Bladder polyp removal cystoscopy

PMC

To the Editor: We report a case of a 3-year old boy that presented with recurrent urine retention secondary to a bladder polyp. Acute urine retention is not common in children. It may be secondary to dysuria whether from urinary tract infection, vaginitis, meatal ulcer, severe constipation with fecal masses compressing the bladder neck, voiding dysfunction, or from medications such as sympathomimetics.1 Urethral obstructive lesions such as valves or stones may present with acute urine retention. Bladder polyps, however, are a very rare cause of acute urine retention in children.

The boy was admitted to the Jordan University Hospital with recurrent acute urine retention and painless gross hematuria of 1-weeks duration. There was a history of urinary frequency, urgency, and suprapubic pain of 2 weeks duration. There was no history of a urine catheter. Physical examination was noncontributory. Urine analysis and culture were negative. A 24-hour urine collection revealed hyperoxaluria. A renal ultrasound was negative.

The patient underwent urethrocystoscopy. There was a mobile greenish soft polypoid pedunculated mass measuring 1.2×0.6×0.5 cm in the bladder dome that was resected. Histopathology revealed an infarcted polyp with polypoid fibrovascular tissue lined by a transitional epithelium lacking nuclear atypia. The stroma was edematous and congested with scanty inflammatory cell infiltrates. There was no evidence of malignancy. The patient had one recurrence of the gross hematuria without recurrence of the polyp as demonstrated on repeat cystoscopy. He was put on pyridoxine for the hyperoxaluria.

Recurrent urine retention in children may result from a variety of causes. However, bladder polyps as a cause are rare. Genitourinary tract polyps can occur anywhere from the renal pelvis to the urethra.2–5 Bladder polyps are rare in both adults and children. They may present with gross hematuria, voiding dysfunction,6 or urine infection.7–10 One should always keep in mind malignant tumours such as rhabdomyosarcoma, which may present in a similar manner. Diagnosis is by histopathology. Polyps are usually benign and do not turn malignant or recur. Al Ahmadie and colleagues reported a giant fibroepithelial polyp in a 3-year old child.11 In our patient, the location of the polyp allowed it to act as an intermittent valve, leading to urine retention alternating with symptom-free periods.

The pathogenesis of bladder genitourinary polyps remains to be elucidated. One hypothesis suggests that stone-initiated chronic irritation of the genitourinary mucosa leads to polyp formation.5 The role of the stone and crystalluria in the initiation of the localized inflammatory trigger seems appealing. Murshidi proposed that chronic localized lamina propria edema may cause a mucosal bulge which culminates into a polyp,5 but this does not explain the presence of congenital polyps. In our patient, the chronic mucosal irritation with oxalate crystal may have contributed to localized edema and polyp formation.

Overview


Bladder cancer

Treating bladder cancer

In cases of non-muscle-invasive bladder cancer, it’s usually possible to remove the cancerous cells while leaving the rest of the bladder intact.

This is done using a surgical technique called transurethral resection of a bladder tumour (TURBT). This is followed by a dose of chemotherapy medication directly into the bladder, to reduce the risk of the cancer returning.

In cases with a higher risk of recurrence, medicine known as Bacillus Calmette-Guérin (BCG) may be injected into the bladder to reduce the risk of the cancer returning.

Treatment for high-risk non-muscle-invasive bladder cancer, or muscle-invasive bladder cancer may involve surgically removing the bladder in an operation known as a cystectomy.

Most patients will have a choice of either surgery or a course of radiotherapy.

When the bladder is removed, you’ll need another way of collecting your urine. Possible options include making an opening in the abdomen so urine can be passed into an external bag, or constructing a new bladder out of a section of bowel. This will be done at the same time as a cystectomy.

After treatment for all types of bladder cancer, you’ll have regular follow-up tests to check for signs of recurrence.

Read more about treating bladder cancer.

Bladder Cancer: Your Questions Answered

Other specialized centers within the Glickman Urological and Kidney Institute for treatment of urologic and kidney conditions include: the Center for Male Infertility, the Center for Genitourinary Reconstruction, the Center for Reproductive Medicine, the Minority Men’s Health Center, the Center for Renal Transplantation and the Center for Female Pelvic Medicine & Reconstructive Surgery.

