What causes bladder cancer is not always clear, but the risk of developing bladder cancer increases with smoking, age, long term bladder problems and unsafe exposure to some industrial chemicals. Bladder tumours usually form in cells lining the bladder. Once a tumour begins to enlarge, it may stay in the lining or grow into the wall of the bladder. If untreated, the tumour may then grow into other structures such as lymph nodes. If the cancer enters the bloodstream it may spread to other areas of the body (metastasis). Often the first symptom noticed is blood in the urine. Other symptoms such as needing to pass urine more often or feeling as if you need to go but can’t, affect about 1/3 of people with early bladder cancer. As the tumour grows these symptoms affect more people. The first test to diagnose bladder cancer is usually a urine sample. The next step is usually a cystoscopy (a tube to allow the doctor/ nurse specialist to look inside the bladder). If there is a tumour a small sample (biopsy) may be taken for testing. An ultrasound scan of the urinary tract may also be organised. CT or MRI scans are also used to scan the body to see if the cancer has spread to other areas. Treatment depends on the size of the tumour and how much it has grown into the bladder wall. Surgery may be considered especially if the tumour is still small. The surgeon can insert a cystoscope through the urethra and cut out the tumour (TURBT) or burn it away (Cystodiathermy). As part of the operation the surgeon may instill a chemotherapy medicine (Epirubicin) into the bladder for one hour. A single epirubicin bladder treatment at the time of surgery has been shown to increase the length of time between bladder tumour recurrences. Following Cystodiathermy or TURBT a patient is placed on a regular programme of cystoscopy surveillance at an outpatient clinic. This is to ensure that any recurrence of bladder tumours are detected early, while they are small. If the tumour has grown more deeply into the bladder wall, the surgeon may perform an operation to remove some or the entire bladder (a partial or full cystectomy). If the whole bladder is removed, an artificial bladder will be created on the inside or a urostomy bag on the outside. Radiation therapy (a high energy X-ray beam) can be used as the main treatment in some people. In others it may be used after surgery to remove any remaining cancer cells. In early cancer, drugs (chemotherapy) or another treatment called Bacille Calmette-Guerin (BCG) may be placed directly into the bladder to kill cancer cells (intravesical treatment). BCG is a vaccine used to prevent tuberculosis but it is also used in the treatment of bladder cancer. The usual situation however is that chemotherapy is used in the later stages of cancer. Chemotherapy can attack cancer cells throughout the body (not just the bladder) and help prevent the cancer spreading. TURBT (PDF, 906.9 KB)

This procedure involves the insertion of a scope into the bladder under local anaesthetic. This allows the doctor or nurse specialist to examine the lining of the (urethra) water pipe and bladder, as well as the prostate in men. The procedure only takes a few minutes and no special preparation is needed. Flexible Cystoscopy (PDF, 110.7 KB)

This term means blood in the urine and may be the result of inflammation or other problems with your kidneys, blockages in your ureter, infection or other problems with your bladder or problems with your prostate. Haematuria can be termed Macroscopic Haematuria (if blood can be seen in the urine when it is passed from the bladder) or Microscopic Haematuria (when the blood in the urine is not visible to the naked eye, but red blood cells can be seen under the microscope in the laboratory). Patients referred with both microscopic and macroscopic haematuria will be posted a Cx Bladder Triage urine test request form to take to Labtests within 30 days of referral. An appointment will also be arranged for a renal tract ultrasound scan (scan of kidneys and bladder (plus prostate in men) . The Cx Bladder Triage urine test and ultrasound scan results will be checked by a senior urology nurse in the urology department. The patient will be informed of the results and notified if any further action is required. Haematuria Investigations (PDF, 231.1 KB)

This term refers to stones in the urinary system. They form in the kidneys but can be found anywhere in the urinary system. They vary in size and the amount of pain they cause. Many of these stones can pass though without help but some require medical intervention. Extracorporeal shockwave lithotripsy (ESWL) is the most frequently used procedure for the treatment of kidney stones. In ESWL, shock waves that are created outside the body travel through the skin and body tissues until they hit the denser stones. The stones break down into very small particles and are easily passed through the urinary tract in the urine. Kidney Stones Information Sheet (PDF, 177.3 KB)

