Sigmoidoscopy is the minimally invasive medical examination of the large intestine from the rectum through the last part of the colon. There are two types of sigmoidoscopy, flexible sigmoidoscopy, which uses a flexible endoscope, and rigid sigmoidoscopy, which uses a rigid device.

Colonoscopy
What To Think About, From Healthwise

• In general, pregnant women or people who have severe heart disease, an abdominal infection, or diverticulitis should not have a colonoscopy unless there is an important reason for it.
• Colonoscopy is a more expensive procedure than a barium enema and other endoscopic colon tests (such as proctoscopy or sigmoidoscopy), but it can be done less often over time if results are normal. Colonoscopy is recommended every:
• 10 years for people with normal results.
• 3 to 5 years for people with increased risk factors for colorectal cancer or when problems are found during the colonoscopy.
• Most experts, including the American Gastroenterological Association, recommend that people with no risk factors for colorectal cancer start screening tests at age 50. Fecal occult blood testing (FOBT) or a sigmoidoscopy test may be recommended or a colonoscopy or double-contrast barium enema (DCBE) may be used. If results from FOBT or sigmoidoscopy show a problem, a follow-up colonoscopy is recommended. For more information, see the medical tests Fecal Occult Blood Test, Sigmoidoscopy, and Barium Enema.
• The American Gastroenterological Association recommends that people with risk factors for colorectal cancer start screening tests at age 40. Tests may include FOBT, sigmoidoscopy, barium enema, or colonoscopy. If you are at increased risk of colon cancer, talk to your doctor about which test is best for you and how often you should do the tests.
• Talk to your doctor if you are considering virtual colonoscopy to screen for colon cancer. This procedure is a newer method that uses a CT scan to take two- or three-dimensional pictures of the colon.
• Virtual colonoscopy is less uncomfortable than standard colonoscopy and may be a good test for people with an average risk for colon cancer. However, if you have a virtual colonoscopy and a problem is found, you may need a standard colonoscopy so a biopsy can be done. Virtual colonoscopy may not find small colon polyps as well as a standard colonoscopy.
• For people with a risk for colon cancer, standard colonoscopy may be a better choice because a biopsy can be done or a polyp can be taken out.
• Virtual colonoscopy is not covered by all health insurance plans. Check with your insurance plan before having the test.
• Virtual colonoscopy uses the same colon prep as colonoscopy. For many people, the prep for a colonoscopy is more bothersome than the actual test.

How the Test Will Feel

The sedative and pain medication will provide relaxation and produce a drowsy feeling. A rectal examination usually precedes the test to dilate the rectum and make sure there are no major obstructions. You may have the urge to defecate when the rectal exam is performed or as the colonoscope is inserted.

You may feel pressure as the scope moves inside. Brief cramping and gas pains may be felt as air is inserted or as the scope advances. The passing of gas is necessary and should be expected.

Discomfort may be lessened by taking slow, deep breaths. This will also help relax the abdominal muscles. Mild abdominal cramping and considerable passing of gas may occur after the exam. Sedation should wear off in a few hours. Because of the sedation, you may not feel any discomfort and may have no memory of the test.

Read more at Kosmix.com

Trans Rectal Ultrasound Prostate Biopsy (TRUS-Bx) 

Indications for the initial biopsy
TRUS alone should not be used as a fi rst-line screening study as it lacks acceptable specifi city, is relatively expensive when compared with digital rectal examination (DRE) and prostate specifi c antigen (PSA) testing and adds little information to that already gained by the use of serum PSA and digital rectal examination. The most important role for TRUS is to provide visual guidance for biopsy. In general, most agree that TRUS guided prostate needle biopsy should be performed in men with an abnormal DRE, an elevated PSA (>4.0 ng/ml) or PSA velocity (rate of PSA change) >0.4 to 0.75ng/ml/yr. Also, men who were diagnosed with high-grade prostatic intraepithelial neoplasia (PIN) or atypia on a previous prostate needle biopsy should undergo a repeat biopsy 3 to 12 months later. Less commonly agreed upon recommendations for TRUS guided prostate needle biopsy include, age-specifi c PSA elevation, low percentage free PSA (< 22% to 25%), and prostate specifi c antigen density (PSAD) > 0.15, which is a measure of the amount of PSA relative to the overall prostatic volume (PSA ÷ Prostate Volume in cubic centimeters).
In patients previously treated with curative intent for prostate cancer (i.e. radical prostatectomy, radiation therapy, and cryotherapy) relative indications for TRUS guided prostate needle biopsy includes a palpable abnormality on digital rectal examination or a rising PSA suggestive of local, rather than distant, recurrence.

