Dr. Lievano is a Urology doctor serving the DFW metroplex. His primary office location is at Baylor Scott & White in Fort Worth, Texas.
Urology surgeons can diagnose and treat certain conditions that affect the bladder. These include:
- Urinary incontinence
- Bladder prolapse
- Recurrent urinary tract infections
Recommended Dallas-Fort Worth Bladder Doctors
What Is Bladder Surgery?
The doctors in the Dallas-Fort Worth area offer minimally invasive treatment for people with a variety of bladder conditions. Surgery is most commonly used to treat bladder cancer, but it is an effective treatment for other conditions too.
Prior to surgery, you’ll work with your urologist to determine the best course of treatment. You may be required to stop taking certain medications before the procedure.
Recovery depends on the type of surgery that you have. Open surgery usually creates larger incisions and requires a longer recovery time. Doctors must make sure that patients can express urine before sending them home from the hospital.
Types Of Bladder Surgery
There are a variety of procedures for treating bladder cancer. These include the following.
Transurethral Resection With Fulguration
During this surgery, a thin tube is inserted to the urethra until it reaches the bladder. Called a cystoscope, this tube contains a light and a tool that can be used to remove or burn the tumor.
A cystectomy is the removal of a bladder. During a radical cystectomy, the entire bladder is removed. Lymph nodes or other cancerous tissue may also be taken out. A urinary diversion must be performed if the bladder is completely removed. The urinary diversion creates a new space to store and pass urine.
Removing the whole bladder is not always necessary to treat cancer. In many cases, a segmental or partial cystectomy can be performed. This involves removing part of the bladder while leaving healthy tissue intact. A segmental cystectomy may be the preferred procedure for cancers that have entered one area of the bladder wall.
Reconstructive Bladder Surgery
When part or all of a patient’s bladder is removed, the individual requires reconstructive surgery. A urostomy involves using tissue from the intestinal tract to reconnect the ureters, which are the tubes that typically transfer urine from the kidneys to the bladder.
After bladder surgery, a urostomy redirects urine to an opening in the abdomen instead of the bladder. The urine can be collected in an external pouch.
Some urology surgeons can recreate a bladder using part of the intestines. This “neobladder” sits in the location where the bladder used to be and simulates its function. It stores urine so that an external pouch does not need to be used for a collection.
The neobladder directs the urine out of the body in one of two ways. The surgeon may create an opening in the abdomen, through which the urine can be emptied via a valve when necessary. The urologist may also connect the neobladder to the urethra so that the patient can urinate normally.
Bladder Surgery For Incontinence
There are a few ways to address incontinence in women and men. Stress incontinence happens when pressure is applied to the urinary tract and urine leaks out. This may take place when you cough, sneeze or jump. Overactive bladder, or urge incontinence, occurs when you have trouble controlling the frequency or urgency of urination.
Operations for incontinence aren’t the best course of treatment for everyone, but they can resolve your symptoms permanently. Surgery is often a better option for patients with stress incontinence than those with urge incontinence. However, it can work for both conditions.
You should work with your doctor to determine the best level of treatment for your needs. Conservative treatments are usually the first course of action. If they don’t work, surgery may be considered.
The Right Surgery For Your Diagnosis
Urinary incontinence surgery treats a specific problem. If the cause of your incontinence is mixed, surgery may correct one facet of the issue, but you may need to continue taking medication or undergoing non-surgical treatment for the other condition. This is often the case for people who have a combination of stress and urge incontinence.
Stress Incontinence Surgery
Surgery for stress incontinence consists of physically restructuring part of the bladder. A suspension procedure involves reinforcing parts of the bladder, bladder neck or urethra to prevent them from sagging.
During a sling procedure, tissue or synthetic mesh is used to support the urethra and keep it from opening when pressure is applied. If a tension-free sling is used, your own scar tissue holds it in place. With a conventional sling, stitches are used to attach the sling to your abdomen.
Stress Incontinence Surgery In Males
A male sling procedure helps compress the urethra and shift its position in men who have undergone other types of urologic surgery, such as transurethral resection of the prostate and radical prostatectomy. It involves placing synthetic tape around the urethral bulb. This adds support, allowing the urinary sphincter to resume proper function. The best candidates for this surgery are males with mild to moderate incontinence who don’t have an artificial urinary sphincter.
After prostate surgery, males may experience stress incontinence. A urinary sphincter is a device that can be implanted to help with this condition. It features an occlusive cuff and a pump that the patient operates. An artificial sphincter may be used in women and children, but it is most often used to improve continence in men who have had their prostate removed.
Overactive Bladder Surgery
Nerve stimulation is a type of outpatient surgery for overactive bladder. The surgeon implants a tiny device under the skin. Similar to a pacemaker, this device carries electrical impulses to certain nerves. The messages are painless. They counteract the signals that an overactive bladder sends to the brain.
A bladder or urethra that has prolapsed, or fallen, may need to be repaired if it causes problems. This condition often affects women who have gone through childbirth.
Bladder prolapse is called a cystocele. Urethral prolapse is called a urethrocele. Both conditions can usually be diagnosed during a physical examination.
You may not have symptoms of a prolapsed bladder or urethra, especially if it is not fully prolapsed. If you do have signs of the condition, they may involve incontinence, difficulty urinating or pain. Surgery is not always necessary, but it may help if your symptoms interfere with your daily life.