Procedures

A trial of void is a medical procedure to determine if a person can urinate on their own after a urinary catheter has been removed. The catheter is removed, and the patient is monitored as they attempt to pass urine, often by urinating into a container that can measure the volume. This test is used to see if a catheter can be removed permanently, most often after surgery or an episode of urinary retention. 

What happens during the procedure

• Catheter removal: The balloon on the urinary catheter is deflated, and the catheter is carefully removed. 

• Waiting to urinate: You may be asked to drink fluids to help fill the bladder. You will wait for the urge to urinate. 

• Urinating and measuring: When you feel the need to urinate, you will do so into a container. The volume of urine is measured and recorded. 

• Monitoring: You may need to repeat this process for several hours to ensure your bladder is emptying properly. 

• Post-procedure: After the test, you will either be cleared to go home or, if you are unable to urinate, a healthcare provider will discuss the next steps, such as reinserting the catheter or other treatment options. 

Why a trial of void is performed

• After surgery: To check if a temporary catheter can be removed and the patient can resume normal urination. 

• After urinary retention: To see if the bladder has recovered enough to manage urination independently. 

• To avoid further intervention: If successful, a trial of void can help a patient avoid more invasive procedures. 

A uroflow test is a simple, non-invasive test that provides valuable information about well you are urinating, including the speed and strength of your urinary flow. During the test you will urinate into a special toilet that will analyze your stream and provide a real time graphical analysis. You should urinate in whatever position is easiest for you (sitting or standing). Immediately after you have finished voiding, we will perform a bedside ultrasound of your bladder by placing a probe on your lower abdomen. This will tell us how well you are emptying your bladder. The urologist will use this information to help guide your treatment.

Preparation

• Come to your appointment with a with comfortably full bladder and ready to urinate.

• You can eat prior to this procedure and take all of your home medications as usual

Post Procedure

• You should have no symptoms after this procedure

A urodynamics test will last approximately 60 minutes. 

To begin your test, the nurse will ask you to empty your bladder in a special chair. Therefore, we ask that you please make every attempt to come to the clinic with a full bladder. The nurse will then place a small catheter into the bladder to see how well you emptied your bladder and to check for a urinary tract infection. If a urinary tract infection is present, your test will be rescheduled following antibiotic therapy.

During the test, two small tubes (catheters) are inserted into the body: one goes into the bladder and the other one goes into the vagina or rectum. The nurse performing the procedure will determine where the second catheter will be placed after reviewing your doctor’s clinical notes. The tube that goes into the bladder will be used to fill the bladder with water and will measure the pressure in the bladder. The other catheter will measure the pressure in your abdomen. During this procedure, we will also monitor the sphincter muscle of the urethra and its ability to hold urine in your bladder. Any slight discomfort you may feel during the test should go away within a few minutes.

Prior to filling your bladder with water, the nurse will give you instructions on sensations and feelings that need to be noted during the procedure. As your bladder is being filled with fluid through the tube (catheter), you will tell the nurse what your bladder feels like. When your bladder is full, several other tests will be performed to aid your doctor in diagnosing and treating your condition(s). You may be asked to cough or bear down to mimic the symptoms you are experiencing. The nurse will monitor your bladder function, urethral function, and muscle activity during the test. After the test, you will be asked to empty your bladder. Everything will be explained to you as the test is being performed.

The catheters will be taken out when the test is over. You may experience minor discomfort where the catheters were placed, but this will only last for a few hours. A warm tub bath may help ease discomfort. It is also important to increase your fluid consumption over the next 24 to 48 hours. Drink at least 8-10 glasses of water unless you have a medical condition which limits your fluid consumption.

After the tests are completed, you should continue your regular diet, medications, and activities unless given other instructions by the doctor.

The results of your studies will be reviewed with you in detail by your doctor. 

A urodynamics test will last approximately 60 minutes. 

To begin your test, the nurse will ask you to empty your bladder in a special chair. Therefore, we ask that you please make every attempt to come to the clinic with a full bladder. The nurse will then place a small catheter into the bladder to see how well you emptied your bladder and to check for a urinary tract infection. If a urinary tract infection is present, your test will be rescheduled following antibiotic therapy.

During the test, two small tubes (catheters) are inserted into the body: one goes into the bladder and the other one goes into the vagina or rectum. The nurse performing the procedure will determine where the second catheter will be placed after reviewing your doctor’s clinical notes. The tube that goes into the bladder will be used to fill the bladder with water and will measure the pressure in the bladder. The other catheter will measure the pressure in your abdomen. During this procedure, we will also monitor the sphincter muscle of the urethra and its ability to hold urine in your bladder. Any slight discomfort you may feel during the test should go away within a few minutes.

