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Urologic Care for Bladder Conditions

Virtua urologists offer care for all types of bladder conditions, including both routine and major or chronic conditions.   They take advantage of the latest medical, endoscopic and surgical techniques to treat bladder conditions and safeguard bladder health and function.

Virtua urologists have a focused expertise on a variety of conditions involving the bladder, taking advantage of the most advanced surgical options, as needed.

Virtua urologists employ the most up-to-date urinary testing, radiologic imaging studies, and urologic scoping procedures to evaluate the symptomatic bladder.   Bladder tests include cystoscopy, for which the urologist fills the bladder with a sterile fluid and then inserts a tiny endoscope through the urethra and into the bladder to view this organ for any abnormalities.   Urodynamics testing helps to evaluate patients for any nerve damage that may be causing an under- or overactive bladder.

Urinary Continence

Male and female urinary continence is a major area of focus for Virtua’s urologists.   Incontinence in women is more common than in men.   Older patients and in individuals who have sustained an injury or weakening in the nerves or muscles of the pelvic floor are also are greater risk for this problem.   Too many patients delay treatment until leakage becomes more severe.   Conditions such as stroke, diabetes, and multiple sclerosis as well can be causative factors.

Incontinence is a treatable condition.

Virtua urologic surgeons use a sophisticated algorithm involving many factors to determine best course of care for each individual experiencing urinary incontinence at each point of care.   Conservative care is always the preferred treatment approach of first resort.   Steps can include bladder training, pelvic floor muscle exercises, and medication.   Virtua urologists chose a treatment approach based on the cause of the incontinence.   For this reason, they place great importance on a careful evaluation, sometimes involving radiologic imaging, or nerve or urodynamic testing.   Some medications that they may prescribe, for example, serve to reduce bladder contractions or relax the bladder, while others to shrink the prostate or slow the production of urine.

Women are particularly subject to urinary incontinence due to weakening or compromise of the pelvic-floor muscles or neurologic control of the bladder or both.   Virtua urologists and other advanced urologic teams have offered a significant advance in treating this condition, and its resulting sphincter weakness, in recent years with the advent of the implantable urethral sling, also referred to as a pelvic or bladder sling.   This synthetic mesh sheath, with its ends attached to the pelvic bone, supports the bladder from beneath, reinforcing the pelvic floor and urethra, or surrounds the urethra and bladder neck to reinforce proper shape and positioning – compressing the urethra with enough constant pressure that it does not open until the patient consciously releases the urine.   This significantly increases urinary control by the patient.  The sling remains in place permanently. The procedure is best for patients with mild to moderate urinary incontinence.

In the past, placing such bladder support required a major, open operation.   Now though, the team uses a minimally invasive technique in which it gains access to the pelvic floor and bladder area though one or two small incisions.   Placing urethral slings in this way, usually means that the patient will not need a hospital stay but instead but can undergo the surgery as a same-day procedure.  Most patients are continent again as soon as the uretheral sling procedure is completed and can resume normal, nonstrenous activity (more physical activity permitted after six weeks).

In men, problems in urinary function are often linked to prostate enlargement, which must be addressed first, though other conditions can also cause urinary disruption.   A small portion of men who undergo prostate removal (and, rarely, BPH treatment) will experience incontinence as a result.   Minimally invasive placement of a polypropylene urethral sling, though most commonly used for women, is also available for men in a procedure developed from the female sling surgery.   Surgical access for this procedure in men is through a small incision in the perineum, the space in the groin between the scrotum and rectum.   The Virtua team was the first in its area to offer this procedure for men, which is effective for persistent mild to moderate stress urinary incontinence.   Like the female procedure, it provides faster recovery than previous surgical approaches.

Much less commonly performed but also available in the array of incontinence solutions offered in the Virtua urology program are these treatments:

  • periurethral injection of bulking agents. This quick, easy treatment provides more compression at the base of bladder but is a temporary solutions.
  • implantation of an artificial urinary sphincter. The urologic surgeon would use this approach primarily in men with severe and otherwise intractable stress incontinence due to prostate surgery, or men or women with severe damage to the nerves controlling urinary continence. This device uses a collar at the top of the urethra to keep the bladder sphincter closed, and the patient releases this pressure from this cuff by compressing a button implanted in the scrotum.
  • urinary diversion. In this solution, also used rarely, the urologic surgeon uses intestinal tissue to create a reservoir to retain urine and an opening in the lower abdomen to drain the urine.
  • bladder augmentation. This approach uses various surgical approaches to expand the size of a small bladder.

For patients for whom no other solution is workable, of course, implantation of Foley catheter for external urine drainage to a bag is also a well-established solution.

Finally, the Virtua team can also provide a treatment for patients with nerve or muscle dysfunction that creates bladder control problems in the form of overactive bladder (urinary urge incontinence or urinary frequency incontinence or both) or nonobstructive urinary retention.   When this condition does not respond to conservative therapy, neuromodulation is often the right intervention. Through a minor incision, the team implants a small pacemakerlike device under the skin (usually in the upper buttock area) that gently and continually amplifies signals to the sacral nerve in the lower back.   This nerve, near the tailbone, influences the bladder sphincter and pelvic floor muscles. Called sacral neural stimulation, the procedure only in recent years became available at advanced centers such as Virtua. This neuromodulation is a highly successful strategy that enhances the patient’s voluntary bladder control and regular voiding.   The simple outpatient procedure is preceded by several days of testing the device with the patient before the neurostimulator is implanted, followed by a period of adjustment of the device, which can also be turned off at any time.   The urology team can safely remove the stimulation system at any time with no damage to the nerves.   The treatment can also be successful for urinary urgency or frequency due to interstitial cystitis (see below).

