Cystoscopy

Bladder Problems Find out the different types, and ways to overcome this common problem.

Key Terms: Cystoscopy with bladder distention, Endoscopy, Glomerulation, Retrograde pyelogram, Ureter.

Definition

Cystoscopy (cystourethroscopy) is a diagnostic procedure that is used to look at the bladder (lower urinary tract), collect urine samples, and examine the prostate gland. Performed with an optic instrument known as a cystoscope (urethroscope), this instrument uses a lighted tip for guidance to aid in diagnosing urinary tract disease and prostate disease. Performed by a urologist, this surgical test also enables biopsies to be taken or small stones to be removed by way of a hollow channel in the cystoscope.

Purpose

Categorized as an endoscopic procedure, cystoscopy is used by urologists to examine the entire bladder lining and take biopsies of any areas that look questionable. This test is not used on a routine basis but may benefit the urologist who needs further information about a patient who displays the following symptoms or diagnosis:

• blood in the urine (also known as hematuria)
• incontinence, or the inability to control urination
• a urinary tract infection
• a urinary tract that display signs of congenital abnormalities
• tumors located in the bladder
• the presence of bladder or kidney stones
• a stiffness or strained feeling of the urethra or ureters
• symptoms of an enlarged prostate

Blood and urine studies, in addition to x rays of the kidneys, ureters, and bladder may all occur before a cystoscopy. At the time of the procedure, a retrograde pyelogram may also be performed. Additional blood studies may be needed immediately following cystoscopy.

Precautions

While the cystoscopy procedure is commonly relied on to gather additional diagnostic information, it is an invasive surgical technique that may involve risks for certain patients. Those who are extremely overweight (obese), smoke, are recovering from a recent illness, or are treating a chronic condition may face additional risks from surgery.

Surgical risk also increases in patients who are currently using certain drugs including antihypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; beta blockers; or cortisone. Those who use mind-altering drugs also put themselves at increased risk of complications during surgery. The following mind-altering drugs should be avoided: narcotics, psychedelics, hallucinogens, marijuana, sedatives, hypnotics, or cocaine.

Description

Depending on the type of information needed from a cystoscopy, the procedure typically takes 10–40 minutes to complete. The patient will be asked to urinate before the procedure, which allows an accurate measurement of the remaining urine in the bladder. A well-lubricated cystoscope is inserted through the urethra into the bladder, where a urine sample is taken. Fluid is then pushed in to inflate the bladder and allow the urologist to examine the entire bladder wall.

During an examination, the urologist may take the following steps: remove either bladder or kidney stones; gather tissue samples; and treat any suspicious lesions. In order to perform the x-ray studies known as a retrograde pyelogram, a harmless dye is injected into the ureters by way of a catheter that is passed through the previously placed cystoscope. After completion of all needed tests, the cystoscope is removed.

Preparation

A cystoscopic procedure can be completed in a hospital, a doctor's office, or an outpatient surgical facility. An injection of spinal or general anesthetic may be used prior to a cystoscopy. Although this test is typically performed on an outpatient basis, a patient may require up to three days' recovery in the hospital.

Aftercare

Patients who have undergone a cystoscopy will be instructed to follow these steps to ensure a quick recovery:

• Because of soreness or discomfort that may occur in the urethra, especially while urinating, several warm baths a day are recommended to relieve any pain.
• Allow four days for recovery.
• Be aware that blood may appear in the urine. This is common and soon clears up in one to two days following the procedure.
• Avoid strenuous exercise for a minimum of two weeks following cystoscopy.
• Sexual relations may continue when the urologist determines that healing is complete.
• Wait at least two days after surgery before driving.

Patients may also be prescribed pain relievers and antibiotics following surgery. Minor pain may also be treated with over-the-counter, nonprescription drugs such as acetaminophen.

Risks

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 also contact their physician if they experience any of the following symptoms following surgery: pain at or redness or swelling around the surgical site; drainage or bleeding from the surgical site; signs of infection, which may include headache, muscle aches, dizziness, an overall ill feeling, and fever; nausea or vomiting; strenuous or painful urination; or symptoms that may result as side effects from the medication.

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.

Questions to Ask the Doctor

• Why do I need a cystoscopic examination?
• How long will a cystoscopic procedure take?
• How long is recovery from a cystoscopic procedure?

