Cystoscopy

This is a procedure that allows the doctor to look inside your bladder with a telescope.  

Getting ready for the test:

• You may eat and drink normally before the test, if you are having a urodynamics test at the same time as the cystoscopy, please follow the instructions for fluid intake for the urodynamics test.
• If you have any symptoms of bladder infection before the test, please call and let your doctor know. Symptoms of bladder infection include: burning with urination, increased frequency of urination.  

During the test:

• The nurse will ask you for a urine sample to test for infection, if you have a bladder infection, the test may not be safe to perform. ·        
• You will be asked to undress from the waist down. You will be asked to lye down and the nurse will place a numbing gel on your urethra. ·        
• The doctor will gently insert the telescope into your bladder and fill your bladder with fluid. ·        
• The test takes approximately 10 minutes or less.  

Risks of the procedure:

• Risks are few, they include bladder infection, injury to the bladder or urethra       
• The doctor will discuss these risks with you prior to the procedure.

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Bladder Function Testing, also known as Urodynamics

This is a test that allows your doctor to evaluate your bladder function including how your bladder stores urine, if it leaks urine, and how it empties urine.  

Getting Ready for the Test:

• You do not have to fast for the test.        
• Drink 24-32 ounces of fluid 60-90 minutes prior to the test so you arrive with a full bladder. You should not be uncomfortable. If you have urinary urgency, you may adjust the amount of water and the time that you drink the water to suit the bladder.         
• Avoid drinks with caffeine on the day of your test (e.g. coffee, tea, and sodas).     
• Bathe or shower before your test.         
• A woman's menstrual cycle does not interfere with the test. You may wear a tampon.    
• If you currently wear a pessary for pelvic organ prolapse, please wear it to your appointment.         
• You may find it more comfortable if you have a bowel movement before the test. This is not essential.         
• Do not empty your bladder when you arrive at the office.
• Speak with a nurse if you feel you must empty your bladder.         
• If you are taking antibiotics for a urinary tract infection (UTI) or bladder infection, notify your physician's office immediately. We may reschedule your bladder test. ·        
• If you have symptoms of a urinary tract infection (UTI), please notify your physician's office immediately. We may reschedule your bladder test.       
• Bring a list of all prescribed and over-the-counter medications you are taking.         
• If you are taking overactive bladder medications like Detrol (Tolterodine), Ditropan (Oxybutynin), Vesicare (Solifenacin), Enablex (Darifenacin), Gelnique (topical Oxybutynin), Oxytrol (transdermal Oxybutynin), Sanctura (Trospium), Myrbetriq (Mirabegron), Toviaz (Fesoterodine) please discontinue for 3 days prior to testing.  

What Happens During the Test:

The nurse asks you about your symptoms and general health before starting the test.  

There are three phases to the test:  

Phase 1         

• You are asked to urinate into a container. The container is connected to a computer that records the speed and amount of urine you pass.  

Phase 2         

• A small catheter is inserted into your bladder and another small catheter is inserted into your rectum or vagina.        
• Your bladder will be slowly filled with sterile water and the nurse will ask you a series of questions while your bladder is being filled.
• This part of the test shows what happens in the bladder as it fills.

It measures: 

1. How much pressure there is
2. How much fluid you hold before you feel full            
3. How much your bladder can hold            
4. If you leak when you cough or bear down  

Phase 3          

• You are asked to urinate into a container.
• The catheter and rectal or vaginal catheter are removed when your test is finished.   

Follow this link for more information in English, click here.

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Percutaneous Tibial Nerve Stimulation (PTNS)  

Overactive bladder and urge urinary incontinence are common conditions that cause frequent urination, urgency to urinate, and urinary leakage with an urge to urinate. Peripheral tibial nerve stimulation (PTNS) is a nerve therapy that can help improve bladder control. The therapy is similar to acupuncture and is completed in the office. Therapy consists of twelve weekly appointments, if this is successful, you can continue the therapy monthly to maintain the improvement in bladder control.  

Getting Ready for the Procedure:

• You do not need to fast for the procedure.
• Bathe or shower before the procedure.
• Please notify your physician's office immediately if you have a skin infection or rash on your ankles. We may reschedule your procedure.

What Happens During the Procedure:

• At your first, sixth, and twelfth appointments, you will be asked to complete a questionnaire about your bladder symptoms.
• You will be seated in a comfortable chair.
• The inside of your ankle will be cleaned and a small needle will be inserted.
• The needle will be connected to a stimulating device to stimulate a nerve to help you better control your bladder.
• The treatment will be adjusted so that it is comfortable.
• The treatment will continue for thirty minutes.
• When the treatment is complete, the needle will be removed.

Risks of the Procedure:

• There is a small risk of discomfort during the treatment, the stimulation is adjusted to avoid this.
• You may experience bruising at the treatment site.

Follow this link for more information in English, click here.

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Bladder OnabotulinumtoxinA (Botox) Injection

Overactive bladder and urge urinary incontinence are common conditions that cause frequent urination, urgency to urinate, and urinary leakage with an urge to urinate. Injecting the bladder with onabotulinumtoxinA (Botox) partially paralyzes the bladder temporarily to treat these symptoms. It takes up to two weeks following injection for the medication to take effect.  

