Bladder Biopsy with Fulguration:
What is a Bladder Biopsy?
A bladder biopsy is an in office or surgical procedure where tissue from the bladder lining is obtained and analyzed by a pathologist using special staining and a microscopic evaluation.
Why a Bladder Biopsy Is Done:
Your doctor will perform a bladder biopsy if he or she suspects your symptoms might be caused by bladder cancer or if previously seen areas of the bladder looked atypical. Early bladder cancer may be completely asymptomatic but symptoms that are sometimes associated with bladder cancer include:
- blood in the urine
- a change in voiding pattern
- frequent urination
- painful urination
- lower back pain
These symptoms are common for many bladder conditions, so screening and preventative medicine is extremely important.
Prior to the procedure, you may undergo some imaging tests, such as an Ultrasound or CT scan. These will help detect detect if there is a growth on your bladder wall or any other pathology. The scans, however, cannot tell if a growth or polyp is cancerous. That can only be determined when your biopsy sample is reviewed under a microscope.
After your bladder biopsy or fulguration, you may have blood or blood clots in your urine. This typically lasts for two or three days following the procedure, but drinking plenty of fluids can help keep the urine clear. You may also experience a mild burning sensation when you urinate that usually disappears by the next day. Drinking lots of water will keep the urine dilute and less irritating. Over-the-counter pain relief medicines, such as acetaminophen (Tylenol) or ibuprofen (Advil) are very effective You may be prescribed something something specifically for bladder spasm and discomfort. There is an OTC med called Azo, found at any pharmacy, thais meant specifically for bladder discomfort.
How to Prepare for a Bladder Biopsy?
The only preparation prior to a cystoscopy is to take any prescribed antibiotic sometime in the morning before the procedure. You should take a shower and wash as you would normally do. You may eat and drink anything you wish prior. You may drive yourself to the office and back.
When you arrive for your biopsy we will have you empty your bladder just prior to the procedure. Please be able to leave a sample for us to screen prior to the study.
How a Bladder Biopsy is Performed?
The procedure typically lasts less than two minutes.
First you will be seated in a special chair that puts you in a reclined position. Your urethra is then prepped and numbed using a topical lidocaine.
During the procedure, your doctor will use a cystoscope, which is a small, thin lens with a camera that is inserted into your urethra.
In men, the urethra is at the tip of the penis. In women, it is located just above the vaginal opening.
Imagine your bladder as a balloon and the urethra is the neck of the balloon. hThe scope is passed through that short length of the urethra and into the wide space of the bladder. Water will flow through the cystoscope to fill the bladder. You may feel the need to urinate at times, which is normal. Once the bladder is inflated with water, the bladder wall can be well visualized.
The cystoscope has a working channel where an even thinner forcep is passed to obtain a small piece of tissue. This may cause a slight fleeting, pinching sensation. A tiny laser fiber can then be passed to stop any minimal bleeding which may occur or to treat an area already known to be abnormal.
Following Up:
After a Bladder Biopsy It usually takes a 10 days for the results to be ready. The pathology results will be discussed with you at your follow up visit.
Your doctor will be looking for cancer cells or any other pathology detected from the biopsy. If atypical cells are seen, the biopsy helps determine whether it is truly cancer or a premalignant condition. In a cancer diagnosis two things are important:
- invasiveness, or how deeply the cancer has progressed into the bladder wall
- grade, or how closely the cancer cells look like bladder cells
If cancer cells still closely resemble normal appearing bladder cells, then the disease is low-grade. Low-grade cancers are easier to treat and less aggressive than high-grade cancers, or cancers that have reached the point where the cells no longer look like normal cells.
Remember, not all abnormalities in the bladder are cancerous. If your biopsy does not show cancer, it can help determine if another condition is causing your symptoms, such as:
- infection or regions of chronic cystitis
- ulcerations
- stones, foreign body
After your biopsy, you should remember to drink plenty of fluids, and avoid heavy lifting and strenuous activity for 24 hours.
You may resume your normal activities after that. Returning to work the following day is typical. Please call the office if you experience any fever, or persistent pain or bleeding after the first three days
What is Bladder Fulguration?
"Fulguration" of a bladder lesion means to destroy the lesion by utilizing high frequency energy. This energy is channeled using either electrocautery or laser and is easily performed in under a few minutes. Local anesthesia is accomplished two ways: an anesthetic solution is left in the bladder and a topical anesthetic in the urethra. Together, this is an effective way of alleviating any discomfort. Early flat or small papillary bladder tumors and inflammation of interstitial and chronic cystitis are treated easily with this technology.
Fulguration of regions of chronic cystitis or "inflammatory patches" is performed to promote healing of these areas with healthier more resilient tissue. This inflammation of the mucosa allows increased permeability of the normally shielded bladder surface. When the bladder's protective lining is disrupted by the raw areas of inflammation or "ulcers", chemicals and irritants in the urine can seep into the bladder muscle. This then triggers a cascade of events that releases histamines and creates a massive inflammatory cell brigade to the region that can cause severe pain, spasm of the bladder muscle, and constant frequency and urgency. Stretching of these inflamed, raw areas as the bladder fills often dramatically increases pain. Pain also incited as the bladder empties, due to ulcerated areas coming in contact with other bladder surfaces.
Fulguration of chronic cystitis results in greater than 50% improvement in pain in over 90% of patients. There can also be a significant improvement of the constant bladder pressure and the relentless urgency and frequency associated with chronic cystitis .
"Fulguration" of a bladder lesion means to destroy the lesion by utilizing high frequency energy. This energy is channeled using either electrocautery or laser and is easily performed in under a few minutes. Local anesthesia is accomplished two ways: an anesthetic solution is left in the bladder and a topical anesthetic in the urethra. Together, this is an effective way of alleviating any discomfort. Early flat or small papillary bladder tumors and inflammation of interstitial and chronic cystitis are treated easily with this technology.
Fulguration of regions of chronic cystitis or "inflammatory patches" is performed to promote healing of these areas with healthier more resilient tissue. This inflammation of the mucosa allows increased permeability of the normally shielded bladder surface. When the bladder's protective lining is disrupted by the raw areas of inflammation or "ulcers", chemicals and irritants in the urine can seep into the bladder muscle. This then triggers a cascade of events that releases histamines and creates a massive inflammatory cell brigade to the region that can cause severe pain, spasm of the bladder muscle, and constant frequency and urgency. Stretching of these inflamed, raw areas as the bladder fills often dramatically increases pain. Pain also incited as the bladder empties, due to ulcerated areas coming in contact with other bladder surfaces.
Fulguration of chronic cystitis results in greater than 50% improvement in pain in over 90% of patients. There can also be a significant improvement of the constant bladder pressure and the relentless urgency and frequency associated with chronic cystitis .