The Glickman Urological and Kidney Institute merges Cleveland Clinic’s urology and nephrology programs. This consolidation of disciplines allows us to better serve patients in the prevention, diagnosis and treatment of kidney disease while we continue to provide high-quality patient care and carry on innovative research in all aspects of urology. The Glickman Urological & Kidney Institute offers innovative treatments, including minimally invasive, scarless options for urologic procedures and medical management of kidney disease

Urology and nephrology physicians and scientists at Cleveland Clinic are recognized worldwide for excellence in patient care, teaching and research. This year, U.S. News & World Report ranked our urology and kidney disease programs No. 2 in the nation.

In addition to Cleveland Clinic’s main campus, our urologists and nephrologists practice in the community at Cleveland Clinic family health and surgery centers and in our affiliated medical offices. Whether your doctor refers you or you make your own appointment, you can feel comfortable knowing that the Cleveland Clinic doctor who will care for you is experienced in diagnosing and treating many patients with your condition.

On Your Health

MyChart®: Your Personal Health Connection, is a secure, online health management tool that connects Cleveland Clinic patients with their personalized health information. All you need is access to a computer. For more information about MyChart®, call toll-free at 866.915.3383 or send an email to: [email protected]

A remote second opinion may also be requested from Cleveland Clinic through the secure Cleveland Clinic MyConsult® website. To request a remote second opinion, visit eclevelandclinic.org/myConsult

This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician’s independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of the Cleveland Clinic institution or other Cleveland Clinic physicians. ©Copyright 1995-2013. The Cleveland Clinic Foundation. All rights reserved.

What causes a small, benign polyp to develop into severe invasive bladder cancer?

Some people develop invasive bladder cancer, which is where the cancer has grown through the muscle layer of the bladder. When this occurs, there is a higher risk that the cancer will spread to other areas of the body and it is much more difficult to treat.

Until now the signalling process that allows a benign, small polyp to develop into something that spreads and is invasive has not been clear. But research carried out by a team at Plymouth University has for the first identified an important mechanism behind this process.

The research is published Aug. 1, 2013 in the American Journal of Physiology — Renal Physiology.

Key to the research is a protein, pancreatic secretory trypsin inhibitor (PSTI), which is present in most bladder cancers. The research has identified the role PSTI plays in the signalling process that allows the spread and invasion of bladder cancer.

By understanding the process by which this protein helps the cells to spread, and invade into other tissue, researchers can start to develop ways to interrupt this process, potentially leading to new treatments.. This has the potential to improve the survival and life quality of those with early diagnosed bladder cancer, and reduce the instances where rigorous drug regimes or invasive surgery are required.

The research was led by Professor Raymond Playford and Dr. Tanya Marchbank from Plymouth University. Professor Playford said: “Although bladder cancer can be readily treated if caught early enough, once it starts to invade into deeper tissues and spread to distant sites it is a much more difficult, painful and life-affecting cancer to live with. Treatment becomes more difficult as tumours grow deeper into the bladder wall and spread, and survival rates decline — it is estimated that just 25 per cent of those with severe invasive bladder cancer will be alive and well three years after diagnosis and treatment. By identifying the mechanism by which bladder cancer develops and spreads, we hope that in time therapies that manipulate this mechanism may be developed to improve the quality of life and survival rates of those with invasive bladder cancer.”

Forum

Welcome to somewhere you don’t want to be!! But all of us have “been there, done that” so we know what you are facing and even a bit of how you feel.
First, to try to answer a few of your questions. The most common form of bladder cancer, transitional cell uretheal carcinoma, often presents as a little mushroom or tree-like structure growing out from the bladder lining. The odds are pretty good that something like this is malignant. Your urologist has had a LOT of experience looking at these critters!! Of course, he could be wrong. Only the results of the TURB will tell the true story….is it cancer and what grade/stage (how fast it might grow and how far has it gone so far.)
CT scans are one way of finding abnormalities, but as you have discovered they are not omnipotent. Neither are urine cytology tests or the urologist’s eyes. The only way to know for sure what is there to to look at it directly, remove it, and send it to the pathology lab for analysis.
IF you should have bladder cancer, it is very likely that it was found early. Many of us here on the Forum have had this diagnosis and have been doing fine. I was diagnosed almost 11 years ago (high grade, non-invasive) and following treatment have had no recurrences or problems. You can do this too!!
Sara Anne

Ask the experts

What is a lesion in the bladder?

Doctor’s response

A lesion in the bladder is a general term that describes some abnormality that occurs in the bladder, the hollow container that holds urine until it’s ready to be expelled from the body. The key to understanding the question is the definition of a “lesion”. Various lesions may range from benign to serious.

