscopically. But for the remaing  ¾ of the patients, ulcer can not be seen in the bladder so  their treatment becomes more difficult.

What is the treatment?
Botox injection into the bladder:
Botilinum toxin (botox) is used in medical treatment especially in Dermotology for a long time. Botox injection into the bladder is mostly used  for the treatment of 2 urological diseseas which are Overactive  bladder syndrome and Painful  bladder syndrome (Intersistial Cystitis). It blocks the sensory nerves in the bladder that transmits pain and inflammation. Injecting the botox to the right point in the bladder is a great solution to  Painful Bladder Syndrome and should be repeated in 5-6 months. Botox injection is performed during cystoscopy under general anesthesia.

Augmentation Cystoplasty (Bladder  Augmentation): It is a surgery to make the bladder larger. This surgery is performed when the patients have trouble urinating. During the surgery a small piece of intestine is removed and attached to the top of the bladder. The patients stay in hospital 6-7 days after surgery. 1/3 of the patients may still have pain after the surgery. If their quality of life getting worse we perform Cystectomy to  remove the urethra together with bladder. Then İleal Conduit surgery is performed to make a new urinary diversion.

We have performed the Augmentation Cystoplasty to many of our patients who had Urinary incontinence problems. They were urinating 20-30 times per a day. After a detailed evaluation we diagnosed Intersistial cystitis. We performed Bladder Augmentation to those patients. They have no more pain and urination problems.

OVERACTIVE BLADDER (URGENCY/FREQUENCY SNDROME):

Active Bladder Syndrome can be seen in men but mostly seen in women as 4 -5 times more. The symptoms are urinary urgency, frequency of urination, urge incontincence, leakage and nocturia (need to get up and urinate at least 2 times each night). There is no pain.

What is the treatment? 

1st level treatment: To limit

Maintaining a healthy weight. Overweight can add pressure on the bladder so the  overweighting patients must loose weight. When the patients loose 8 kg, leakage problem really decreases.

2nd level treatment: The bladder training  exercises instructed by the urologist and medications

3rl level treatment: Botox injection into the bladder muscle under general anesthesia. If the surgeon injects to the right point in the bladder this therapy is very effective. Patient should stay at the hospital for 1 night. Sometimes one injection may be enough but as botox wears off in time, generally it needs to be repeated.

4th level treatment: Augmentation Cystoplasty.This is a rare treatment. We perform this surgery to the patients who did not have  good results with the other therapies.

NEUROGENIC BLADDER:

Neurogenic bladder is a condition in which problems with nervous sytem affect the bladder and urination. Lower urinary tract is the system storing and voiding  the urine in both men and women. Bladder and urethra are the organs performing this function  by the help of a healthy nervous system. This system consists of all nerves between brain, spinal cord in spine and  the pelvis.  

Urological Reflection of Neurological diseases:

Stroke: Happens to 5/1000 people each year .Overactive bladder symptoms, Nocturia (need to get up to urinate at least 2 times each night) and Leakage may happen to the patients with stroke after 1 month. 75 percent of these patients recovers in 6 months spontaneously. 

Dementia: Happens to 6.5% of people over 65 years and  80% of those people suffering Alzheimer. These patients mostly have Overactive bladder syndrome and leakage.As they get older the problems become more severe.

Parkinson’s Disease:  ½ of the patients are affected by urination problems in the beginning. Urinary urgency  and Nocturia are mostly seen problems. If the patients have MSA (Multiple System Atrophy-it is an other kind of Brain disease with similarities to features of Parkinsonism)  together with Parkinson’s disease, they loose their ability of bladder contraction and can not empty the bladder completely.

We can diagnose urination problems of the patients with Parkinson’s disease by urodynamic testing. This testing involves the evaluation of bladder and voiding function. It shows us whether the ability of bladder contraction is lost or not.

Multiple sclerosis:

10% of the patients have urination problems in the beginning of the disease. 75% of the patients have urination problems after 10 years. 75% of the patients have Overactive bladder syndrome while 25% of them loose the ability of bladder contraction. Using urodynamic testing we evaluate the situation and determine the treatment.

Myelomeningocele: It is a defect of the backbone and spinal cord. This is a congenital anomaly.  These are patients underwent surgeries performed by neurosurgeons in their childhood and got well.  But when they reach puberty, urination problems happen. The most important problem is the high pressure inside their bladder. Because of this they urinate very frequently which may cause  kidney dysfunctioning. We perform Augmentation Cystoplasty surgery to those patients to decrease the high pressure of their bladder.

