Cystoscopy
Cystoscopy
Definition
Cystoscopy (cystourethroscopy) is a diagnostic procedure that uses a
cystoscope, which is an endoscope especially designed for urological use
to examine the bladder, lower urinary tract, and prostate gland. It can
also be used to collect urine samples, perform biopsies, and remove small
Cystoscopy is performed by urologists to examine the entire bladder lining
and take biopsies of any questionable areas. Cystoscopy may be prescribed
for patients who display the following conditions:
blood in the urine (hematuria)
inability to control urination (incontinence)
urinary tract infection
signs of congenital abnormalities in the urinary tract
suspected tumors in the bladder
bladder or kidney stones
signs or symptoms of an enlarged prostate
pain or difficulty urinating (dysuria)
disorders of or injuries to the urinary tract
symptoms of interstitial cystitis
Blood and urine studies, in addition to x rays of the kidneys, ureters,
and bladder, may be performed before a cystoscopy to obtain as much
diagnostic information as possible. During the cystoscopy, a retrograde
pyelogram may also be performed to examine the kidneys and ureters.
Description
There are two types of cystoscopes used to carry out the procedure, a
rigid type and a flexible type. Both types are used for the same purposes
and differ only in their method of insertion. The rigid type requires that
the patient adopt the lithotomy position, meaning that the patient lies on
his or her back with knees up and apart. The flexible cystoscope does not
require the lithotomy position.
A cystoscopy typically lasts from 10–40 minutes. The patient is
asked to urinate before surgery and advised that relaxing pelvic muscles
will help make this part of the procedure easier. A well-lubricated
flexible or rigid cystoscope (urethroscope) is passed through the urethra
into the bladder where a urine sample is taken. There may be some
discomfort as the instrument is inserted. Fluid is then injected to
inflate the bladder and allow the urologist to examine the entire bladder
wall. The cystoscope uses a lighted tip for guidance and enables biopsies
to be taken or small stones to be removed through a hollow channel in the
cystoscope.
During a cystoscopy, the urologist may remove bladder stones or kidney
stones, gather tissue samples, and perform x-ray studies. To remove
stones, an instrument that looks like a tiny basket or grasper is inserted
through the cystoscope so that small stones can be extracted through the
scope's channel. For a biopsy, special forceps are inserted through
the cystoscope to pinch off a tissue sample. Alternatively, a small
brush-like instrument may be inserted to scrape off some tissue. To
perform x-ray studies such as a retrograde pyelogram, a dye is injected
into the ureter by way of a catheter passed through the cystoscope. After
completion of all required tests, the cystoscope is removed.
Preparation
Patients may be asked to give a urine sample before cytoscopy to check for
infection and to avoid urinating for an hour before this part of the
procedure. They wear a hospital gown during the procedure and the lower
part of the body is covered with a sterile drape. A sedative may be given
about one hour prior to the operation to help the patient relax. The
region of the urethra is cleansed and a local anesthetic is applied.
Spinal or general anesthesia may also be used for the procedure.
Distension of the bladder with fluid is particularly painful, and if it
needs to be done, as in the case of evaluating interstitial cystitis,
general anesthesia is required. A signed consent form is necessary for
this procedure.
After removal of the cystoscope, the urethra is usually sore, and patients
should expect to feel a burning sensation while urinating for one to two
days following
the procedure. To alleviate discomfort or pain, patients may be
prescribed pain medication, and
may also be required to prevent infection. Minor pain may also be treated
with over-the-counter, nonprescription drugs such as
. To relieve discomfort, patients may be advised to drink two 8-oz glasses
of water each hour for two hours and to take a warm bath to relieve the
burning feeling. If not able to bathe, they may be advised to hold a warm,
damp washcloth over the urethral opening.
Patients who have undergone a cystoscopy are instructed to:
Take warm baths to relieve pain.
Rest and refrain from driving for several days, especially if general
anesthesia was used.
Expect any blood in the urine to clear up in one to two days.
Avoid strenuous
during recovery.
Postpone sexual relations until the urologist determines that healing is
As with any surgical procedure, there are some risks involved with a
cystoscopy. Complications may include profuse bleeding, a damaged urethra,
a perforated bladder, a urinary tract infection, or an injured penis.
Patients should contact their physician if they experience any of the
following symptoms after the procedure, including pain, redness, swelling,
drainage, or bleeding fr signs of generalized
infection, which may include headache, muscle aches, dizziness, or an
overall i or difficult or painful
urination.
Cystoscopy is a commonly performed procedure, but it is an invasive
technique that involves small yet significant risk. If anesthesia is
required, there is additional risk, particularly for people who are obese,
smoke, or are in poor health. Those undergoing anesthesia must inform the
doctor of any medications they are taking.
Normal results
A successful cystoscopy includes a thorough examination of the bladder and
collection of urine samples for cultures. If no abnormalities are seen,
the results are indicated as normal. In this case, the bladder wall
appears smooth and the bladder is seen to be of normal size, shape, and
position, without obstructions, growths, or stones.
The treating physician can tell the patient what was seen inside the
bladder right after the procedure. If a biopsy sample was taken, this will
take several days to be examined and tested.
Cystoscopy allows the urologist to detect inflammation of the bladder
lining, prostatic enlargement, or tumors. If these are seen, further
evaluation or biopsies may be needed. Cystoscopy with bladder distention
can also evaluate interstitial cystitis. Bladder stones, urethral
strictures, diverticula, or congenital abnormalities can also be detected.
Alternatives
There are procedures that can provide some information about the lining of
the bladder, for example, however, none of these provide as much
information to the doctor as a cystoscopy.
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organizations
American Urological Association. 1120 North Charles Street, Baltimore, MD
21201. (410) 727-1100.
American Foundation for Urologic Disease. 1128 North Charles Street,
Baltimore, MD 21201. (800) 242-2383.
Interstitial Cystitis Association. 51 Monroe Street, Suite 1402,
Rockville, MD 20850. (301) 610-5300.
Society of Urologic Nurses and Associates. East Holly Avenue, Box 56,
Pitman, NJ . (609) 256-2335.
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Jennifer E. Sisk Monique Laberge, PhD
WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?
Cystoscopy is typically performed on an outpatient basis, but up to three
days of recovery in the hospital is sometimes required. The procedure can
be performed in a hospital, doctor's office, cystoscopy suite, or
urology office, depending on the condition of the patient and the
anesthesia required. If general anesthesia is required, an
anesthesiologist is present to administer the anesthesia and monitor the
patient. The cystoscopy procedure is performed by a urologist, urologic
surgeon, or urogynecologist, with assistance from nurses experienced in
urologic procedures. If x rays are taken during the procedure, a
uroradiologist or radiologic technologist is required to operate the x-ray
equipment. Biopsy tissue samples are sent to the clinical laboratory for
examination by a pathologist.
QUESTIONS TO ASK THE DOCTOR
What will happen during the procedure?
How do I prepare for cytoscopy?
Will cystoscopy hurt?
How long will the test last?
How many cytoscopies do you perform each year?
Are there any risks associated with the procedure?
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