For Patients

What does the procedure involve?

This is the surgical removal of the foreskin and is only indicated for disease or tightness of the foreskin itself.

What are the alternatives to this procedure?

Drugs to relieve inflammation and avoid circumcision.

What should I expect before the procedure?

You will usually be admitted on the same day as your surgery. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, and your named nurse. You will be asked not to eat or drink for 6 hours before surgery.

What happens during the procedure?

A full general anaesthetic (where you will be asleep throughout the procedure), a spinal anaesthetic (where you are awake but unable to feel anything from the waist down) or a local anaesthetic injection around the penis may be used. All methods minimise pain; your anaesthetist will explain the pros and cons of each type of anaesthetic to you. Local anaesthetic is also injected into the base of the penis to aid pain control after the operation; this can be used as the sole form of anaesthesia in some patients. All methods minimise post-operative pain.

The entire foreskin will be removed using an incision just behind the head of the penis. This leaves the head of the penis completely exposed with no redundant skin.

What happens immediately after the procedure?

You may experience discomfort for a few days after the procedure but painkillers will be given to you to take home. Absorbable stitches are normally used which do not require removal. Vaseline should be applied to the tip of the penis and around the stitch line to prevent the penis from adhering to your underclothes and it is advisable to wear light clothing for 2-3 days. Passing urine will be painless and will not be affected by the operation. The average hospital stay is less than 1 day.

Are there any side-effects?

Most procedures have a potential for side-effects. You should be reassured that, although all these complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure.

The penis will swell after the operation and this can last for several days. Sometimes bleeding occurs and rarely another operation is required for this to be controlled. You may experience permanently altered or reduced sensation in the head of the penis. Any operation generates scar tissue and you may not be completely satisfied with the cosmetic result. Sometimes there is a need for removal of excessive skin at a later date.

What should I expect when I get home?

When you leave hospital, you will be given a “draft” discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge. It will be at least 10 days before healing occurs and you may return to work when you are comfortable enough and your GP is satisfied with your progress. Most people require at least a week off work. You should refrain from sexual intercourse for a minimum of 4 weeks.

What else should I look out for?

There will be marked swelling of the penis for a few days. This will last 3-4 days and will then subside but do not be alarmed because this is expected. However, if you develop a temperature, increased redness, throbbing or drainage at the site of the operation, please contact your GP.

Are there any other important points?

You will not normally be given a follow-up outpatient appointment after circumcision unless this is felt necessary by your Consultant.

What does the procedure involve?

This is the removal or repair of a fluid sac surrounding the testicle to prevent further accumulation of fluid.

What are the alternatives to this procedure?

Observation, removal of the fluid with a needle, various other surgical approaches.

What should I expect before the procedure?

You will usually be admitted on the same day as your surgery. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, and your named nurse. You will be asked not to eat or drink for 6 hours before surgery.

What happens during the procedure?

Either a full general anaesthetic (where you will be asleep throughout the procedure) or a spinal anaesthetic (where you are awake but unable to feel anything from the waist down) will be used. All methods minimise pain; your anaesthetist will explain the pros and cons of each type of anaesthetic to you. The surgeon will make a small incision in the scrotum and drain the fluid from around the testicle. The remaining sac is then stitched up with absorbable sutures. Occasionally, the surgeon may remove the fluid sac completely.

What happens immediately after the procedure?

You may experience discomfort for a few days after the procedure but painkillers will be given to you to take home. Absorbable stitches are normally used which do not require removal. The average hospital stay is less than 1 day.

Are there any side-effects?

Most procedures have a potential for side-effects. You should be reassured that, although all these complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure.

You will experience swelling of the scrotum lasting several days. You may also notice seepage of yellowish fluid from the wound for several days after surgery. Sometimes there is significant bruising due to blood collecting around the testicle. This sometimes requires a further operation to deal with the bleeding.

Rarely, there may be a recurrence of the fluid collection, and there is a small risk of developing chronic pain in the testicle or scrotum.

What should I expect when I get home?

When you leave hospital, you will be given a “draft” discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge. The wound should be kept clean and dry for 24 hours. Thereafter, if a dressing is in place, this can be removed following a short bath or shower. Until the area, heals, do not have lengthy baths or showers since this will encourage the stitches to dissolve too quickly and may cause infection.

