Hydrodistention of the Bladder & Biopsy
Hydro = water
Distention = to stretch by filling
Biopsy = to take a sample of tissue for analysis by a pathologist
This procedure can be both diagnostic (helping to make a diagnosis) as well as therapeutic(resulting in treatment or relief). In short, your bladder will be filled with water so that we can examine the inner bladder wall appearance after it has been distended. One or a few small biopsies may also be taken from the wall of the bladder.
The purpose of this procedure is to help diagnose a condition known as interstitial cystitis(IC). This condition may present with one or a combination of pelvic pain, urinary frequency and nocturia (getting up at night to urinate), and urgency (strong sensation or urge to urinate).Although far more common in women, we are now realizing that some men, once thought to have chronic prostatitis (inflammation of the prostate) or prostadynia (chronic pelvic pain),may have IC. This disease complex in both women and men is not fully understood, and has been categorized as "chronic pelvic pain syndrome" or CPPS.
Interstitial cystitis is thought to be due to a breakdown of a specialized protective coating lining the inner wall of the bladder. In the absence of this glycosaminoglycan (GAG) layer, the urine can leak in between the cells and cause irritation, inflammation, and pain. A careful history, physical examination, and urine tests are very important in excluding other problems that may present with similar symptoms. If there is a strong suspicion of IC, we may then suggest this procedure.
When we distend the bladder, we look for specific changes in the wall that we can see through a small telescope termed a cystoscope. A biopsy may be taken to rule out abnormalities in the bladder. Because patients with IC usually have a small capacity bladder (one that holds only small volumes), distention of the bladder can temporarily, and rarely permanently alleviate some of the urinary frequency and even some of the pain.
As with any procedure in which anesthesia is administered, you will be asked not to eat or drink anything after midnight on the evening prior to your procedure. You may brush your teeth in the morning but not swallow the water. If you are on medications that must be taken, you will have discussed this with us and/or the anesthesiologist and instructions will have been given to you. The procedure will not be performed if you are currently taking, or have recently taken any medication that may interfere with your ability to clot your blood ("blood thinners, aspirin, anti-inflammatory medicines, etc...").
The most common of these medications are aspirin and all related pain relievers or anti-inflammatory compounds (whether prescription or over-the-counter). Please refer to the attached list and tell us if you took any of these within the past seven days.
If your new medication is not on the list, alert us immediately so that we may ensure optimal procedure safety. We will have reviewed all of your current medications with you during thepre-operative/pre-procedure consultation. You are obligated to inform us if anything has changed (medication or otherwise) since your previous visit.
To review the basics of what we discussed in the office: A hydrodistention is done under general anesthesia (complete sleep). It can also be done with a spinal. The actual procedure usually takes less than 30 minutes. You will be placed lying down on your back with your legs gently elevated in holsters (called stirrups). The cystoscope (which has continuous fluid running through it) is inserted into the urethra and into the bladder. We examine the bladder to evaluate the walls prior to distention. Fluid is then run through the scope until the bladder is distended to a specifically calculated pressure. Once filled, we allow the fluid to remain in the bladder for a specific time. The bladder is then drained. After drainage, we begin to slowly fill the bladder again while examining the bladder to look for specific abnormalities in the appearance of the walls. With the bladder minimally full, we may then take one or a few biopsies. The biopsy areas may then be cauterized (burned) so that they do not bleed. The bladder is carefully inspected once again and emptied. The scope is removed and the procedure is over.
You will be in the recovery room for a short time before being discharged home. You may feel a strong sense of urgency to urinate even though your bladder is empty. It is also common to feel pressure in the pelvis. Patients may have no blood in the urine, mild blood, or even a significant amount of blood or small clots. It is rare for the blood to not disappear within a few days. You will be discharged home with your usual medications, possibly a short antibiotic course (if indicated) and perhaps a pain medication. You may take an over-the-counter pain medication (to which you are not allergic) instead of the prescription pill if your discomfort is only mild or moderate.
