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Surgical Daycare Procedures


Transurethral Resection Bladder Tumor (TURBT)

Transurethral resection (TUR) of the bladder is a surgical procedure that is usedboth to diagnose bladder cancer and to remove cancerous tissue from the bladder. This procedure is also called a TURBT (transurethral resection for bladder tumor). General anesthesia or spinal anesthesia is usually used. During TUR surgery, a cystoscope is passed into the bladder through the urethra. A tool called a resectoscope is used to remove the cancer for biopsy and to burn away any remaining cancer cells.
Bladder cancer can come back after this surgery, so repeat TURs are sometimes needed.

 
Post Operative Instructions

Drink 4 to 6 glasses of water daily to flush any blood out of the urine until urine runs clear of blood.
There will be an increase of blood in your urine if you are taking any type of blood thinners post operatively (ei: ASA, Warfarin, Coumadin, Plavix)
There is a small risk of infection requiring treatment with antibiotics. Symptoms of infection may include fever, frequent urination with burning and/or odor to urine.  Please contact the office if you are experiencing any of the above.
You may feel the need to urinate frequently for a while after the surgery, but this should improve over time. You may have blood in your urine for up to 4 to 6 weeks following surgery. You may be instructed to avoid strenuous activity for about 3 weeks following TUR.

 

 

Prostate Transurethral resection holmium Laser

A minimally invasive procedure using a holmium laser for treating BPH.

 

Post Operative Instructions

Drink 4 to 6 glasses of water daily to flush any blood out of the urine until urine runs clear of blood.
There will be an increase of blood in your urine if you are taking any type of blood thinners post operatively (ei: ASA, Warfarin, Coumadin, Plavix)
There is a small risk of infection requiring treatment with antibiotics. Symptoms of infection may include fever, frequent urination with burning and/or odor to urine.  Please contact the office if you are experiencing any of the above.
You may feel the need to urinate frequently for a while after the surgery, but this should improve over time. You may have blood in your urine for up to 4 to 6 weeks following surgery. You may be instructed to avoid strenuous activity for about 3 weeks following TUR.

 

 

Cystoscopy


This is a minimally invasive procedure that is done in the office or the hospital to examine the urethra and bladder in women and the urethra, prostate and bladder in men.

A small amount of lubricant is placed in the cystoscope and, while looking through the eye piece of the cystoscope, the urologist will look down the urine passage way and examine the inside of the bladder for tumors, stones, or infection.  In women, with incontinence, the bladder is filled and the cystoscope removed, then the women is asked to cough and strain to see if there is any leakage of urine while lying down.  The patient may be asked to repeat this while standing.


Post Operative Instructions

Drink 4 to 6 glasses of water daily to flush any blood out of the urine, until it runs clear of blood.
There will be an increase of blood in your urine if you are taking any type of blood thinners post operatively (ei: ASA, Warfarin, Coumadin, Plavix)
There is a small risk of infection requiring treatment with antibiotics. Symptoms of infection may include fever, frequent urination with burning and/or odor to urine.  Please contact the office if you are experiencing any of the above.
You may feel the need to urinate frequently for a while after the surgery, but this should improve over time. You may have blood in your urine for up to 1 to 2 weeks following the cystoscopy.

 

 

ESWL (Lithotripsy Shockwave Extracorporeal ESWL)

Shock wave lithotripsy (ESWL) is a non-surgical treatment in which high energy shock waves are used to pulverize a stone into smaller fragments which can pass more easily and with less pain.
A special machine is used to generate shock waves.  X-rays or ultrasound are used to focus the shock waves precisely on the stone.  The shock waves pass harmlessly through body tissues until they hit the hard stone causing it to break up.  The fragments can then flush out in the urine.
In some situations ESWL may not be possible or effective.  These Include:

  • Very large stones
  • Very hard stones
  • Patients who are very overweight, because shock waves may bot be able to reach the stone
  • During Pregnancy
  • Patients with bleedning disorders or taking blood thinners like warfarin
Other treatment options may be considered for these patients.  Special precautions may be required for ESWL in those with cardiac pacemakers.  Some stones will require more than one ESWL treatment for complete clearance.

Post ESWL Treatment

You may pass stone fragments for a few weeks after ESWL.  About 80% of patients treated with ESWL are stone free by three months after their treatment.  There may be pain and mild bruising of the skin where the shock waves entered the body.  Aching back of flank pain may accompany the passage of stone fragments, particularly in the first few days.  Mild pain can often be controlled with Tylenol or Advil.
It is not unusual to see blood in the urine for up to one week.  Clearing of blood and flushing stone fragments will be facilitated by drinking at least 4 to 6 glasses of water for the first 2 weeks.  Most people are able to return to work and resume their usual activities when they are comfortable, usually with a day or two of their ESWL treatment.

 

 

Risk of Shockwave Lithotripsy

Heaving bleeding is rare after ESWL.  Internal bruising in or around the treated kidney is occasionally seen.  Fever, chills or shakes after ESWL may indicate infection.  Medical attention should be sought promptly so that treatment can be provided if necessary.  Occasionally, blockage of a ureter with stone fragments after ESWL will require additional treatment, including surgery.