In this procedure the doctor passes an ultrasound probe into the back passage. The prostate can then be viewed as an ultrasound image. This image will guide the doctor in taking samples of the prostate with a biopsy needle placed alongside the ultrasound probe. It is important to read the information sheet sent prior to the appointment and to take the antibiotics that are prescribed as instructed. WDHB Urology asks men to present to a nurse led clinic a few weeks prior to their planned prostate biopsy. At this appointment men are educated about the prostate biopsy process and a short health history is taken. The clinic nurse will also gently insert a laboratory 'swab' just inside the man's back passage to take a sample of the bacteria living in his bowel. The results of this swab will enable the doctor / nurse practitioner to prescribe the most appropriate antibiotic for the man to take prior to his prostate biopsy. Prostate Biopsy Procedure Information (PDF, 242.6 KB)

Prostate cancer typically consists of many, very small, tumours within the prostate. At this stage, the disease is often curable (rates of 90% or better) with standard treatments such as surgery or radiation. Unfortunately, at this stage the cancer produces few or no symptoms and can be difficult to detect. If untreated and allowed to grow, the cells from these tumours can spread to other parts of the body in a process called metastasis. Once the cancer has spread beyond the prostate, cure rates drop dramatically. In most cases, prostate cancer is a relatively slow-growing cancer, which means that it typically takes a number of years for the disease to become detectable, and even longer to spread beyond the prostate. However, a small percentage of patients experience more aggressive forms of prostate cancer. Treatments options for prostate cancer include active surveillance, surgery, radiation, hormone treatment and chemotherapy. Which treatment is chosen depends on factors such as the stage of the cancer and the patient’s age, other health issues and willingness to undergo certain procedures or therapies – some of which may have side effects. Active Surveillance (PDF, 308.3 KB) Radical Prostatectomy (PDF, 1,001.6 KB)

This is the term used to describe inflammation of the prostate gland. Symptoms can include increased need to pass urine and pain on passing urine as well as perhaps lower back pain. Sometimes this inflammation is due to an infection and an antibiotic will be prescribed, otherwise pain relief medication may be prescribed. Prostatitis (PDF, 199.3 KB)

A UTI is caused by an infection in the urinary tract. Women get UTIs more often than men. UTIs are treated with antibiotics. Drinking lots of water also helps by flushing out the bacteria. If the infection is in the bladder it is called cystitis. If the infection is in the kidneys it is called pyelonephritis.

Urodynamic tests measure the storage of urine in the bladder and the flow of urine from the bladder through the urethra. Your doctor may want to do an urodynamic test if you are having symptoms that suggest problems with the muscles or nerves of your lower urinary system and pelvis. Urodynamic Study (PDF, 186.5 KB)

Urinary incontinence or loss of bladder control is the involuntary passage of urine (passing urine without meaning to). There are many causes and types of incontinence, and many treatment options. Women are affected by urinary incontinence more often than men. Treatment ranges from simple exercises to surgery. Suburethral Sling for men (PDF, 708.7 KB)

Urinary retention, or abnormal holding of urine in the bladder, is a common urological problem. Possible causes of acute urinary retention (sudden inability to urinate) include a blockage in the urinary system, stress or nerve problems. Chronic urinary retention (some urine is always left in the bladder after emptying) may be caused by bladder muscle failure, nerve damage, or obstructions in the urinary tract. Treatment for urinary retention depends on the cause.

This test involves passing urine into a special machine which measures the speed of the urine flow and graphs it for assessment by the doctor or nurse. You will be able to pass urine into the machine in private for this test. A flowrate needs to be performed when you have a full bladder so you can either come to your appointment with a full bladder or come early to drink in preparation. Flowrate test (PDF, 177.2 KB)