Expectations of Outcome
As mentioned earlier, this procedure is both diagnostic and perhaps therapeutic. We can tell you what we observed visually in the bladder when we see you in the recovery area, but it will take up to a week before we have the results of the biopsy (if taken).
With regard to your symptoms, anything is possible after this procedure. You may feel a sense of relief (that can persist for days, weeks, or even months; longer), you may notice no change, or your symptoms can be made more severe from the trauma to the bladder. In these instances, the increase is almost always temporary, and the symptoms dissipate over the next fibroglandular elements days. They may return to your baseline or you may notice significant relief.
Many patients who have this procedure done with noticeable symptomatic relief will usually elect to have it repeated in the future. A biopsy is not necessary in repeat procedures because the diagnosis may already have been established.
Possible Complications of the Procedure
ALL surgical procedures, regardless of complexity or time, can be associated with unforeseen problems. They may be immediate or even quite delayed in presentation. While we have discussed these and possibly others in your consultation, we would like you to have a list so that you may ask questions if you are still concerned.
Aside from anesthesia complications, it is important that every patient be made aware of all possible outcomes which may include, but are not limited to:
- Hematuria/Clot Retention: As we distend the bladder, blood vessels in the bladder wall are stretched and can tear. We expect this finding in those who are found to have IC. In these patients, we almost always note some minor oozing of blood. As mentioned, the blood almost always disappears within a few days. Rarely, some of the veins can continue to ooze or a scab of a biopsied area can fall off and cause recurrent hematuria (blood in the urine). In most cases, we can observe, and the bleeding eventually stops. If clots form, it can block the flow of urine and we may consequently need to irrigate out the clots through a catheter. In unusual circumstances, we may have to return to the operating room to put the scope back inside and remove the clots and possibly cauterize the vessels.
- Urinary Tract Infection or Urosepsis (Bloodstream Infection): Following any procedure, it is possible for you to get an infection with bacteria that typically cause urinary tract infections (UTIs). It may be a simple bladder infection that presents with symptoms of burning urination, urinary frequency and a strong urge to urinate. This will usually resolve with a few days of antibiotics. If the infection enters the bloodstream, you might feel very ill. This type of infection often presents with urinary symptoms and any combination of the following: fevers, shaking chills, weakness or dizziness, nausea and vomiting. You may require a short hospitalization for intravenous antibiotics, fluids, and observation. This scenario is more common in diabetics, patients on long-term steroids, or in patients with disorders of the immune system.
*If you have symptoms suggesting any of the above after your discharge from the hospital, you must contact us immediately or go to the nearest emergency room.
- Urinary Retention: In men, pressure from the scope can occasionally cause swelling in large and/or obstructing prostates. It may block the flow of urine and cause "retention." In most circumstances, it resolves with a catheter over the next few days. Less commonly are medications or a prostate procedure required.
- Perforation: The wall of the bladder can be perforated during the distention and less commonly from the superficial biopsy. In most cases, all we need to do is leave the catheter in for an extra few days to allow self-healing. If the perforation occurs in a specific area of the bladder, we may need to perform a formal bladder repair through an incision in the abdomen, or place a drainage tube in the lower abdomen to evacuate this fluid.
We provide this literature for patients and family members. It is intended to be an educational supplement that highlights some of the important points of what we have previously discussed in the office.
Alternative treatments, the purpose of the procedure/surgery, and the points in this handout have been covered in our face-to-face consultation(s).
The information contained in this document is intended solely to inform and educate and should not be used as a substitute for medical evaluation, advice, diagnosis or treatment by a physician or other healthcare professional. While Delta Medix endeavors to ensure the reliability of information, such information is subject to change as new health information becomes available. Delta Medix cannot and does not guaranty the accuracy or completeness of the information contained in this document, and assumes no liability for its content or for any errors or omissions. Please call your doctor if you have any questions.
Delta Medix, P.C.