 

 

Circumcision

Circumcision involves removal of the foreskin to expose the covered glans or head of penis.  Most circumcisions performed in North America after the neonatal period (after two weeks of age) are needed for medical reasons.  These include infections of the bladder or foreskin and, more commonly, tightening of the foreskin that prevents its retraction over the head of the penis (Phimosis)

 

Post Operative Instructions

Any pain after the operation can usually be controlled with Tylenol.
There is often swelling of the loose skin of the penis initially, but this usually disappears within 2 weeks.
The stitches do not have to be removed, they will fall out on their own.
If dressing is used, ask for instructions on its care.
If the incision becomes quite swollen, sore to touch, very red and drainage is observed, this could be an indication of infections.  Please contact your urologists office for instructions.

 

 

Retrograde Pyelogram

A retrograde pyelogram is a diagnostic X-ray procedure used in combination with a cystoscopy to determine the presence of stones, tumors, or other obstructions in the kidneys and ureters.
During the retrograde pyelogram, the physician inserts an endoscope through the urethra into the bladder.  The physician then examines the bladder by inserting a catheter into the ureter(s).  A contrast dye injected through the catheter(s) highlights trouble spots on the X-rays, which are taken at timed intervals.  After the removal of the catheter(s), the physician checks for the retention of the contrast dye.

 

Post Operative Instructions

Drink 4 to 6 glasses of water daily to flush any blood out of the urine, until it runs clear of blood.

There will be an increase of blood in your urine if you are taking any type of blood thinners post operatively (ei: ASA, Warfarin, Coumadin, Plavix)
There is a small risk of infection requiring treatment with antibiotics. Symptoms of infection may include fever, frequent urination with burning and/or odor to urine.  Please contact the office if you are experiencing any of the above.
You may feel the need to urinate frequently for a while after the surgery, but this should improve over time. You may have blood in your urine for up to 1 to 2 weeks following the retrograde pyelogram.




Vasectomy

A vasectomy is considered a permanent method of birth control. A vasectomy prevents the release of sperm when a man ejaculates. During a vasectomy, the vas deferens from each testicle is clamped, cut, or otherwise sealed. This prevents sperm from mixing with the semen that is ejaculated from the penis. An egg cannot be fertilized when there are no sperm in the semen. The testicles continue to produce sperm, but the sperm are reabsorbed by the body. (This also happens to sperm that are not ejaculated after a while, regardless of whether you have had a vasectomy.) Because the tubes are blocked before the seminal vesicles and prostate, you still ejaculate about the same amount of fluid.

 

Post Operative Instructions
The scrotum may become swollen or even bruised after procedure.  Ice may be applied to scrotal area.  If pain medication is needed, usually Tylenol or Advil is suggested.

If swelling persists of scrotum, accompanied with redness around incisions and/or drainage, fever and/or chills, this could be an indication of infection.  Please contact your urologist office.




Prostate biopsy

Prostate biopsies are often recommended when PSA levels are high or a lump is found on the prostate during DRE. Since biopsies can be painful, local anaesthetic is used to make men more comfortable.
An ultrasound probe is inserted into the rectum and it creates images of the prostate. The doctor looks for suspicious areas and using a hollow needle, removes small tissue samples. If no abnormalities can be seen on the ultrasound, eight sections of tissue are taken from different areas of the prostate. These samples are then examined to see if cancer cells can be found and how aggressive the cancer is.

Post operative Instructions

After a biopsy, many men will pass a little blood in the urine or from the rectum and most men will also notice that their semen becomes discolored.  This can persist up to 4 to 6 weeks after the biopsy. These side effects are both normal and will disappear with time. 
Infections after biopsy are rare but can occasionally be quite severe. Antibiotics before and after the procedure can lower the risk.
There will be an increase of blood in your urine if you are taking any type of blood thinners post operatively (ei: ASA, Warfarin, Coumadin, Plavix)
Drink 4 to 6 glasses of water daily to flush any blood out of the urine until urine runs clear of blood.

 

 

Hydrocelectomy

Hydrocelectomy, also known as hydrocele repair, is a surgical procedure performed to correct a hydrocele. A hydrocele is an accumulation of peritoneal fluid in a membrane called the tunica vaginalis, which covers the front and sides of the male testes. Hydroceles occur because of defective absorption of tissue fluid or irritation of the membrane leading to overproduction of fluid. In addition to filling the tunic vaginalis, the fluid may also fill a portion of the spermatic duct (epididymis) in the scrotum.

 

Post Operative Instructions

The scrotal may be quite swollen and bruised.
A penrose drain may be placed in scrotum to help drain excess fluid from scrotum.  This drain is usually removed before leaving hospital.  In some cases you may go home with your drain and you will be directed to contact your urologist office for further instructions regarding removal.
If the incision becomes quite swollen, sore to touch, very red and a pus like drainage is observed, this could be an indication of infections.  Please contact your urologists office for instructions.
You may have dicomfort and be sent home with pain medication or be indicated to take Tylenol or Advil for relief of discomfort.

