Drawer 27 cards
Bladder and Prostate Procedures
A plain-language comparison of seven procedures that treat or investigate the bladder, prostate and urethra, and how they differ in route and recovery.
Cards in this drawer
No. 06Bladder and prostate
Cystoscopy
A look inside the urethra and bladder with a thin scope.
Route: Through the urethra, using a thin camera
No. 07Bladder and prostate
Transurethral resection of bladder tumor
Removal of a bladder tumor through the urethra, to treat it and to find out what it is.
Route: Through the urethra, using a resectoscope
No. 08Bladder and prostate
Transurethral resection of the prostate
Trimming away prostate tissue that blocks the flow of urine.
Route: Through the urethra, using a resectoscope
No. 09Bladder and prostate
Holmium laser enucleation of the prostate
A laser frees the inner prostate tissue that blocks urine flow so it can be removed.
Route: Through the urethra, using a laser
No. 10Bladder and prostate
Sacral neuromodulation
A small implanted device that stimulates the nerves involved in bladder control.
Route: A thin lead near the lower-back nerves, joined to a small implanted device
No. 11Bladder and prostate
Botulinum toxin injections into the bladder
Small injections into the bladder wall to calm an overactive bladder.
Route: Through the urethra, with a scope and a fine needle
No. 12Bladder and prostate
Urethrotomy and urethral dilation
Widening a narrowed urethra by a controlled cut or by gradual stretching.
Route: Through the urethra, under scope guidance
Problems with the bladder, prostate and urethra (the tube that carries urine out of the body) can be investigated or treated in several ways. The seven cards in this drawer are a first map for patients, families and students, not a guide to choosing between them. Individual plans differ, and the treating urologist makes the final call.
How the procedures differ in route
Most of these procedures travel up the urethra and need no cut in the skin. Cystoscopy is the starting point: a thin scope, flexible or rigid, is passed into the bladder so the urologist can look at its lining. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says the same instrument can also be used to take a tissue sample or to treat some problems, which is why several other cards build on it.
Removing bladder tumors, called TURBT, follows the same route. Two prostate operations travel that way too. TURP is a transurethral resection, which means tissue is cut away through the urethra, and HoLEP is a laser method. Urethrotomy and urethral dilation widen a narrowed urethra, and Cleveland Clinic describes the knife used in urethrotomy as passing through a cystoscope. Botulinum toxin injections place small doses into bladder tissue. Sacral neuromodulation works differently again, through a thin wire and a pulse generator implanted under the skin of the lower back.
When each is typically considered
NIDDK lists blood in the urine, repeated infections and trouble passing urine among the reasons for cystoscopy, and says abnormal tissue or tumors can also be removed or sampled that way. For an enlarged prostate, NIDDK says surgery to remove part of the prostate may be needed if medicines do not help, symptoms are severe or complications develop. Transurethral resection and laser surgery are among the methods it names, which are the approaches behind TURP and HoLEP.
Mayo Clinic describes behavioral therapies as the first choice for an overactive bladder, with medicines, bladder injections and nerve stimulation among the other options. It says sacral nerve stimulation begins with a trial wire before any device is implanted, and that botulinum toxin effects most often last six months or more. Cleveland Clinic describes dilation and urethrotomy as treatments for urethral strictures (narrow bands of scar tissue), and says scarring may return and need further treatment.
Recovery compared
Recovery varies widely across the drawer. NIDDK says people usually go home after an office cystoscopy, with mild burning or a little blood in the urine that should settle within a day. After prostate surgery NIDDK says a catheter may be needed for several days, and the urinary catheter card explains what that involves.
The pelvic floor muscle training card covers exercises for the muscles that help control the bladder. For a broader view of healing, see recovery and rehabilitation, and the glossary explains terms used across these cards.