A lesion is a region in organ or tissue (in this case, the bladder) that is suffer damage through such mechanisms as follows:

  • Injury (for example penetrating trauma from a car accident),
  • Disease (cancer that has spread to other organs to the bladder,
  • ulceration (anything that causes loss of bladder tissue thickness such as bladder cancer),
  • infection (bladder infections that can be caused by bacteria or other pathogens),
  • and/or tumor formation (mass formation of abnormal bladder tissue that is usually cancerous).

Consequently, if you are told the you have a lesion in the bladder, your doctor or your team of doctors needs to be more specific and define to you what they mean by the term “lesion”. Alternatively, it is possible that your doctor discovers a lesion during diagnostic testing. In some instances, your doctor or biopsy results sent to your doctor from a pathologist will further define the nature of the bladder lesion.

Treatment of any bladder lesion is usually determined by the underlying mechanisms that caused the lesion. For example, penetrating to the bladder may involve surgery whereas infection may require specific antimicrobial treatments. You and your doctors need to discuss what treatment protocol is best for your individual circumstance.

For more information, read our full medical articles on bladder cancer and bladder infection signs, symptoms, treatment, and prognosis.

Are Bladder Polyps a Serious Health Risk?

Q1. My husband has three polyps in his bladder. Are they dangerous, even if they turn out not to be cancerous? If he has them removed, what will the surgery entail?

— Linda, Kansas

Most polyps in the bladder are actually bladder cancers. The majority of bladder cancers are noninvasive lesions that protrude into the hollow of the bladder on stalks, like a cauliflower. Bladder tumors are identified by cystoscopy, whereby a scope is passed up the urethra into the bladder to allow for visual inspection of the inside of the bladder. This is usually performed in the urologist’s office. Treatment involves “transurethral resection” — in simple terms, the doctor scrapes out the tumors with a cautery instrument for pathological examination. The procedure is usually an outpatient surgery, with possible limited hospitalization to obtain tissue for diagnosis and to attempt further treatment. In many cases, resection of the tumors will be the main surgical treatment of a bladder tumor. Additional treatments may involve installation of chemotherapy or immunotherapy agents in the bladder.

A smaller subset of bladder cancers consists of tumors that are invasive. While they may have the appearance of polyps, they invade into the deep muscle of the bladder wall. In these instances, if biopsies confirm the invasive nature of the tumors, surgical removal of the bladder may be necessary. Noninvasive bladder cancers, if they are not removed, can progress to become invasive.

Excellent treatments exist for all stages of bladder cancer, and thus timely evaluation and treatment are important.

Q2. My doctor is testing me for flank pain. What is flank pain, what causes it, and what would prompt him to look for it?

— Lonny, Florida

Flank pain occurs in the kidney region in the middle to lower back, and typically it is felt in an area that stretches from the lower ribs in the mid back below the shoulder blade around to the front of the abdomen. Flank pain is often the result of a kidney abnormality, such as a stone, an obstruction, a tumor, or an infection. The first steps in evaluating flank pain are a physical examination and urinalysis. Other tests may be needed after this. Only rarely will the physical exam find signs of a kidney mass, for instance. If the urinalysis shows blood in the urine, this would be an indication that further radiographic studies are needed to evaluate the kidneys.

Learn more in the Everyday Health Bladder Cancer Center.

Transitional cell carcinoma (urinary bladder)

Transitional cell carcinoma (TCC) is the most common primary neoplasm of the urinary bladder, and bladder TCC is the most common tumor of the entire urinary system.

This article concerns itself with transitional cell carcinomas of the bladder specifically. Related articles include:

  • general discussion: transitional cell carcinoma of the urinary tract
  • TCCs in other locations:
    • transitional cell carcinoma of the renal pelvis
    • transitional cell carcinoma of the ureter
  • other histologies:
    • squamous cell carcinoma of the bladder
    • adenocarcinoma of the bladder

On this page:

Epidemiology

Epidemiology of transitional cell carcinomas of the bladder is similar to those of the rest of the urinary tract: please refer to urinary tract TCC for further details.

Clinical presentation

Hematuria is the most common presenting complaint, which may be macroscopic or microscopic. A tumor located at the vesicoureteric junction may result in ureteral obstruction and hydronephrosis, which may present with flank pain. Additionally, a tumor near the urethral orifice may result in bladder outlet obstruction and urinary retention.

Occasionally patients only present once systemic symptoms of a metastatic disease are present.

Diagnosis and local tumor staging are, usually, achieved with cystoscopy and full-thickness biopsy 4.