Abnormal Results

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, in addition to the removal of some tumors.

Resources

Periodicals

Chew, Lisa, and Stephan D. Fihn. "Recurrent cystitis in nonpregnant women." Western Journal of Medicine 170 (May 1999): 274-277.

Gilmour, D.T., P.L. Dwyer, and M.P. Carey. "Lower urinary tract injury during gynecologic surgery and its detection by intraoperative cystoscopy." Obstetrics and Gynecology 5, no. 2 (1999): 883-889.

Neumayer, Leigh, A., Mary K. Mastin, and Douglas M. Hinson. "Performance Standards: Piece of Cake or Pie in the sky?" Journal of Surgical Research 88 (2000): 47-50.

Organizations

American Cancer Society. 1599 Clifton Road, NE, Atlanta, GA 30329-4251. (800)ACS-2345. http://www.cancer.org/. The American Cancer Society (ACS) is a nationwide community-based voluntary health organization dedicated to eliminating cancer as a major health problem and is the largest source of private, nonprofit cancer funds. The ACS hopes to prevent cancer, save lives, and diminish suffering from cancer through research, education, advocacy, and service.

Interstitial Cystitis Association (ICA). 51 Monroe Street, Suite 1402, Rockville, MD 20850. 1-800-HELP-ICA. http://www.ichelp.org. Founded in 1984, the ICA is a not-for-profit health organization dedicated to providing patient and physician educational information and programs, patient support, public awareness, and research funding.

National Institute of Diabetes & Digestive & Kidney Disease. Office of Communications and Public Liaison, NIDDK, NIH, 31 Center Drive, MSC 2560, Bethesda, MD 20892-2560. NIDDK_Inquiries@nih.gov. http://www.niddk.nih.gov. Mission to understand, treat, and prevent diseases, such as diabetes and obesity, digestive diseases such as hepatitis and inflammatory bowel disease, kidney and urologic diseases such as kidney failure and prostate enlargement, and blood diseases such as the anemias.

National Kidney and Urologic Diseases Information Clearinghouse. 3 Information Way, Bethesda, MD 20892-3580. 1-800-891-5390. nkudic@info.niddk.nih.gov. http://www.niddk.nih.gov/health/kidney/nkudic.htm. Knowledge and understanding about diseases of the kidneys and urologic system among people with these conditions and their families, health care professionals, and the general public.

—Beth A. Kapes

View more Health videos

Examination of the bladder by means of a cystoscope, which is introduced into the urinary meatus and passed through the urethra and into the bladder.
A catheter can be passed through the cystoscope into the bladder or, if necessary, beyond, into the ureters and kidneys. In this way samples of urine can be obtained for diagnostic purposes. Also, radiopaque fluids can be injected into the bladder or ureters for x-rays of the urinary tract. See also pyelography.

Cystoscopy
Intervention
A sterile flexible cystoscope in an operating theatre
ICD-9-CM	57.31-57.33
MeSH	D003558

Cystoscopy (si-ˈstäs-kə-pē) is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope.

Diagnostic cystoscopy is usually carried out with local anaesthesia. General anaesthesia is sometimes used for operative cystoscopic procedures.

The urethra is the tube that carries urine from the bladder to the outside of the body. The cystoscope has lenses like a telescope or microscope. These lenses let the doctor focus on the inner surfaces of the urinary tract. Some cystoscopes use optical fibres (flexible glass fibres) that carry an image from the tip of the instrument to a viewing piece at the other end. Cystoscopes range from between the thickness of a pencil, up to approximately 9mm and have a light at the tip. Many cystoscopes have extra tubes to guide other instruments for surgical procedures to treat urinary problems.

There are two main types of cystoscopy - flexible and rigid - differing in the flexibility of the cystoscope. Flexible cystoscopy is carried out with local anaesthesia on both sexes. Typically, a topical anesthetic, most often xylocaine gel (common brand names are Anestacon and Instillagel) is employed. The medication is instilled into the urethra via the urinary meatus five to ten minutes prior to the beginning of the procedure. Rigid cystoscopy can be performed under the same conditions, but is generally carried out under general anaesthesia, particularly in male subjects, due to the pain caused by the probe.