Prior to filling your bladder with water, the nurse will give you instructions on sensations and feelings that need to be noted during the procedure. As your bladder is being filled with fluid through the tube (catheter), you will tell the nurse what your bladder feels like. When your bladder is full, several other tests will be performed to aid your doctor in diagnosing and treating your condition(s). You may be asked to cough or bear down to mimic the symptoms you are experiencing. The nurse will monitor your bladder function, urethral function, and muscle activity during the test. After the test, you will be asked to empty your bladder. Everything will be explained to you as the test is being performed.

The catheters will be taken out when the test is over. You may experience minor discomfort where the catheters were placed, but this will only last for a few hours. A warm tub bath may help ease discomfort. It is also important to increase your fluid consumption over the next 24 to 48 hours. Drink at least 8-10 glasses of water unless you have a medical condition which limits your fluid consumption.

After the tests are completed, you should continue your regular diet, medications, and activities unless given other instructions by the doctor.

The results of your studies will be reviewed with you in detail by your doctor. 

Ureteroscopy with laser is a minimally invasive procedure to remove kidney stones by using a thin scope called a ureteroscope and a laser to break the stones into small fragments that can be passed or removed, with a temporary ureteral stent sometimes placed to ensure proper drainage. Performed under general anesthesia, the laser lithotripsy uses heat to fragment the stone, with techniques like the holmium laser ensuring precise control and preventing damage to the ureteral wall.  

What It Treats 

• Kidney Stones: This procedure is primarily used to treat kidney stones that are lodged in the ureter (the tube connecting the kidney to the bladder) and cannot pass on their own.

• Stones in Any Location: Ureteroscopy can address stones in the kidney or any part of the ureter.

How It Works

• Anesthesia: The procedure is performed under general anesthesia, so you will be asleep. 

• Scope Insertion: A thin, flexible instrument called a ureteroscope is inserted through the urethra and guided into the ureter and kidney to locate the stone. 

• Laser Fragmentation: A laser fiber is passed through the scope and directed at the stone. The laser's energy breaks the stone into very small pieces, called dust or small fragments. 

• Stone Removal/Passage: The fragmented stone pieces can then either be removed in a small basket, or they are small enough to pass out of the body through the urine over time. 

• Stent Placement: A temporary, flexible tube called a ureteral stent is often placed in the ureter to help urine and stone fragments drain from the kidney and to prevent blockage after the procedure. 

What to Expect After

• Recovery: You can typically go home the same day. 

• Activity: Walking is encouraged to prevent blood clots, but you may need to avoid strenuous activities and heavy lifting for a few days. 

• Stent Discomfort: You may feel discomfort from the ureteral stent, including symptoms like increased frequency of urination or blood in your urine. 

• Follow-Up: You may receive a prescription for antibiotics to prevent infection and instructions on managing any discomfort from the stent. 

TURBT, or Transurethral Resection of Bladder Tumor, is a minimally invasive surgical procedure used to both diagnose and treat bladder cancer. A surgeon uses a cystoscope inserted through the urethra to remove tumors from the bladder wall. The removed tissue is then sent to a lab to be tested to determine if it's cancerous and to understand how deeply it has grown.  

How it works

• Procedure: A surgeon inserts a thin tube called a resectoscope (or cystoscope) through the urethra into the bladder. 

• Removal: The surgeon uses a wire loop on the end of the scope to cut out the tumor and a margin of surrounding tissue. 

• Cauterization: The loop can also use heat to seal blood vessels and stop bleeding (electrocauterization). 

• Diagnosis: The removed tissue is sent to a pathologist for analysis to check for cancer cells and their grade and stage. 

• Anesthesia: The procedure is performed under local, spinal, or general anesthesia. 

Reasons for a TURBT

• Diagnosis: To diagnose bladder cancer and determine if it has grown into the muscle layer of the bladder wall. 

• Treatment: It is the most common treatment for superficial bladder cancer (non-muscle invasive). 

• Debulking: It can remove as much of a deeper tumor as possible before other treatments are started. 

After the procedure

• Recovery: Patients may feel discomfort, pain, or have blood in their urine for one to two weeks. 

• Aftercare: It is important to rest, stay hydrated, and avoid strenuous activity as advised by the doctor. 

• Follow-up: A second, more extensive TURBT may sometimes be needed to ensure all cancer is removed. 

Transurethral resection of the prostate (TURP) is a common surgical procedure to remove inner portions of an enlarged prostate gland (BPH) to improve urine flow. A resectoscope is inserted through the urethra, requiring a 1-2 day hospital stay and temporary catheter use. It is highly effective for relieving symptoms. 

What happens during prostate surgery?

• This type of prostate surgery removes parts of the prostate to let your urine flow more freely and your bladder empty more completely. This surgery is a safe and effective treatment for most men.