Pathology

As is the case elsewhere along the urinary tract, transitional cell carcinomas of the bladder fall into two broad groups 4:

  • superficial: 70-80%
    • most are papillary 70%
    • high-grade carcinoma in situ: 30% (see TCC grading)
  • invasive: 20-30%
Location

The bladder is by far the most common site of transitional cell carcinomas, 50 times more common than TCC of the renal pelvis, and 100 times more common than TCC of the ureter 1. Bladder TCCs are the most common tumor of the entire urinary tract.

There is a known association of TCCs developing within bladder diverticula, presumably due to urinary stasis which leads to chronic urothelial irritation and potentially the exaggerated exposure to urinary carcinogens 10-12.

Risk factors
  • cyclophosphamide (a chemotherapy agent) increases the risk of bladder transitional cell carcinoma with a dose-response pattern 8
  • aromatic amines in tobacco smoke
  • arylamines used in rubber and plastic manufacturing
  • polycyclic aromatic hydrocarbons in industrial combustion processes (such as smelting)

Radiographic features

Imaging of bladder transitional cell carcinomas has a number of roles:

  • incidental discovery of the tumor
  • tumor staging (see staging of transitional cell carcinoma of the bladder)
    • tumor staging of locally advanced masses
    • evaluation of distant metastases and nodal status
  • surveillance
Ultrasound

Ultrasound has a limited role to play in either diagnosis or staging transitional cell carcinomas of the urinary tract in general.

CT

Bladder transitional cell carcinomas appear as either focal regions of thickening of the bladder wall, or as masses protruding into the bladder lumen, or in advanced cases, extending into adjacent tissues. Care should be taken in assessing bladder wall thickness as this changes with the degree of bladder distension and varies from patient to patient, e.g. patients with bladder outlet obstruction due to benign prostatic hypertrophy. In general, however, asymmetric mural thickening should be viewed with suspicion.

The masses are of soft tissue attenuation and may be encrusted with small calcifications.

Although unable to distinguish between T1, T2 and T3a (microscopic extravesical spread), CT is able to distinguish T3b tumors (stranding/nodules in perivesical fat) and T4 tumors (direct extension into adjacent structures/loss of normal fat plane) 4.

Care should be exercised when interpreting stranding or nodularity following transurethral resection or even biopsy, as these changes may be postoperative 4.

Nodal metastases are common, seen in 30% of T2 tumors and 60% of T3 and T4 tumors 4.

CT or conventional urography

Urography’s primary role is in the assessment of the remainder of the urinary tract for transitional cell carcinomas of the renal pelvis or ureter.

When tumors are large and of papillary morphology, contrast filling the interstices between papillary projections can lead to a dappled appearance referred to as the stipple sign 2.

MRI

MRI is superior to other modalities in locally staging the tumor and is in some instances able to distinguish T1 from T2 tumors on T2 weighted images.

  • T1: isointense compared to muscle 4
  • T2
    • slightly hyperintense compared to muscle
    • useful in determining the low signal muscle layer and its discontinuity when muscle wall invasion
  • T1 C+ (Gd): shows enhancement
PET

Unfortunately, FDG is excreted into the urine and thus accumulates in the bladder, making it unsuitable for diagnosis of urinary tract tumors. It does have a role to play in the assessment of nodal or distant metastases.

Treatment and prognosis

Treatment is strongly influenced by tumor stage.

Superficial tumors can be treated with local transurethral resection +/- intravesical therapy. Ta tumors can be treated solely by resection. Carcinoma in situ or T1 tumor usually requires both resection and intravesical therapy (bacille Calmette-Guerin (BCG) or chemotherapy, e.g. mitomycin C) 6.

Invasive tumors require radical cystectomy +/- chemotherapy and/or external beam radiotherapy 5.

A critical part of the management of patients with TCCs is an awareness of the high rate of recurrence due to field effect on the entire urothelium. Approximately 2-4% of patients with a bladder TCC will go on to develop one or more TCCs of the renal pelvis or ureter 3,4.

Superficial tumors (which account for 70-80% of all cases) although having in themselves excellent prognosis, with almost no risk of metastases, have a predilection for recurrence (70% recur within 3 years) and these recurrences are more likely to be invasive. This is especially the case with carcinoma in situ 4.

Invasive tumors, on the other hand, have poorer prognosis demonstrating both local invasions of perivesical tissues, lymphatic spread to local nodes and eventual haematogenous metastases 4.

Overall bladder transitional cell carcinomas have a 5-year survival of 82%, contributed mainly by the large proportion of superficial tumors (5-year survival of 94%). Patients with metastatic disease, in contrast, have a poor prognosis (5-year survival of 6%) 4.