 

 

Spermatocelectomy

Spermatoceles are benign cysts of the scrotum.  For a number of reason, such as trauma, infection, congenital abnormalilties of for no reason at all, one of the tubes of the epididymis no longer transports sperm properly.  The ned result is a widening of the tube into a small cavity, or cyst.  This could be compared to the effects of a dam that creates a lake by blocking the flow of water.  Over time, your spermatocele has become large enough to become painful or interferes with your daily activities.

 

Post operative Instructions

Patients are encourage to continue scrotal support, using an athletic supporter for a minimum of 48 hours after discharge.
Gentle scrotal elevation while the patient is supine may decrease the likelihood of uncomfortable post operative swelling.  Intermittent application of cold or ice packs to the dressing is commonly used.
Oral analgesics should provide adequate post operative pain relief.
Patients are instructed to keep the dressing in place, to allow the wound to dry for 48 hours, and to avoid strenuous activity for 2 weeks.
Risks of the surgery include bleeding, pain, and infection, which are associated with any surgical procedure.  The unique risks include recurrence of the spermatocele.  Since the epididymis is left in place, there is the possiblity of another duct blocking at a later time.

 

 

Ureteroscopy

The investigation and treatment of many problems of the kidneys and their drainage system may require visual examination.  The ureter is the tube that drains urine from each kidney to the bladder.  Ureteroscopy is a procedure in which a narrow telescope is passed through the urethra (urinary tube) and bladder, into the ureter toward the kidney.  Ureteroscopy is performed most often for removal of a kidney stone which has become trapped in the ureter. Investigation and treatment of unexplained urinary bleeding or blockage of a ureter may also require ureteroscopy.

 

Post operative Instruction

Drink 4 to 6 glasses of water daily to flush any blood out of the urine, until it runs clear of blood.
There will be an increase of blood in your urine if you are taking any type of blood thinners post operatively (ei: ASA, Warfarin, Coumadin, Plavix)
There is a small risk of infection requiring treatment with antibiotics. Symptoms of infection may include fever, frequent urination with burning and/or odor to urine.  Please contact the office if you are experiencing any of the above.
You may feel the need to urinate frequently for a while after the surgery, but this should improve over time. You may have blood in your urine for up to 1 to 2 weeks following the ureteroscopy.

 

 

Botox Bladder Injection

Introduction

Botox is a purified toxin made from a bacterium. As such this is a toxic product but its use has been standardized in a variety of disorders in medicine as well as in certain urological conditions. Botulinum toxin described herein is an attempt to affect the muscles in your bladder in order to help your urinary symptoms.

Urinary disorders

Botox has been successful in treating a variety of bladder and urinary continence disorders. These include overactive bladder, multiple sclerosis, spinal cord injury with neuropathic bladder, stroke, interstitial cystitis, urinary retention and certain forms of prostatism. In each of these conditions it is realized that the over activity of affected muscles cause the symptoms which lead to symptoms. Botox produces a temporary paralysis of the injected muscles, improving and sometimes resolving the symptoms all together. 


Botox injection into the bladder muscles

Your overactive bladder will produce symptoms of urinary frequency, urgency and urge incontinence. You may have tried alternative treatment in the form of medication and behavioural treatment in the form of bladder training which has not helped you. You must try these treatments before undergoing Botox injection to the bladder. In your condition the Botox is injected into the bladder muscle wall in several specific locations. The published reports indicate great success with minimal or no side effects. Most people will find that urgency and urge incontinence are resolved or greatly improved. 


Duration of benefits

The maximum relief of symptoms with Botox is usually seen 7 to 14 days after the injection and normally lasts between 6-10 months. You may need repeat injection if your symptoms recur. 


How is the Botox injected

Injection of Botox into the bladder is a minimally invasive procedure and can be performed as a day case procedure. This can be done under local as well as under general anaesthetic using a cystoscope. The Botox is injected into 20- 30 sites in your bladder.

(If you wish to have Botox injection done under a general anaesthetic, this procedure is only done at the private surgical centre and it is a cost to the patient. Cost involves surgical centre fee, anesthesiologist fee and medication fee as well as all supplies needed for procedure).

Botulinum Toxin (Botox) medication is not covered under pharmacare.  If you have third party coverage, please contact them as some do cover 80% of this prescription cost.  Average price (per vial) of Botulinum Toxin Type A is $350.00.

Dr. Pommerville’s fee for injecting botox in covered under MSP, but there is an in office charge of $40.00 for the use of the endoscopic needle used to inject the bladder.


Side effects

The use of Botox is very safe. Very rarely, however, there are minor side effects. Occasionally headache, light-headedness, fever, abdominal pain and diarrhea may occur. You will experience blood in your urine, up to 48hrs after the botox injection. Many of the side effects are not necessarily a direct result of Botox. Rarely patients may experience flu like symptoms and may need to be looked after as an inpatient in the hospital. There have been no deaths reported. Because the injection has a paralyzing effect on the muscle of the bladder there is a small chance that you will experience problems in emptying your bladder. This seems to occur in about 4% of patients and lasts for about six weeks. If this happens we shall have to teach you the technique of intermittent self catheterization in order to empty you bladder until you are able to do this unaided.