Bladder Cancer

Each year in the U.S., urologists diagnose tens of thousands of new cases of bladder cancer.   Men and Causcasians are more likely to develop bladder cancer but smoking is the greatest risk factor.

The Virtua urologic surgery team provides aggressive treatment for this meant to cure the disease but retain as much function as possible, and they work closely with other cancer specialists to plan and deliver that patient’s overall care plan.   Surgery to remove bladder cancer remains an essential component of treatment for most patients.

The Virtua team offers the most advanced option available for bladder cancer that is localized (early-stage superficial cancers confined in the bladder): minimally invasive endoscopic surgery.   The surgeon inserts a thin tool that includes a scope through the urethra to locate the tumor and scrape or burn it away.

But bladder cancer produces few signs or symptoms in its early stages, and so is often discovered in a more advanced status. Fortunately, the ability of modern imaging tools to spot bladder tumors, either incidentally or when patients are evaluated for symptoms, enables physicians to discover such cancers when they are much smaller than those caught decades ago.   This, among other factors, has helped lead to improved cure rate.

In the cases where patients do have symptoms first, this is usually blood in the urine (hematuria) without pain. Typically this will prompt the Virtua team to examine the inside of the bladder with the cystoscope.   In a previous era, patients often had a tumor mass large enough for the urologist to feel, as well as blood in the urine with pain, by the point they were examined.   But the lesions discovered today are, on average, less advanced than those found in the past.   When found and addressed at an early stage, bladder cancer is very treatable, with a five-year survival rate near 95 percent.

For almost all patients, bladder cancer surgery means total removal of the bladder.   Partial cystectomies are less common, but may be appropriate for carefully selected patients.   Improved surgical techniques permit surgeons to more dependably avoid injury to the nerve bundles that control erections in men who must undergo cystectomy.

For most patients diagnosed with invasive bladder cancer, the operation involves removing the bladder and pelvic lymph nodes – and in men the prostate as well (cystoprostatectomy), and in women the uterus and sometimes part of anterior vaginal wall.   For this reason the procedure is also referred to as a radical cystectomy.   As part of the operation, surgeon will also construct a urinary diversion – a bladder reconstruction that uses intestinal tissue to create a new bladder or a conduit for direct removal of the urine to an external urostomy bag.

Currently, surgeons are more likely to use a conventional open procedure for this cystectomy operation.   This is especially for the female patient who has significant adhesion within the pelvis.

At advanced centers such as Virtua, though, the staff conducts a growing number of cystectomies as well with robotic surgery, especially for cases of invasive bladder cancer.   Our Lady of Virtua Medical Center is the only facility in South Jersey to employ the da Vinci surgical system to perform a robotic cystoprostatectomy.  The success of the robotic approach in managing bladder cancer has been reported for several years, but is rarely performed outside major medical centers.    The procedure, in which Virtua urologic surgeons remove the cancerous tissue through six small incisions, is technically challenging.

In a less invasive procedure, the robotic operation affords the Virtua’ surgeons the same capabilities available with open surgery of:

  • meticulous dissection for standard/extended lymphadenectomy;
  • complete bladder removal with minimal blood loss;
  • precise suturing of the DVC and creation of a watertight urethra-neobladder;
  • enhanced ability to preserve neurovascular bundles;
  • and rapid return of bowel function.

Virtua urologists work in close coordination with Virtua medical and radiation oncologists to integrate chemotherapy, and sometimes immunotherapy or radiation therapy, into the treatment sequence.   Radiation therapy can sometimes be delivered in the physician-office urology center.

Interstitial Cystitis

Chronic inflammation of the bladder wall occurs primarily in women.   Virtua urologists are experienced in identifying this often misdiagnosed condition, which is also called painful bladder syndrome.  Various factors may create a compromise of the inner lining of the bladder, leading to ongoing irritation of the bladder wall.  Inflammation can swell the walls of the bladder or scar the bladder, making it stiff and less pliable.

Symptoms include pain during intercourse, pelvic pain, and urinary discomfort, frequency or urgency.   Urologic testing may include cystoscopy and biopsy.   A stepwise progression of care is often needed to find a treatment that resolves the problem.   Care may include:

  • medication to treat the inflammation or the symptoms, delivered orally or into the bladder;
  • conservative or invasive manipulations of the bladder;
  • bladder training;
  • transcutaneous nerve stimulation (TENS);
  • sacral or pudendal nerve stimulation (see above);
  • dietary adjustments;
  • or surgery.  

Bladder Infection

Urinary infections can affect the urethra, bladder, ureter, or kidneys, causing pain, bleeding, and other symptoms.   Virtua urologists have extensive experience screening for, diagnosing, and evaluating these infections and offering prompt, targeted, and complete medical treatment.

To lean more, call 1-888-847-8823.

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