Differential diagnosis

General imaging differential considerations include:

  • other bladder tumors / bladder cancers
  • squamous cell carcinoma of the bladder
  • adenocarcinoma of the bladder
  • benign prostatic hypertrophy/prostate cancer
  • ureteric jets may simulate a filling defect

Bladder cancer

  • after having tests that have shown a bladder tumour
  • You usually have it under general anaesthetic, which means you are asleep. In some hospitals, you may have a spinal anaesthetic instead of a general anaesthetic. This is an injection into your spine (epidural) so you can’t feel anything from below your waist.

    This treatment takes between 15 to 90 minutes.

    How you have it

    The surgeon puts a thin rigid tube called a cystoscope into your urethra.

    The cystoscope has optic fibres inside it, a light, camera and eyepiece at one end. The surgeon can look through the eyepiece or see images on a TV screen.

    The surgeon passes small instruments down the cystoscope to cut any tumours out of your bladder lining.

    What happens

    You usually have this at the hospital in the day surgery unit. You might go home on the same day of your operation. But sometimes you have to stay in overnight or for a couple of days.

    Before the operation

    A nurse usually sees you in pre-assessment clinic a week or two before surgery.

    They’ll take some measurements (weight, temperature, heart and breathing rate, oxygen levels and your blood pressure).

    You might have a blood test, chest x-ray and ECG. This is normal for anyone having a general anaesthetic.

    The nurse gives you instructions about the operation and what to bring on the day. It’s a good idea to bring an overnight bag. They’ll also tell you when to stop eating or drinking.

    For a general anaesthetic, you usually have to stop eating at least 6 hours beforehand. And you can drink sips of water up to 2 hours before.

    When you arrive

    On the day of your operation you’ll see the surgeon who will explain the procedure and ask you to sign a consent form. This is a good time to ask any questions.

    You’ll also meet your anaesthetist who will get you to sleep and look after you while you’re asleep.

    The nurse gives you a hospital gown to change into. So you need to remove all your clothing.

    Your surgeon may put a dye into your bladder an hour before your surgery. The dye is sensitive to light. During the surgery they shine a blue light on the bladder lining. This is called photodynamic diagnosis (PDD). It can help to show up areas of cancer more clearly.

    The nurse and porter take you to the anaesthetic room on a theatre trolley.

    You usually have a small tube put into your vein (cannula) before you have the anaesthetic. This is so they can give you medicines directly into your vein. Most hospitals also give you an injection of antibiotics before the procedure.

    The operation

    Once you are asleep or the spinal anaesthetic is working your surgeon passes the cystoscope into your urethra.

    They use the cystoscope to look at the inside of your bladder. They also pass small instruments down the cystoscope. They use these instruments to remove any tumours. They then use a probe to seal (cauterise) the area to stop any bleeding.

    Cystoscopy for a man

    Cystoscopy for a woman

    Chemotherapy

    Usually you have a dose of chemotherapy into the bladder at the end of your operation. Or you may have it when you return to the ward. You have it within 6 hours of having the operation.

    This is to help stop the bladder cancer from coming back and get rid of any cancer cells that may have been left behind.

    After surgery

    You go to a recovery area to rest after an anaesthetic. Your nurse monitors you and takes regular measurements until you wake up from the anaesthetic properly.

    You can eat and drink normally.

    You may have a tube into your bladder (catheter) to drain urine into a bag for a short time. The nurse removes it before you go home.

    You may see blood in your urine. This might last for up to 3 days. This won’t mean you can’t go home.

    You may notice some bleeding 10 to 14 days after the operation. Do not worry about this it can be normal. Drink plenty but if it doesn’t stop within 24 hours call your advice line.

    Your doctor asks you to drink lots of fluids, to flush out your bladder. This helps to protect you from getting a urine infection.

    When you first start passing urine it may burn and sting for several days. You’ll be given painkillers to help make this more comfortable.

    If you’re having a general anaesthetic you’ll need someone with you so they can take you home and stay with you overnight. Also for 24 hours after you shouldn’t drive, drink alcohol, operate heavy machinery or sign any legally binding documents.

    Possible risks

    A TURBT is a safe procedure. Your nurse will tell you who to contact if you have any problems after your TURBT. Your doctors will make sure the benefits of having a TURBT outweigh any possible risks.