Technique
Patient preparation
At our institution, we routinely use a three-day course of an oral fl uoroquinolone starting before the biopsy is performed. We instruct the patient to give a self-administered cleansing enema (sodium phosphate and dibasic sodium phosphate) prior to the biopsy to eliminate gas and remove feces. We also recommend that aspirin and non-steroidal anti-infl ammatory (NSAIDS) be discontinued for seven and three days respectively prior to the scheduled prostate needle biopsy. Patients on anticoagulation therapy are not biopsied until the anticoagulant dosage is adjusted or held to allow the coagulation status to normalize.

Transrectal ultrasound procedure
The patient is positioned in either the right or left lateral decubitus position (lying on left side). This allows for easier insertion of the rectal probe. A topical anesthetic ointment is applied to the index fi nger prior to performing the DRE. A 5.0 to 7.5mHz transducer is used for transrectal imaging of the prostate. The probe is gently advanced into the rectum, to the base of the bladder until the seminal vesicles are visualized. Transverse images are then obtained as the probe is moved back from the prostate base to the prostate apex. Hard copy images are made at the level of the seminal vesicles, base, mid-prostate and apex. With the transducer at the largest cross-sectional image in the transverse plane and in the mid-sagittal plane, prostate volume can be calculated. A simple prorated ellipsoid formula is commonly used to calculate prostate volume: (anterior-posterior diameter) x (transverse diameter) x (superior-infereior diameter) x ?/6 (approximately 0.52) is accurate and reproducible.

Information by Peter Carroll, MD and Katsuto Shinohara, MD, see here for full article.

Prostate Biopsy

A prostate gland biopsy is a test to remove small samples of prostate tissue to be examined under a microscope. See an illustration of the prostate gland.

For a prostate biopsy, a thin needle is inserted through the rectum (transrectal biopsy), through the urethra, or through the area between the anus and scrotum (perineum). A transrectal biopsy is the most common method used. The tissue samples taken during the biopsy are examined for cancer cells.

A biopsy may be done when a blood test shows a high level of prostate-specific antigen (PSA) or after a digital rectal examination finds an abnormal prostate or a lump.
Why It Is Done

A prostate biopsy is done to determine:

* If a lump found in the prostate gland is cancer.
* The cause of a high level of prostate-specific antigen (PSA) in the blood.

How To Prepare

Tell your doctor if you:

* Have had any bleeding problems.
* Are allergic to any medications, including anesthetics.
* Take any medications regularly. Be sure your doctor knows the names and doses of all your medications.
* Are taking any blood-thinning medications, such as warfarin (Coumadin), heparin, enoxaparin (Lovenox), aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs).

You will need to sign a consent form that says you understand the risks of a prostate biopsy and agree to have the biopsy done. Talk to your health professional about any concerns you have regarding the need for the biopsy, its risks, how it will be done, or what the results will indicate. To help you understand the importance of the biopsy, fill out the medical test information form(What is a PDF document?).

If a prostate biopsy is done under local anesthesia through the area between the anus and scrotum (perineum), no other special preparation is needed.

If the biopsy is done through the rectum, you may need to have an enema before the biopsy.

If the biopsy is done under general anesthesia, do not eat or drink anything for 8 to 12 hours before the biopsy. During preparation for the biopsy, an intravenous line (IV) is inserted in your arm, and a sedative medication is given about an hour before the biopsy.
How It Is Done

This biopsy is done by a doctor who specializes in men’s genital and urinary problems (urologist) in the doctor’s office, a day surgery clinic, or a hospital operating room.

Before your prostate biopsy, you may be given antibiotics to prevent infection. You may be asked to take off all of your clothes and put on a hospital gown.

Your skin at the biopsy site is cleaned with an antiseptic solution, and the area around it is covered with sterile cloth. Your doctor will wear sterile gloves. It is very important that you do not touch this sterile area.

This information is from WebMD, see full article here.

Radical retropubic prostatectomy is a surgical procedure in which the prostate gland is removed through an incision in the abdomen. It is most often used to treat individuals who have early prostate cancer. Radical retropubic prostatectomy can be performed under general, spinal, or epidural anesthesia and requires blood transfusion less than one-fifth of the time. Radical retropubic prostatectomy is associated with complications such as urinary incontinence and impotence, but these outcomes are related to a combination of individual patient anatomy, surgical technique, and the experience and skill of the surgeon.

Read more at Wikipedia

There are some nice numbers here about the use of the Radial Retropubic Prostatectomy surgery in Europe. It basically states that the surgery is highly effective for T2 cases and should be evaluated for T1c cases.

Transurethral resection (TUR) of the prostate

This page tells you about transurethral resection (TUR) of the prostate.  You can go straight to sections on

* Why you might need a transurethral resection of the prostate
* How a transurethral resection is performed
* After your operation
* Going home
* If you have pain

Why you might need a transurethral resection of the prostate

Sometimes surgery is needed to remove the part of a prostate cancer that is pressing on the urethra - the tube that carries urine from your bladder.  If anything is pressing on the urethra this can make it difficult for you to empty your bladder properly.  Your doctor may suggest an operation that will take away some of the cancer so that you can pass urine more easily again.  This operation is not done to cure your cancer.  But it can relieve symptoms caused by the cancer pressing on your urethra.  This operation is also often used for men who have a non-cancerous (benign) swelling of the prostate gland called BPH.  In this section of CancerHelp we are just describing its use as a treatment for prostate cancer.  This type of surgery is called a TUR or TURP, which stands for ‘transurethral resection of the prostate’.

