Procedures involving the bladder can be divided into endoscopic (cystoscopic), open surgery and keyhole surgery. There are various conditions applicable. Bladder stones can form when the prostate is enlarged, obstructing urine outflow and the urine crystallises during a period of stagnation and these stones are typically crushed using a cystoscopic stone crushing forceps system. This is done as a day procedure under an anaesthetic.
A bladder diverticulum can occur where high pressures mount within the bladder as bladder wall tension rises in order to overcome an enlarged prostate, causing obstruction and a weakness in the wall develops, allowing an outpouch to occur. This outpouching can be small or large, but when quite large and when it fills to a volume > 200-300ml, and it is a non-emptying pouch, it may be an indication for bladder diverticulectomy, and this can be done either open or robotic assisted.
Bladder cancers that are isolated to one particular area of the bladder, not involving the ureter and not involving the bladder neck or prostate, in an easily accessible and mobile part of the bladder, this section of the bladder can be excised, in order to gain cancer clearance, either by way of open or robotic assisted partial cystectomy, with or without pelvic lymph node dissection. This is typically only done for non-muscle invasive bladder cancers, with careful patient selection.
Most commonly within urological surgical practice, the bladder is accessed by the cystoscope, which allows for a full inspection on the lining, using different degree lenses, and the urologist takes biopsies of the bladder lining.
Certain patients have an irritable bladder and may have a non-infective interstitial cystitis. This inflammatory condition may respond to hydrodilatation of the bladder, where the bladder wall is stretched via cystoscopic fluid installation under an anaesthetic, and this can potentially lead to short term symptom relief.
Traditionally for a massively enlarged prostate, over 300g, the prostate could be enucleated by way of retropubic extra-peritoneal access through the bladder, and this operation is termed simple transvesicle enucleative prostatectomy for BPH.