    Some possible risks include:

    Bleeding

    You should contact the hospital immediately if:

    • the bleeding is getting worse
    • there are blood clots in your urine
    • you have severe pain when passing urine
    • you can’t pass urine and have severe pain

    Infection

    There is a risk of infection. Symptoms can include:

    • going to the toilet more often
    • burning and stinging when passing urine
    • high temperature
    • feeling hot and cold or shivery
    • cloudy or offensive smelling urine
    • generally feeling unwell

    Contact your doctor as you might need antibiotics to treat an infection.

    Damage or injury to the bladder

    Rarely, there can be a small tear (perforation) of the bladder or it may be injured. It’s likely this will settle with a catheter for a few days to rest the bladder. Very rarely you may need surgery to help fix this problem.

    Bruising and swelling

    You might get a small bruise around the area where they put the needle in for the cannula.

    There’s is a risk that the anaesthetic or antibiotics will leak outside the vein. This can cause swelling and pain in your arm but it’s rare.

    This information will help you get ready for your cystoscopy (sis-TOS-koh-pee) and other related procedures at Memorial Sloan Kettering (MSK). It describes cystoscopies done in the operating room.

    Back to top Arrow (up) icon.

    About Your Cystoscopy

    A cystoscopy is a procedure that lets your doctor look at your urethra, bladder, and the openings to your ureters (the tubes that carry urine from your kidneys to your bladder) (see Figure 1). It’s done to look for problems in your urinary tract and bladder, such as a blockage in your urethra or tumors in your bladder.

    Figure 1. Female urinary system (left) and male urinary system (right)

    A cystoscopy is done using a thin, hollow, lighted tool called a cystoscope. Your doctor will put the cystoscope into your urethra and slowly move it into your bladder. Small surgical tools can be put through the cystoscope to remove stones, fulgurate (burn off) small growths, or take small samples of tissue for a biopsy.

    Other procedures

    During your cystoscopy, you may also have 1 or more of the following procedures:

    • Transurethral resection of a bladder tumor (TURBT)
      • During a TURBT, your doctor will remove a bladder tumor using a tool that goes through the cystoscope.
    • Ureteroscopy (YER-eh-ter-OS-koh-pee)
      • During a ureteroscopy, your doctor will put a thin tool called a ureteroscope through your urethra, bladder, and ureter. This procedure is done to see if there’s anything blocking or getting in the way of the flow of urine.

      Figure 2. Parts of your kidney

    • Retrograde pyelogram
      • During a retrograde pyelogram, small, thin, catheters (flexible tubes) are guided up to your kidneys through your ureters. Contrast media is injected through the catheters into your kidneys. Then, x-rays are taken of your renal pelvis and ureters (see Figure 2). The contrast media makes these areas stand out so your doctor can see them better.
      • This procedure is done to see if there’s anything blocking or getting in the way of the flow of your urine.
    • Removal of stones or blood clots from your bladder
    • Placement, replacement, or removal of ureteral stents
      • The stents will keep your ureters open. That helps urine flow from your kidneys to your bladder. If your kidney function has improved, your doctor may decide to remove the stent(s) and you may not need a replacement.

    Back to top Arrow (up) icon.

    Before Your Procedure

    Ask about your medications

    Tell your doctor or nurse what medications you’re taking, including prescription and over-the counter medications, patches, creams, and herbal supplements. You may need to stop taking some of them before your procedure.

    If you take medication to thin your blood, such as to treat blood clots or to prevent a heart attack or stroke, ask the doctor who prescribes it for you when to stop taking it. Some examples are aspirin, warfarin (Coumadin®), dalteparin (Fragmin®), heparin, tinzaparin (Innohep®), enoxaparin (Lovenox®), clopidogrel (Plavix®), cilostazol (Pletal®), dabigatran (Pradaxa®), and apixaban (Eliquis®).

    Tell your doctor or nurse if you have had an allergic reaction to contrast media in the past.

    Arrange for someone to take you home, if needed

    If you’re having anesthesia (medication to make you sleep during your procedure), you must have a responsible care partner take you home after your procedure. Make sure to plan this before the day of your procedure.

    If you don’t have someone to take you home, call one of the agencies below. They will send someone to go home with you. There’s usually a charge for this service, and you will need to provide transportation.

    Agencies in New York Agencies in New Jersey
    Partners in Care: 888-735-8913 Caring People: 877-227-4649
    Caring People: 877-227-4649

    10 days before your procedure

    If you take vitamin E, stop taking it 10 days before your procedure. Vitamin E can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

    7 days before your procedure

    If you take aspirin, ask your doctor if you should keep taking it. Aspirin and medications that contain aspirin can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

    2 days before your procedure

    Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil®, Motrin®) and naproxen (Aleve®), 2 days before your procedure. These medications can cause bleeding. For more information, read Common Medications Containing Aspirin and Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs).