Getting Ready for the Procedure:

• You do not have to fast for the procedure.          
• Bathe or shower before your procedure.         
• If you are taking antibiotics for a urinary tract infection (UTI) or bladder infection, notify your physician's office immediately. We may reschedule your procedure.
• If you have symptoms of a urinary tract infection (UTI), please notify your physician's office immediately. We may reschedule your procedure.  

What Happens During the Procedure:

• The nurse will ask you for a urine sample to test for infection, if you have a bladder infection, the test may not be safe to perform.
• You will be asked to undress from the waist down.
• The urethra will be cleaned and a numbing jelly will be placed into the urethra and inside your bladder.
• Your doctor will gently insert a telescope into your bladder and inspect the inside of your bladder and urethra
• The medication is then injected into the wall of the bladder in 10-20 locations.
• The telescope is then removed and you will be asked to empty your bladder.

Risks of the Procedure:

1. Blood in the urine: this is normal for the first 24 hours following the procedure
2. Discomfort with urination: this is normal for the first 24 hours following the procedure, this is expected to be mild 
3. Urinary tract infection
4. Difficulty emptying your bladder: this is uncommon, it occurs in fewer than 10% of women. This may occur up to several weeks following the procedure.  

Follow this link for more information in English, click here.

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Urethral Bulking Procedure Instructions  

Stress urinary incontinence is a common problem caused by weakness in the pelvic floor muscles, the urethra, and supportive tissues. This causes urine leaking with coughing, sneezing, or other physical activity.  

Urethral bulking is one treatment option for stress urinary incontinence. Urethral bulking involves injecting a bulking agent around the urethra. This narrows the urethra, so leakage is less likely to occur.  

Getting Ready for the Procedure:

• You do not have to fast for the procedure.
• Bathe or shower before your procedure.
• If you are taking antibiotics for a urinary tract infection (UTI) or bladder infection, notify your physician's office immediately. We may reschedule your procedure.
• If you have symptoms of a urinary tract infection (UTI), please notify your physician's office immediately. We may reschedule your procedure.  

What Happens During the Procedure:

• The nurse will ask you for a urine sample to test for infection, if you have a bladder infection, the test may not be safe to perform.
• You will be asked to undress from the waist down.
• The urethra will be cleaned and a numbing jelly will be placed into the urethra.
• Your doctor may also inject numbing medication with a needle to make sure that you are comfortable during the procedure.
• Your doctor will gently insert a telescope into your bladder and inspect the inside of your bladder and urethra
• The medication is then injected around your urethra
• The telescope is then removed and you will be asked to cough to see if the medication works, additional injections may be placed, if needed
•  After the procedure, you will be asked to empty your bladder  

Risks of the Procedure:

1. Blood in the urine: this is normal for the first 24 hours following the procedure
2.  Discomfort with urination: this is normal for the first 24 hours following the procedure, this is expected to be mild
3. Urinary tract infection
4. Difficulty emptying your bladder: this is uncommon, it occurs in fewer than 10% of women  

Follow this link for more information in English, click here.

Follow this link for more information in Spanish, click here. 

Basic Nerve Test for Sacroneuromodulation  

Bladder and bowel control problems are often treated with behavioral changes and medications. If these therapies have not worked for you, you may be a candidate for sacral neuromodulation.

Sacral neuromodulation helps to restore normal communication between the bladder or the bowel and the brain to improve bladder and/or bowel control. The therapy is first tested with a basic nerve evaluation to determine if it is effective. If the therapy is effective, a small stimulator device is placed under the skin and a wire carries electrical impulses to the sacral nerves. The basic nerve test is the first step in determining if neuromodulation will work for you.  

What is a basic nerve test?  

This test is performed in the doctor's office and takes about 30 minutes. The skin is numbed in the upper buttock area and one or two thin temporary wires (also called leads) are placed through the skin to a spot near your sacral nerves. A small device, called a neurostimulator, is attached to the other end of the wires and taped to your lower back. Your sacral nerves help control your bladder. The neurostimulator on your back will modulate those nerves for 3 to 7 days. During that time, you need to keep track of your bladder symptoms by filling out a diary. It is important to fill out this diary because we will compare it to a diary before the test.  

What is a “successful test?”  

If you experience a 50% or more improvement in your bladder control problems your test is successful. You can then discuss or schedule a procedure to implant a long-term neurostimulator device. The device will be placed under the skin usually right above the buttock. This minimally invasive procedure is a simple outpatient procedure, performed under sedation and local anesthesia. It takes about 30 to 45 minutes and patients go home that day.   What if the test is unsuccessful?   If you do not experience a 50% or more improvement during the basic nerve test or if for some reason, we were not able to locate the nerve on the day of the basic nerve test, we will proceed with an advanced evaluation test that would be performed as a simple outpatient procedure. These leads are removable, and effects are reversible by removing the leads or turning off the device.  

What if the test is successful?  

If you have at least 50% improvement with the basic nerve test, you will undergo an outpatient procedure to place the stimulator device and the wire that will stimulate your sacral nerves.  

How to prepare for the PNE

• Shower with soap and water the morning of your procedure        
• Wear loose clothing to the procedure  
• You may drive yourself home after the procedure.