It is advisable to wear supportive underpants or a scrotal support until the swelling and discomfort have settled. You are advised to take 10-14 days off work and should avoid any strenuous exercise or heavy lifting to allow wound healing. Sexual intercourse is best avoided for 10 days or until local discomfort has settled.

What else should I look out for?

If you develop a temperature, increased redness, throbbing or drainage at the site of the operation, please contact your GP.

Are there any other important points?

Some lumpiness above or behind the testicle is common following the procedure and is often permanent. Outpatient follow-up is not always necessary and your surgeon will discuss arrangements after your operation.

Your urologist may have arranged for you to have a cystometrogram or bladder pressure test. Please read this information as it gives a brief explanation of the test and will hopefully answer any questions you may have.

Why is the test necessary?

The normal bladder stores urine and then expels it at a convenient time following instructions from the brain. Your symptoms suggest that your bladder may not be working properly and this test helps us to find out why by measuring activity of the bladder as it fills and empties. To do this we need to recreate your symptoms in the clinic by filling your bladder artificially.

How is the test done?

The test takes between 20 and 40 minutes to perform. On your arrival you will be asked to change into a hospital gown. Secure lockers are provided for you to store your clothes and belongings. If possible you then pass urine into a special toilet to measure urine flow and to empty your bladder. Following this we may scan your bladder with an ultrasound machine to see if any urine is left.

You will then be asked to lie down on a couch. The room will be empty except for the specialist nurse or doctor doing the test. They will clean your genital area with a mild antiseptic and introduce a small amount of local anaesthetic jelly into your urinary passage. This sometimes gives mild discomfort. Following this a fine soft tube (catheter) will be gently passed up into the bladder. This feels strange and may sting as it passes through but the feeling quickly wears off. A second thin tube will then be inserted into your bottom (back passage) to measure changes in your tummy during the test. Again this gives a strange feeling which quickly goes away.

Once everything is in place your bladder will be gradually filled with saline (salty water). Throughout the test a specialist nurse or doctor will be with you and will ask about your symptoms and how the bladder feels. When your bladder starts to feel uncomfortable we will ask you to cough and strain to look for leaks or turn some taps on to stimulate your bladder. You should try to hold on to your urine if possible at this point.

We will then ask you to move to a special toilet in the same room. You may be asked to cough or strain again to look for any leakage. We then ask you to pass your urine into the special toilet for which you will be left alone.

During the examination we may take a few X-ray pictures of your bladder to record its appearance during the test. The tubes will then be removed and you will be ready to get dressed and return home. We may also ask you to perform some exercises (coughing, squatting and jumping) whilst wearing a special pad to record any leakage. The doctor or specialist nurse may speak to you about the results before you go.

Is any preparation needed?

It is important that you drink plenty of fluid (1 glass every hour) on the day of the test and the day after. It is very helpful if your bladder is fairly full when you arrive and that you open your bowels before you come for the test. If you think that you may have a bladder infection you should let us know before the test. If there is a chance that you may be pregnant you must tell the nurse when you arrive so we know not to use X-rays. You are welcome to bring your own dressing gown and slippers to the urology suite to make yourself more comfortable.

Will there be any problems afterwards?

Like many medical tests the CMG involves some discomfort and embarrassment and can seem undignified. Throughout the examination professional, trained staff who understand your concerns will look after you and help minimise any discomfort.

After the test it will sting when you pass your water for a couple of days and you may experience a mild ache in the bladder which should quickly improve. You may also pass a little blood with the urine the first time you pass urine.

About 5% (5 in a 100) patients who have this test get a bladder infection (cystitis) afterwards. If this happens the stinging will get worse and you may become feverish. If this occurs you should see your local doctor (GP) as soon as possible and explain the situation or come to the emergency admission suite at the Freeman to get some antibiotics. If you are at higher risk of getting an infection or are particularly concerned about the possibility you will be given a short course of antibiotics to take when you leave.

When will I be told about the results?

The doctor or specialist nurse doing the test will briefly explain the results and may organise some treatment straight away. The findings of the test are always sent to your consultant who will then write to you or arrange for you to be seen in the out patient clinic to explain the findings and discuss your problems.

How can other questions be answered?