    Back to top Arrow (up) icon.

    The Day Before Your Procedure

    Note the time of your appointment

    A clerk from the Admitting Office will call you after 2:00 pm the day before your procedure. If your procedure is scheduled for a Monday, they will call you on the Friday before. If you don’t get a call by 7:00 pm, please call 212-639-5014.

    The staff member will tell you what time to arrive at the hospital for your procedure. They will also tell you where to go. This will be one of the following locations:

    • Presurgical Center (PSC) on the 2nd Floor
      1275 York Avenue (between East 67th and East 68th Streets)
      New York, NY 10065
      M elevator to the 2nd floor
    • Presurgical Center (PSC) on the 6th Floor
      1275 York Avenue (between East 67th and East 68th Streets)
      New York, NY 10065
      B elevator to the 6th floor

    Instructions for eating and drinking before your procedure

    • Do not eat anything after midnight the night before your procedure. This includes hard candy and gum.
    • Between midnight and up until 2 hours before your scheduled arrival time, you may drink a total of 12 ounces of water (see figure).
    • Starting 2 hours before your scheduled arrival time, do not eat or drink anything. This includes water.

    Back to top Arrow (up) icon.

    The Day of Your Procedure

    Things to remember

    • Take a shower with soap and water. You can brush your teeth and rinse your mouth.
    • Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne.
    • Don’t wear any metal objects. Remove all jewelry, including body piercings.
    • Leave valuable items (such as credit cards, jewelry, and your checkbook) at home.
    • Bring only the money you may want for small purchases (such as a newspaper).

    Where to park

    MSK’s parking garage is located on East 66th Street between York and First Avenues. If you have questions about prices, call 212-639-2338.

    To reach the garage, turn onto East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There’s a tunnel that you can walk through that connects the garage to the hospital.

    There are also other garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.

    What to expect

    Your nurse will start an intravenous (IV) line in your vein. The IV line will be used to give you anesthesia (medication to make you sleep) before and during your procedure.

    Once you’re asleep, your doctor will do the cystoscopy and any other procedures you’re having. They may put a urinary (Foley®) catheter into your bladder at the end of your cystoscopy to help drain your urine into a bag.

    Your procedure will take up to 1 hour.

    Back to top Arrow (up) icon.

    After Your Procedure

    In the hospital

    When you wake up, you will be in the Post Anesthesia Care Unit (PACU). A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels. They will also check your urine output to make sure your flow of urine isn’t blocked.

    You may still have the urinary catheter in your bladder. It may be removed before you’re discharged or a few days after your procedure.

    • If your catheter is removed before you go home, you must urinate before you’re discharged.
    • If you go home with the catheter in place, your nurse will show you how to care for it before you go home.

    Your nurse will explain your discharge instructions to you and your caregiver before you go home.

    At home

    • You may need to take medication(s) at home, such as antibiotics to prevent infection or medications to relieve discomfort. Follow the instructions your doctor gives you.
    • Don’t drive for 24 hours after your procedure.
    • Ask your doctor or nurse when you can go back to work.
    • Drink 8 (8-ounce) glasses of liquids every day for the first 2 weeks after your procedure. Avoid drinking liquids after 8:00 pm so that you don’t have to go to the bathroom during the night.
    • Be sure to get plenty of rest.

    Changes when you urinate

    You will most likely have blood in your urine (hematuria) after your procedure. This should go away within 1 week.

    You may also urinate more often than usual and have pain or burning when you urinate. These symptoms can last for 3 to 4 weeks, but they should slowly get better as you heal. Drinking lots of liquids will also help.

    If these changes don’t get better or if they get worse, call your doctor. You may have a urinary tract infection (UTI).

    Urinary catheter

    You may feel a strong urge to urinate while the catheter is in place. This happens because the small inflated balloon that keeps it in place may make your bladder feel full. Relaxing and letting the urine flow will decrease this urge.

    Biopsy or tumor removal

    If you had a biopsy or a tumor removal, you will have a scab inside your bladder. The scab will loosen within a month. If it loosens before the wound is completely healed, it may cause bleeding. If this happens, rest and drink more liquids. Most bleeding will stop within 3 to 4 hours, but it’s best to rest that day to help stop the bleeding.

    Call your doctor if the bleeding doesn’t stop or if you can’t urinate.

