What does this procedure involve?
This involves putting a telescope through your urethra (waterpipe) to look at the lining of the bladder. If we find any abnormality in your bladder, we may biopsy the area, remove it completely using diathermy or simply cauterise it to stop the bleeding. We then stretch the neck of your bladder gently using plastic or metal dilators.
What are the alternatives?
- Flexible cystoscopy – performed under local anaesthetic, but you may find stretching your bladder neck too painful without a general anaesthetic
- Observation – if your symptoms are mild, we may simply monitor your condition regularly
What happens on the day of the procedure?
Your urologist (or a member of their team) will briefly review your history and medications, and will discuss the surgery again with you to confirm your consent.
An anaesthetist will see you to discuss the options of a general anaesthetic or spinal anaesthetic. The anaesthetist will also discuss pain relief after the procedure with you.
We may provide you with a pair of TED stockings to wear, and we may give you a heparin injection to thin your blood. These help to prevent blood clots from developing and passing into your lungs. Your medical team will decide whether you need to continue these after you go home.
Details of the procedure
- We normally use either a general anaesthetic (where you are asleep) or a spinal anaesthetic (where you are unable to feel anything from your waist down)
- We may give you an injection of antibiotics before the procedure, after you have been checked for any allergies
- We put a telescope through your urethra (water pipe) to look into your bladder and to see the bladder neck
- If we find anything abnormal in your bladder, we may biopsy or remove it with diathermy
- We then gently stretch the neck of your bladder using metal or plastic dilators
- We may put in a temporary bladder catheter which is normally removed the following morning
- The procedure normally takes five to 10 minutes to complete
- You will normally go home on the same day as your procedure; if you have had a catheter put in, we will make arrangements for this to be removed
Are there any after-effects?
The possible after-effects and your risk of getting them are shown below. Some are self-limiting or reversible, but others are not. We have not listed very rare after-effects (occurring in less than 1 in 250 patients) individually. The impact of these after-effects can vary a lot from patient to patient; you should ask your surgeon’s advice about the risks and their impact on you as an individual:
| After-effect | Risk |
|---|---|
| Mild burning or bleeding on passing urine for a short time after the procedure |
 Almost all patients |
| Temporary insertion of a bladder catheter which needs to be removed later |
Almost all patients |
| Permission for telescopic removal/biopsy of an abnormality, if found |
Almost all patients |
| Infection of the bladder requiring antibiotic treatment |
 Between 1 in 10 & 1 in 50 patients |
| Recurrence of the narrowing with return of your symptoms |
Between 1 in 10 & 1 in 50 patients |
| Perforation of the bladder requiring a temporary catheter or open surgical repair |
 Between 1 in 50 & 1 in 250 patients |
| Delayed bleeding requiring removal of clots or further surgery |
Between 1 in 50 & 1 in 250 patients |
| Anaesthetic or cardiovascular problems possibly requiring intensive care (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death) |
Between 1 in 50 & 1 in 250 patients (your anaesthetist can estimate your individual risk) |
What is my risk of a hospital-acquired infection?
Your risk of getting an infection in hospital is between 4 & 6%; this includes getting MRSA or a Clostridium difficile bowel infection. This figure is higher if you are in a “high-risk” group of patients such as patients who have had:
- Long-term drainage tubes (e.g. catheters)
- Long hospital stays
- Multiple hospital admissions
What can I expect when I get home?
- You will be given advice about your recovery at home
- You will be given a copy of your discharge summary and a copy will also be sent to your GP
- Any antibiotics or other tablets you may need will be arranged & dispensed from the hospital pharmacy
- You should drink twice as much fluid as you would normally for the first 24 to 48 hours, to flush your system through and reduce the risk of infection
- If you cannot pass urine after your bladder catheter is removed, you may be discharged with a catheter in; we will show you how to manage it at home and arrange for you to have it removed at an appropriate time
- If you develop a fever, severe pain on passing urine, inability to pass urine or worsening bleeding, you should contact your GP immediately
- If you need a follow-up outpatient appointment or further investigations, we will arrange them for you, and tell you when they will take place
- You may return to work when you are comfortable enough and when your GP is satisfied with your progress
General information about surgical procedures
Before your procedure
Please tell a member of the medical team if you have:
- An implanted foreign body (stent, joint replacement, pacemaker, heart valve, blood vessel graft)
- A regular prescription for a blood thinning agent (e.g. warfarin, aspirin, clopidogrel, rivaroxaban, dabigatran)
- A present or previous MRSA infection
- A high risk of variant-CJD (e.g. if you have had a corneal transplant, a neurosurgical dural transplant or human growth hormone treatment)
Questions you may wish to ask
If you wish to learn more about what will happen, you can find a list of suggested questions called “Having An Operation” on the website of the Royal College of Surgeons of England. You may also wish to ask your surgeon for his/her personal results and experience with this procedure.
Before you go home
We will tell you how the procedure went and you should:
- Make sure you understand what has been done
- Ask the surgeon if everything went as planned
- Let the staff know if you have any discomfort
- Ask what you can (and cannot) do at home
- Make sure you know what happens next
- Ask when you can return to normal activities
We will give you advice about what to look out for when you get home. Your surgeon or nurse will also give you details of who to contact, and how to contact them, in the event of problems.
Smoking and surgery
Ideally, we would prefer you to stop smoking before any procedure. Smoking can worsen some urological conditions and makes complications more likely after surgery. For advice on stopping, you can:
- Contact your GP
- Access your local NHS Smoking Help Online
- Ring the free NHS Smoking Helpline on 0300 123 1044
Driving after surgery
It is your responsibility to make sure you are fit to drive after any surgical procedure. You only need to contact the DVLA if your ability to drive is likely to be affected for more than three months. If it is, you should check with your insurance company before driving again.