Contents 1 Medical uses 2 Male and female urinary tracts 3 Test Procedures 4 Post Procedural Care and Information 5 Notes 6 References

Medical uses

Cystoscopy may be recommended for any of the following conditions:^[1]

• Frequent urinary tract infections
• Blood in the urine (hematuria)
• Loss of bladder control (incontinence) or overactive bladder
• Unusual cells found in urine sample
• Need for a bladder catheter
• Painful urination, chronic pelvic pain, or interstitial cystitis
• Urinary blockage such as from prostate enlargement, stricture, or narrowing of the urinary tract
• Stone in the urinary tract
• Unusual growth, polyp, tumor, or cancer

Male and female urinary tracts

Images from a cystoscopy. The top two images show the interior of the bladder of a male patient. In the top-right image, the cystoscope has been bent within the bladder to look back on itself. The bottom two images show an inflamed urethra

If a patient has a stone lodged higher in the urinary tract, the doctor may use a much finer calibre scope called a ureteroscope through the bladder and up into the ureter. (The ureter is the tube that carries urine from the kidney to the bladder). The doctor can then see the stone and remove it with a small basket at the end of a wire which is inserted through an extra tube in the ureteroscope. For larger stones, the doctor may also use the extra tube in the ureteroscope to extend a flexible fiber that carries a laser beam to break the stone into smaller pieces that can then pass out of the body in the urine.

Test Procedures

Doctors may have special instructions, but in most cases, patients are able to eat normally and return to normal activities after the test. Patients are sometimes asked to give a urine sample before the test to check for infection. These patients should ensure that they do not urinate for a sufficient period time, such that they are able to urinate prior to this part of the test.

Patients will have to remove their clothing covering the lower part of the body, although some doctors may prefer if the patient wears a hospital gown for the examination and covers the lower part of the body with a sterile drape. In most cases, patients lie on their backs with their knees slightly parted. Occasionally, a patient may also need to have their knees raised. This is particularly when undergoing a Rigid Cystoscopy examination. For flexible cystoscopy procedures the patient is almost always alert and a local anesthetic is applied to reduce discomfort. In cases requiring a rigid cystoscopy it is not unusual for the patient to be given a general anesthetic, as these can be more uncomfortable, particularly for men. A doctor, nurse or technician will clean the area around the urethral opening and apply a local anesthetic. The local anesthetic is applied direct from a tube or needleless syringe into the urinary tract. Often, skin preparation is performed with Hibitane^[2]

Patients receiving a ureteroscopy may receive a spinal or general anaesthetic.

The doctor will gently insert the tip of the cystoscope into the urethra and slowly glide it up into the bladder. The procedure is more painful for men than for women due to the length and narrow diameter of the male urethra. Relaxing the pelvic muscles helps make this part of the test easier. A sterile liquid (water, saline, or glycine solution) will flow through the cystoscope to slowly fill the bladder and stretch it so that the doctor has a better view of the bladder wall.

As the bladder reaches capacity, patients typically feel some mild discomfort and the urge to urinate.

The time from insertion of the cystoscope to removal may be only a few minutes, or it may be longer if the doctor finds a stone and decides to remove it, or in cases where a biopsy is required. Taking a biopsy (a small tissue sample for examination under a microscope) will also make the procedure last longer. In most cases, the entire examination, including preparation, will take about 15 to 20 minutes.

Post Procedural Care and Information

This section does not cite any references or sources. Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed. (December 2011)

After the test, patients often have some burning feeling when they urinate and often see small amounts of blood in their urine. Procedures using rigid instrumentation often result in urinary incontinence and leakage from idiopathic causes to urethral damage. Occasionally, patients may feel some lower abdominal pains, reflecting bladder muscle spasms, but these are not common.

Common (non-invasive) prescriptions to relieve discomfort after the test may include:

• Drinking 32 fluid ounces (1 L) of water over 2 hours.
• Taking a warm bath to relieve the burning feeling.
• Holding a warm, damp washcloth over the urethral opening.

Prior to the early 1990s, it was common practice for the physician performing the procedure to prescribe an antibiotic to take for a few days to prevent an infection. Since that time, many urologists will order a "Urine C & S" (urinalysis with bacterial/fungal cultures and testing for sensitivities to anti-infective medications) prior to the performance of the cystoscopy, and as part of the pre-operative workup. Depending on the results of the testing and other circumstances, he or she may elect to prescribe a 10 to 14 day course of antibiotic or other anti-infective treatment, commencing 3 days before the cystoscopy is to be performed, as this may alleviate some inflammation of the urethra prior to the procedure. This practice may provide an additional benefit by preventing an accidental infection from occurring during the procedure. The full-course of antibiotic treatment also lessens the possibility of the bacteria becoming resistant to the antibiotic/anti-infective agent prescribed.