It is very important that you know the reason for the test and that you are happy for it to be performed. If you have any queries you can ring the urodynamics secretary who will give you confidential advice (the telephone number is on the appointment card). Alternatively you can speak to your consultant’s secretary by ringing 0191 2336161and asking to be put through to him/her. The secretary may be able to answer your question, get a doctor to speak with you, or arrange a further out patient appointment. Finally you can speak to the staff in the urology suite when you arrive for the test.

Introduction

As with many other medical tests, you main anxieties before a flexible cystoscopy will be due to a fear of the unknown. This information aims to tell you what to expect and answer any questions you may have.

What is a cystoscopy?

The term cystoscopy comes from the Greek ‘cysto’ for bladder and ‘scopy’ meaning to look. Modern, advanced techniques ensure flexible cystoscopy is simple, quick and painless.

When you have a cystoscopy, a tube containing a miniature telescope is passed through the urine pipe (urethra) so that the doctor can examine the inside of the bladder. It is usual to look at the urethra itself so the correct term ‘cystourethroscopy’ is also used for the examination.

Why flexible cystoscopy?

The lenses at each end of a flexible cystoscope are connected by a bundle of tiny glass fibres which allows the telescope to bend freely. The flexible cystoscope adjusts itself to fit the curving male urethra. This allows it to pass through painlessly, avoiding the need for a general anaesthetic. The examination can be done with the patient lying flat, in a comfortable position. Flexible cystoscopy is usually done in the urology investigation suite.

Why do I need a cystoscopy?

Some urinary symptoms are due to problems in the bladder or the urethra. Sometimes the cause will be clear from x-rays or tests of the blood or urine, but often the only way your doctor can be sure what is going on is to take a look inside with a cystoscope.

What preparation is needed?

No special preparation is required. This means that on the day of the investigation you can eat and drink as usual. You turn up for your appointment, have your cystoscopy and then leave the suite. There is no need to rest afterwards. When you get to the urology suite you will usually be asked to change into a hospital gown. This is to protect your clothes during the procedure. You will then be asked to empty your bladder. The nurse will give you a container and instructions if a urine specimen is to be provided.

The flexible cystoscopy

The doctor or specialist nurse will clean the genitals with a mild disinfectant and then surround the area with a paper sheet. Try not to touch it with your hands. Although you do not need a general anaesthetic for flexible cystoscopy, the urethra needs to be prepared with anaesthetic jelly which is gently squeezed into it from a tube or syringe. The jelly numbs the urethra and lubricates it. The doctor or specialist nurse then gently inserts the tip of the flexible cystoscope into the urethra.

Men may be asked to try to pass urine when the instrument reaches the sphincter below the prostate gland. In trying to pass urine the sphincter naturally relaxes and the cystoscope can pass through more easily. Don’t worry, no urine will actually come out while the cystoscope is in the urethra. There may be momentary stinging as the sphincter opens.

Once the flexible cystoscope is in the bladder, saline (salt water) solution is run into the bladder through the cystoscope to fill the bladder. This allows the doctor or specialist nurse to examine the bladder in its entirety. It is therefore natural at the end of the examination to feel as if you need to pass water again. It is usual for a nurse to stay with you throughout the examination, which is very quick, usually no more than five minutes. You may experience some slight discomfort but it will not last long.

Is the flexible cystoscope used only to examine the bladder?

Because you are awake, only painless operations can be done during flexible cystoscopy. Often the flexible cystoscope will only be used to look and if something more needs to be done, you will be asked to come back for a procedure under general anaesthetic (i.e. you are asleep). However, it is possible to take specimens (biopsies) from the lining of the bladder without discomfort.

What are the after effects of flexible cystoscopy?

Most patients have no trouble after a flexible cystoscopy. A mild burning on passing urine usually gets better within a day or so. Drinking extra water will help. A little bleeding is common, especially if a biopsy has been taken. An occasional problem after flexible cystoscopy is a urine infection. If you have a temperature, pain, persistent burning or bleeding, contact your doctor.

Finally, relax and listen to what the doctor/nurse tells you. There are advantages to being awake for your cystoscopy. If you are getting more discomfort than you think you should have, tell the doctor or nurse. If you have any questions, ask them. Having a flexible cystoscopy may not be exactly enjoyable, but you may find it interesting and informative as you can watch the examination yourself on the monitor. You can expect to be told the results of your examination straight away.