How a transurethral resection is performed

A TUR is performed by passing a thin tube up the urethra via your penis.  The tube is a telescope, so the surgeon can see inside your urethra.  The blockage is removed using an instrument attached to the telescope that can cut away the abnormal areas.  This operation usually means about 2 or 3 nights in hospital.

You usually have a TUR under a general anaesthetic, but for some men, it is done with a spinal anaesthetic.  This means you are awake, but cannot feel anything below the level of the anaesthetic injection into your spine.  You may have heard this type of anaesthetic called an epidural.  It is often used for childbirth.  Your doctor will suggest a spinal anaesthetic if there are reasons why you shouldn’t have a general anaesthetic, for example if your lungs are not as healthy as they might be.

After your operation

It’s best if you can start moving around as soon as possible. You’ll probably be up and about within 24 hours.

You may have a drip (intravenous infusion) to replace your body fluids.  It will be taken out as soon as you are drinking normally again.  It is important to drink plenty of fluids.

You may also have a tube (catheter) into your bladder to drain your urine into a collecting bag.  After this surgery, it is quite normal to have blood clots forming in your urine.  To prevent the blood clots blocking this catheter, ‘bladder irrigation’ may be used. This means that fluid is passed into your bladder and drained out through the catheter.  The blood in your urine will slowly clear and then the catheter can come out.  This is normally about 2 or 3 days after your surgery.  You must tell your nurse as soon as you pass urine after your catheter has been removed.  Sometimes, men cannot pass urine when their catheter first comes out.  This may be because there is still swelling around the neck of the bladder and the prostate after your surgery.  If you cannot pass urine, you will probably have the catheter put back and you can try without it again in a day or so.

Sometimes the catheter must stay in place for a while after you go home. Before you leave hospital the nurse will show you how to look after your catheter. The nurses can also arrange a district nurse to visit you at home to help with any problems.

There is general information about the side effects of surgery in the About Cancer section of CancerHelp UK.

Going home

Before you leave hospital your nurse will give you an appointment for the outpatient clinic for a check up. This is a good time to discuss any problems you may have after your operation.  The appointment is usually 6 weeks after your surgery.

Most men go home within 3 days or so of their TUR.  If you think you might have problems coping at home, let your nurse or social worker know when you are first admitted so that they can arrange help.

If you have pain

You may have some pain or discomfort for a few days after your operation. But there are many types of painkilling drugs.

Remember - if you continue to have pain tell the doctor or nurse looking after you as soon as possible. Your painkillers can be changed - different drugs suit different people.

Read more at http://www.cancerhelp.org.uk/help/default.asp?page=2873

Transurethral resection (TUR) for bladder cancer

Surgery Overview

Transurethral resection (TUR) of the bladder is a surgical procedure that is used both to diagnose bladder cancer and to remove cancerous tissue from the bladder. General anesthesia or spinal anesthesia is usually used. During TUR surgery, a cystoscope is passed into the bladder through the urethra. A tool called a resectoscope is used to remove the cancer for biopsy and to burn away any remaining cancer cells.

The recurrence rate for stage I bladder cancer following TUR is approximately 50% to 80%, so repeat TURs are sometimes needed.1

What To Expect After Surgery

Following surgery, a catheter may be placed in the urethra to help stop bleeding and to prevent blockage of the urethra. When the bleeding has stopped, the catheter is removed. You may need to stay in the hospital 2 to 4 days.

You may feel the need to urinate frequently for a while after the surgery, but this should improve over time. You may have blood in your urine for up to 2 to 3 weeks following surgery.

You may be instructed to avoid strenuous activity for about 3 weeks following TUR.

Why It Is Done

About 70% of people have early-stage and low-grade superficial bladder cancer that can be effectively treated with a TUR.2

How Well It Works

TUR is the most common and effective treatment for early-stage superficial bladder cancer. It may also be effective for more advanced cancer if all the cancer is removed and biopsies show that no cancer cells remain.

Risks

The risks of TUR include:

* Bleeding.
* Bladder infection (cystitis).
* Perforation of the wall of the bladder.
* Blood in the urine (hematuria).
* Blockage of the urethra by blood clots in the bladder.

What To Think About

Treatment with TUR may be followed by chemotherapy or biological therapy.

If superficial bladder cancer recurs, follow-up TURs may be done regularly.2

About 30% of people with stage I or high-grade superficial bladder cancer are treated with a TUR, but additional chemotherapy or biological therapy may be recommended.

Read more at http://www.questdiagnostics.com/kbase/topic/detail/surgical/uh1456/detail.htm

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