Physicians may also prescribe an oral urinary analgesic, Phenazopyridine or a combination (urinary) analgesic/anti-infective/anti-spasmodic medication containing Methylene Blue, Methanamine, Hyoscyamine Sulfate and Phenyl Salicylate for irritation and/or dysuria patients may experience after the procedure. At two weeks post-procedure, the practitioner may order a follow-up evaluation including a repeat of the urinalysis with cultures and sensitivities, and a Uroflowmetric study (which evaluates the volume of urine released from the body, the speed with which it is released, and how long the release takes).

Notes

1. ^ Cystoscopy and Ureteroscopy - The Doctors Lounge(TM)
2. ^ http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS-%20(General%20Monographs-%20H)/HIBITANE.html

References

• Cystoscopy and Ureteroscopy on the National Institute of Diabetes and Digestive and Kidney Diseases website
• IMAJ Study into the Adverse Effects of Cystoscopy and its impact on patients quality of life and sexual performance (Vol 6, August 2004) http://www.ima.org.il/imaj/ar04aug-7.pdf
• An earlier version of this article was adapted from the public domain NIH Publication No. 01-4800, at http://www.niddk.nih.gov/health/kidney/pubs/cystoscopy/cystoscopy.htm which says, "This e-text is not copyrighted. The clearinghouse encourages users of this e-pub to duplicate and distribute as many copies as desired."

v d e Urologic surgical and other procedures (ICD-9-CM V3 55-59+89.2, ICD-10-PCS 0T) Kidney Nephrostomy (Percutaneous nephrostomy) · Nephrotomy · Endoscopy (Nephroscopy) · Renal biopsy · Nephrectomy · Kidney transplantation · Nephropexy Ureter Ureterostomy · Urinary diversion · Ureterosigmoidostomy · Ureterolysis · Endoscopy (Ureteroscopy) Urinary bladder Cystectomy (Suprapubic cystostomy) · Endoscopy (Cystoscopy) Urethra Urethropexy · Urethrotomy · Urethral sounding · Urethroplasty General Medical imaging: Pyelogram (Intravenous pyelogram, Retrograde pyelogram) · Kidneys, ureters, and bladder x-ray · Radioisotope renography · Cystography · Retrograde urethrogram · Voiding cystourethrogram Urodynamic testing (Cystometry) Urinary catheterization · Dialysis Lithotripsy: Laser lithotripsy · Extracorporeal shock wave lithotripsy M: URI anat/phys/devp/cell noco/acba/cong/tumr, sysi/epon, urte proc/itvp, drug (G4B), blte, urte

v d e Endoscopy GI tract upper: pharyngoscopy (pharynx) · esophagogastroduodenoscopy (esophagus, stomach, duodenum) lower: enteroscopy (small intestine) · colonoscopy (colon) · sigmoidoscopy (sigmoid colon, rectum) · rectoscopy (rectum) · proctoscopy (rectum, anus) · anoscopy (anus) · capsule endoscopy accessory: cholangioscopy (bile duct) Respiratory tract rhinoscopy (nose) · laryngoscopy (larynx) · bronchoscopy (trachea, bronchi) Urinary tract nephroscopy (kidney) · ureteroscopy (ureter) · cystoscopy (urinary bladder) Female reproductive system gynoscopy · colposcopy (cervix) · hysteroscopy (uterus) · falloposcopy (fallopian tubes) · culdoscopy Closed cavity via incision laparoscopy [peritoneoscopy) (abdominal, pelvic cavity) · arthroscopy (joint cavity) · thoracoscopy (pleural cavity) · mediastinoscopy (mediastinum) · coelioscopy (abdominal cavity) During pregnancy amnioscopy (amniotic sac) · fetoscopy (fetus) · embryoscopy (embryo) Cardiovascular angioscopy Others otoscopy (ear) · antroscopy (maxillary sinus) · ventriculoscopy (brain ventricles)

This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)