The Bladder & Urethra

The urinary bladder is a hollow distensible (or elastic) muscular organ that collects and stores urine from the kidneys before disposal by urination. Urine enters the bladder via the ureters and exits via the urethra where the urethral sphincter relaxes and the bladder contracts leading to the passage of urine to the outside.. The typical human bladder can hold between 300 and 500 mL before the urge to empty occurs

Bladder cancer is where a growth of abnormal tissue, known as a tumour, develops in the bladder lining. In some cases, the tumour spreads into the surrounding muscles

The most common presentation of bladder cancer is with blood in the urine that is usually seen, but sometimes picked up on a dipstick and is usually painless. If you experience these symptoms you should visit a urologist. Occasionally bladder cancer can present with urine infections or a change in urination, such as the need to pee more frequently.

The diagnosis of bladder cancer is usually made with a series of blood and urine tests, some scans (CT or ultrasound), and a cystoscopy. A cystoscopy involves passing a very fine camera down the urethra and into the bladder. Local anaesthetic is used and the procedure only lasts a few minutes.

If a cancer is seen then the next step is to be admitted for a further cystoscopy under anaesthetic, where the cancer is either removed with a biopsy or scrapped away with (trans-urethral resection of a bladder tumour or TURBT). It is normal to put some chemotherapy into the bladder after this procedure (mitomycin), which is helpful in preventing recurrence. This procedure is usually performed under general anaesthesia, and may involve spending a night in hospital. Recovery afterwards is fast, but we advise restraining from physical activity for a couple of weeks afterwards. There are small risks of bleeding and urine infection. Very rarely a perforation is made in the wall of the bladder, which requires a catheter to be left in place for a week whilst the bladder heals.

For most bladder cancer this treatment is all that is required, with the final decision made after a pathologist examines the specimen that was removed. If a cancer has invaded the bladder wall then it might be necessary to have further treatment such as removal of the bladder.

Bladder cancer frequently recurs, and you will need to have regular cystoscopic follow up for up to 10 years.

Overactive bladder (OAB), also known as overactive bladder syndrome, is a condition where there is a frequent feeling of needing to urinate to a degree that it negatively affects a person's life. The frequent need to urinate may occur during the day, at night, or both. If there is loss of bladder control then it is known as urge incontinence. More than 40% of people with overactive bladder have incontinence. it is not life-threatening condition.

Treatment for this condition involves a number of conservative measures such as pelvic floor exercises, bladder retraining, and fluid management. There are several medications also licensed for this condition. Some of these are poorly tolerated because of side effects. There is a new class of drug available recently (Mirabegron), which may avoid these.

When these measures have failed there are alternative options such as putting Botox into the wall of bladder. This can performed under general or local anaesthesia, and can be up to 70% effective. There is a risk of not being able to pass urine afterwards, and so it is necessary to learn how to self catheterize before embarking on this treatment as a precaution.

A urinary tract infection (UTI) is common and affects part of the urinary tract. When it affects the lower urinary tract it is known as a bladder infection (cystitis) and when it affects the upper urinary tract it is known as kidney infection (pyelonephritis).

Most common symptoms include:

  • Frequency and urgency
  • Burning when passing urine (dysuria)
  • Lower Abdominal pain (suprapubic pain)
  • Blood in the urine (haematuria)

Most common Risk factors include:

  • Sexual intercourse (honeymoon cystitis)
  • post menopausal
  • Poor emptying of the bladder
  • Kidney Stones
  • Diabetes
  • Urinary tract abnormalities prostate enlargement

They can be very frequent causing distressing symptoms. In these situations it can be helpful to see a urologist to rule out any significant underlying cause and advise on further management. Investigations usually include a urine dipstick and culture (mid- stream urine or MSU), ultrasound of the urinary tract, assessment of bladder emptying and occasionally a cystoscopy.

Conservative measures:

  • Wearing loose fitting cotton underwear
  • Wiping from front to back
  • Drinking lots of fluid
  • Drinking cranberry juice (this is controversial)

Medical treatments:

  • Low dose antibiotic prophylaxis involves taking a low dose of an appropriate antibiotic every night for long periods (6 months or more)
  • Taking an antibiotic after sex if that is the trigger
  • If recurrent UTIs not responding to oral antibiotics then a medication can be put directly into the bladder as an outpatient (Cystistat®)