• A special tool (called a resectoscope) is passed through your penis that contains the urethra (See diagram Anatomy of prostate, side view) and hollows out the inside of your prostate.

• This process, called trans-urethral resection of the prostate, or TURP, is the most common method used when surgery is necessary.

What should I know before this surgery?

• Your surgery will be done at a hospital and usually, you will be admitted the same day as your operation.

• You will be given information about the time, date, and location of the surgery along with any examinations that you might need.

• You may also meet with your anaesthesiologist who will let you know how to make you most comfortable during surgery (See below “What happens during surgery?”).

• You will be asked about medications that you are taking (such as blood thinners, aspirin, arthritis medications or even “natural herbs”) because they could possibly increase your risk for bleeding. It may be necessary to stop taking any before surgery. It is important to talk with your doctor if you are not sure about what you are taking.

What occurs during surgery?

• There are two main types of anaesthetic used to prevent pain during the surgery:

1. Spinal anaesthetic (“freezing” you from the waist down with a needle in your back)

2. General anaesthetic (putting you completely to sleep).

• The resectoscope is used to cut away parts of the prostate that are bulging into or blocking the urethra.

• The cut-away pieces are cleared out of the bladder and removed through the urethra.

• No cuts are made to the skin.

• The entire surgery usually takes 1 to 2 hours 

• At the end of the operation, a catheter (plastic drainage tube) is passed through the penis into the

bladder to help with emptying urine out of the bladder.

• A watery solution is then used to wash any blood out of the bladder.

• All of the tissue removed at surgery is carefully analyzed to ensure it does not contain cancer.

• This procedure does not increase your risk of developing prostate cancer nor does it cure cancer.

What happens right after surgery?

• You will spend about one to two hours in the Recovery Room until it is safe for you to return to your hospital room.

• You can then eat and drink.

• In some cases, you may go home the same day you may need to stay in the hospital for one to three

days (See catheter below).

What do I need to know about the catheter?

• The catheter usually remains in place for one or two days until the fluid that is leaking out is fairly clear.

• During that time, you may need to continue flushing out the bladder with a watery solution.

• If the catheter feels uncomfortable, the symptoms are usually mild.

• Sometimes there may be cramps in your bladder. If this cramping bothers you, medication can often provide relief.

• Once you are told that your bladder is emptying satisfactorily, you will be discharged. This could be one to three days after your operation, as mentioned above.

• Even if some men are sent home with a catheter still in place, it is usually removed within a few days.

What can I expect when the catheter is taken out?

• At the time the catheter is taken out, you may be asked to take a deep breath in and out to relax the muscles in your pelvis. As you breathe out, the doctor will gently pull the catheter out. You may feel temporarily uncomfortable.

• After the catheter is taken out, you may find that you have the following for a while.

– Sudden and very strong urges to urinate,

– Discomfort when urinating,

– Dribbling or leaking urine.

• These symptoms usually disappear in a few weeks when the inflammation clears up and the muscles

that control this area become stronger.

What can I expect when the catheter is taken out?

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For the first 4 weeks, avoid:

Any heavy lifting (over 10 kg or 20 lb.)

Strenuous physical activity (jumping, running, hiking uphill, fast cycling)

Sexual activity

Becoming constipated

Up to 6 weeks after surgery:

You may see blood in your urine 

Although it happens less often, you may also pass some small blood clots

To clean out your bladder, you will need to drink large amounts of fluids (water if possible)

Regularly drink about 8 ounces/250 ml every 2 hours (only when awake)

Cystolitholapaxy is a minimally invasive surgical procedure to break up and remove bladder stones without the need for an incision. A surgeon inserts a cystoscope, a tube with a camera, into the bladder through the urethra to locate the stones. Then, instruments like a laser or other tools are used to fragment the stones into smaller pieces, which are then flushed or removed.  

What happens during the procedure?

• Anesthesia: The procedure is typically performed under local or general anesthesia, so you should not feel pain during the surgery. 

• Cystoscope insertion: A urologist will insert a thin tube called a cystoscope with a camera on the end through the urethra and into the bladder to see the stones. 

• Stone fragmentation: A specialized tool is passed through the cystoscope to break the stones into small pieces. This can be done using a laser, ultrasonic waves, or a mechanical "stone punch". 

• Stone removal: The fragments are then washed out of the bladder with fluids or removed with a suction device. 

• Potential for other procedures: In some cases, cystolitholapaxy can be performed at the same time as other procedures, such as those for an enlarged prostate. 

What to expect afterwards

• Recovery: Patients can often go home the same day. 

• Activity restrictions: You may need to avoid strenuous activities like heavy lifting, running, or cycling for a couple of weeks, and may need to avoid sex for 1-2 weeks. 

• Risks: There is a small risk of developing an infection or injury to the bladder. 

• Driving: You may not be able to drive for about a week after surgery.