Some of these patients are recommended to perform self-catheterization to drain urine for decreasing the pressure.This is called  Clean Intermitten Catheterization (CIC) method meaning using catheter or tube  4-6 times a day to empty the bladder.We don’t prefer this method. We eliminate the need for CIC with a detailed urological evaluation and performing precise surgery.

What is neurogenic bladder? Who gets this diagnosis? Is this an accurate diagnosis?

Urination problems cause high pressure in the bladder which can ultimately damage the kidneys.  Longstanding and poorly controlled pressure cause kidney dysfunction.

In order to diagnose Neurogenic Bladder to a patient with urination problems,the condition should be congenital (present at birth) or due to a trauma / accident which caused injury to the brain and  the spinal cord. Or the above listed  diseases must be accompanied by. Otherwise it is not easy to diagnose without detailed evaluation and urodynamic testing. Unfortunately we see that the patients are easily diagnosed NB and recommended to perform self –catheterization (CIC). For our patients who don’t have a history of brain trauma or accident, we perform urodynamic testing or cystoscopy under general anesthesia after a detailed urological examination. Here i want to insist once again that if the patient has no history of above mentioned diseases or fall, accident, brain or spine trauma  they do not need self-catheterization (CIC) 4-6 times a day  to void urine.

Who can undergo Augmentation Cystoplasty (Bladder Enlargement)?

Any patient with marked reduction of bladder capacity may be a candidate for Augmentation Cystoplasty. It is a surgery to make bladder larger and decrease the bladder pressure  in order to be able to save the kidneys. It is a type of abdominal surgery. Surgeon makes an incision (cut) in the patient’s abdomen to reach to the bladder. He removes a section of small or large intestine and attaches it to the top of the bladder. The patient needs to be hospitalized 6-7 days. After the surgery we get good results with the patients having  bladder shrinkage due to:

  • * Myelomeningocele
  • * Radiation therapy.
  • * Urinary system tuberculosis (kidneys,prostate,bladder)
  • * Severe overactive bladder (when all the other treatments failed)
  • * Congenital small bladder
  • * Painful Bladder Syndrome

Below, you’ll find  the opinions of our patient who underwent Augmentation Cystoplasty surgery. Our patient had urinary incontinence, leakage and  frequent urination problems. We examined the case in detail and diagnosed Interstitial Cystitis. Then we performed Augmentation surgery and enlarged the bladder with attaching a piece of intestine. He has no more pain and incontinence now.

BLADDER CANCER: This is the only life threatening urological disease if not diagnosed in early stage and not treated properly. You can find detailed information about Bladder Cancer,Female Bladder Cancer, High Risky Bladder Cancer and Orthotopic Neobladder in our web site.

Briefly, the main sign of Bladder Cancer is Hematuria (blood in urine). The second most common sign is Dysuria (burning during urination). When these signs are seen, first thing to do is Urinary System or Abdominal ultarsound. CT scan of abdomen  and Intravenous CT Urography are the  imaging techniques to detect bladder tumor. 98% of the detected tumors are cancer. To be able to remove the tumor and to see what we have TURBT (Transurethral Resection of Bladder Tumor) surgery is needed. During the procedure the surgeon passes an electric wire loop through a cystoscope and into the bladder to remove the tumor which will be sent to a pathology lab for testing. The doctors perform this procedure through urethra in women, through penis in men.

In accordance with the Pathological report,the doctor describes bladder cancer as either Low-grade or High-grade.

Low-grade bladder cancer: Cystoscopy is needed every 3 months to catch and remove newly emerging tumors. After 3 months, chemotherapy medicine  injection into the bladder may be needed to prevent the recurrence.

High-grade bladder cancer: These are Ta, T1, T2 level high grade tumors.

Ta level: The cancer is only the inner most layer of the bladder lining. Ta level is non-invasive papillary tumors which are more likely to come back. More TURBT procedures are needed to look for signs that the cancer has returned. It is repeated commonly 4-6 months after the first TURBT. This is called re-TURBT (see high risky bladder tumors)

T1 level: The tumor has spread to the connective tissue that seperates the lining of the bladder from the muscles beneath but it doesn’t involve the bladder wall muscle. If the pathological report describes the tumor as only one with a diameter less than 3cm, there is a need for re-TURBT 4-6 months after the first one. If the reports says that tumor is high level but  a large size tumor then radical cystectomy surgery is needed to remove the bladder for life saving.

T2 level: The tumor has spread to the muscle of the bladder wall. In this case imaging examinations such as MRI, PET SCAN, CT SCAN needed to see whether the cancer has spread and to detect lymph node metastasis. If there is metastasis to the lymph nodes or to other organs we start with chemotherapy treatment first. After completing chemotherapy treatment, Radical Cystectomy surgery is performed. If there is no spread, we perform Radical Cystectomy immediately.

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