    Urinary stents

    • You may feel the stents. They usually feel like pain in your kidney (your side or middle to upper back). The pain may be worse when you urinate or exercise. Your doctor may give you medication to help with the pain.
    • Drink plenty of liquids while you have the stents.

    Activity

    • If you need to go on car trips that are longer than 1 hour for 1 week after your procedure, talk with your doctor or nurse.
    • Don’t lift objects heavier than 10 pounds (4.5 kilograms) for 2 weeks after your procedure.
    • Don’t do strenuous exercise, such as tennis, jogging, or exercise programs, for 2 weeks after your procedure.
    • You can walk and climb stairs right away after your procedure.

    Follow-up care

    If you had ureteral stents placed during your procedure, call your doctor’s office to schedule a follow-up appointment. The stents will need to be changed every 3 to 6 months, or as instructed by your doctor.

    Back to top Arrow (up) icon.

    Call Your Doctor or Nurse if You Have:

    • Continuous bright red blood or blood clots in your urine
    • Bleeding (pink urine) for more than 1 week that isn’t getting better
    • Pain or burning when you urinate for more than 3 days that isn’t getting better
    • Frequent urination for more than 3 days that isn’t getting better
    • A fever of 101 °F (38.3 °C) or higher
    • Shaking chills
    • Pain in your lower back
    • An inability to urinate

    Back to top Arrow (up) icon.

    A polyp is an abnormal growth of tissue projecting from a mucous membrane. Bladder polyps, in particular, are becoming more of an issue for medical professionals. Polyps in the bladder are suspected to be associated with lifestyle choices such as smoking or exposure to harmful chemical elements, but the cause of bladder polyps is not known. A certain parasitic infection called schistosomiasis has been discovered to be associated with the development of bladder polyps, which result from parasitic eggs released into the bladder wall tissue, leading to polyp formation. Men are afflicted more often by bladder polyps, generally being diagnosed after the age of 55.

    How are the bladder polyps found?

    A combination of contributing factors increases a person’s predisposition to bladder polyps. Chronic inflammatory disorders along with genetic variants increase the chances for their development. Those with a family history of bladder polyps are more likely to develop them themselves.

    Bladder infections such as chronic cystitis result in the urinary tract system becoming chronically inflamed. The condition leads to a proliferation of the mucosal lining of the bladder, cause it to bulge into the bladder cavity in the form of a polyp. While this does not occur in all cases of chronic cystitis, when the conditions are right and the genetics of the person support polyp development, it’s common.

    Bladder polyps come in different sizes, ranging from a few millimeters to several centimeters in diameter. Polyps appear in several ways, but most look like an abnormal growth of tissue attached to the surface of a tissue lining by a stalk or a peduncle. Polyps can form in other places besides the bladder, including the colon, stomach, nose, ear, and uterus.

    In the majority of patients with bladder polyps, symptoms are not present in the early stages. However, a common symptom is the presence of blood in the urine. If this symptom occurs, it will often lead to further investigation to help identify the cause. Other possible symptoms include increased frequency of urination and pain while urinating.

    Diagnosing and treating bladder polyps

    When seeing your physician for a suspected problem with urination, such as increased frequency or bloody urine, the most common test to do will be a urinalysis. This will help the doctor determine where the red blood cells could possibly be coming from and to rule out any possible cause of infection.

    In a case where bladder polyps are the cause of symptom presentation, the next step for diagnosis would be getting an ultrasound. This is a procedure where sound waves at the upper limit of human hearing are used to measure distances. Ultrasound imaging can be used to see if any abnormalities in urinary tract structure are present, such as polyps.
    Once polyps have been seen on imaging studies, further testing is still warranted. This often comes in the form of endoscopic examination of the bladder, or cystoscopy. This test involves the use of a very small camera at the end of a tube to be inserted into the bladder. This will give a direct image of the mucosal lining.

    This will have the doctor determine the size and appearance of any growth found within. Often times, the endoscopic tube is equipped with a decisive that is able to retrieve tissue or a biopsy for diagnostic testing. A biopsy will give conclusive results if the growth is cancerous or not.

    If the polyp is indeed found to be cancerous, it may be removed entirely though cystoscopy as part of a bladder polyp removal procedure. Chemotherapeutic agents may also be employed to aid in cancer treatment. If polyps in the bladder are identified at a later stage, cancer may have already spread to distant muscle and tissue that surrounds the bladder, with surgical removal of the bladder possibly being necessary.

    Related: What is an enlarged bladder? Causes and symptoms

    About the author

    Leave a Reply

    Your email address will not be published. Required fields are marked *