What is it ?
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You have two kidneys, which help to make urine. They lie deep in your back just in front of your lowest ribs.
The kidneys produce urine which is drained through a tube called the ureter (one for each kidney) in your bladder.
Your bladder is like a soft rubber balloon and drains through a fine tube (urethra) which has an opening into the penis or the front of the vagina.
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.
Before the Operation
Stop smoking and get your weight down if you are overweight.
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 will be checked for past illnesses and will 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. Before you sign the consent form, make sure that you fully understand all the information that was given to you regarding your health problems, the possible and proposed treatments and any potential risks. Feel free to ask more questions if things are not entirely clear.
Any tissues that are removed during the operation will be sent for tests to help plan the appropriate treatment. Any remaining tissue that is left over after the tests will be discarded.
Before the operation and as part of the consent process, you may be asked to give permission for any ’left over’ pieces to be used for medical research that has been approved by the hospital. It is entirely up to you to allow this or not.
Many hospitals now run special preadmission clinics, where you visit a week or so before the operation, where these checks will be made.
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, you will feel that something is happening in the area you are being operated on, 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 take 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 fine plastic tube (a urine catheter) back up into the bladder. This will allow urine to drain freely into a bag, which is better for you if the urine has small clots of blood after the operation. It will also allow the doctors and the nurses to measure the amount of urine you make after the operation.
Another benefit of having a catheter is that it will offer you some comfort by emptying your bladder after the operation, especially when after an operation it may not be that easy for you.
Usually you can go home the same day. If there are any problems with the operation, you will need to stay longer. This may happen if the operation is done under general anaesthetic, with an anaesthetic injection in your back, or if the urine has some small amounts of blood after the operation. The doctors will let you know about this at the time.
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 or obese patients. 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. If the infection is only in your urine, you will be given antibiotics tablets to treat the infection.
Although rare, if the infection is more serious and spreads through your bloodstream, you will need to remain in hospital so doctors can give you intravenous antibiotics (through a vein in one of your arms).
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.
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