Bladder

It is a very special organ, present only in males. It’s main function is to hold urethra, which controls urine. And it also holds two muscular cylinders which control the vital function of achieving erection of penis, necessary for successful sexual act.

Prepuce is a foreskin covering the bulb of penis distally. It is this part of skin, which is removed during religious or medically warranted circumcision.

Prepuce can get affected by infection, narrowing, stones within, and malignancy (cancer).

Penis can get affected by skin lesions of the covering skin, fibrous plaque of the muscular cylinders of erection, narrowing of the contained urethra, and curvatures of penis

Introduction

Urinary bladder is a muscular reservoir, meant to store urine till it is physiologically adequately distended. Then with urination reflex, it contracts and the urine is voided. Ureters are long muscular conduits, which bring urine into the urinary bladder, from the kidneys.

Each ureter opens into the bladder through a separate submucous tunnel, which prevents reverse reflux of urine into the ureter from the bladder, while passing urine. Urinary bladder us richly innervated with special nerves, which transmit the degree of distension to the nervous system, and also with nerves which carry impulses for it’s contraction, when it is right time to void urine.

Urinary Bladder Diseases

Urinary bladder disesases can arise from it’s epithelial lining , from it’s muscular component or from extrinsic juxtavesical organs surrounding the bladder.

Uroepethelial Lining Diseases

Infection, called Cystitis. Tumors arising from the bladder epithelium, which in majority are malignant, but some may be benign. These are far more common in tobacco users or in patients exposed to chemical or rubber industrial factories.

Urinary Bladder Muscular Diseases

Normally bladder muscle contracts under neurogenic control from the brain, through afferent nerve impulses fired from the spinal center for urination. It causes muscles to contract the bladder to throw urine out of the body through urethra, with simultaneous relaxation of the external urinary sphincter, so that urine flows out without any resistance.

In certain diseases, this co-ordinated muscular function of the bladder is deranged, resulting in ineffective voiding of urine. Common derangements include:

Over Active Bladder (OAB): This condition causes premature contraction of the urinary bladder muscles, before it is adequately distended to it’s physiological capacity.It results in marked frequency of urination, with urgency, occasionally resulting in leakage of urination.

Infection of the bladder ( Cystitis): In presence of infection, the bladder muscle contracts much earlier than adequate distension is achieved, due to irritation of the epithelium. Fortunately, this settles down spontaneously with treatment of cystitis.

Neurogenic Bladder: In these conditions, the muscular actions of the bladder are deranged in variable ways, depending on the type of neurogenic dysfunction. As mentioned earlier, for efficient voiding of urine, neurogenic innervation of bladder and it’s functional integrity is extremely vital.

A number of clinical conditions may adversely affect this delicate balance, resulting in either ineffective storage, ineffective voiding or variable combination of both.

Common examples of such clinical conditions include congenital spinal deformities, central nervous dysfunction, spinal trauma or compression, diseases of peripheral nervous system, commonest being diabetic neuropathy.

Diseases of Bladder Due to Surrounding Structures

The surrounding organs include colon, intestines, and in females uterus and vagina in addition.

The commonest diseases of surrounding organs which may affect bladder include:

  • Sigmoid colon diverticulitis, causing colovesical fistula in rare cases.
  • Crohn’s disease of intestine, causing enterovesical fistulae
  • Large fibroids of the uterus, causing extrinsic compression over the bladder
  • Iatrogenic injury to bladder during surgery on the uterus, causing vesicovaginal fistulae or ureterovaginal fistula
  • Vaginal malignancy, in advanced stages, may cause vesicovaginal fistula or colovaginal fistula or complex vesicocolivaginal fistula.

Urological Surgeries Offered for Diseases of Urinary Bladder

I do a plethora of surgical treatment of numerous urinary bladder pathologies, which include the following:

  • Cystoscopy
  • Intra vesical Injection for VUR
  • Trans Urethral Resection of Bladder Tumors (TUR-BT)
  • Hydrodistension of bladder
  • Bladder biopsies and Check Scopies after TUR-BT
  • Intravesical Chemo and Immunotherapy
  • Surgical Correction of Colovesical, Vesicovaginal and ureterovaginal fitulae.
  • Partial Cystectomy for malignancy
  • Suprapubic cystotomy.
  • And many other customized treatments

I perform these surgeries by the most optimum approach for the clinical conditions, which include Endoscopic, Laparoscopic , Robotic or by open surgical approach.

The approach is customized for each patient and in vast majority, discussed with patients preoperatively.