Cystoscopy

Endoscopy of the urinary bladder via the urethra is called cystoscopy. Diagnostic cystoscopy is usually carried out with local anaesthesia. General anaesthesia is sometimes used for operative cystoscopic procedures.

When a patient has a urinary problem, the doctor may use a cystoscope to see the inside of the bladder and urethra.

There are two main types of cystoscopy - flexible cystoscopy and rigid cystoscopy. Flexible cystoscopy requires only local anaesthesia (usually lidocaine, in the form of a gel, such as the brand name Instillagel). Rigid cytoscopy requires general anaesthesia due to the discomfort cause by the probe. However, rigid cystoscopy can be performed as a day case.

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. The cystoscope is as thin as a pencil and has a light at the tip. Many cystoscopes have extra tubes to guide other instruments for procedures to treat urinary problems.

A doctor may recommend cystoscopy for any of the following conditions:

• 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 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

If a patient has a stone lodged higher in the urinary tract, the doctor may extend the cystoscope through the bladder and up into the ureter. (The ureter is the tube that carries urine from the kidney to the bladder. When used to view the ureters, the cystoscope is called a ureteroscope.) 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. The doctor may also use the extra tube in the cystoscope 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 avoid urinating for an hour before this part of the test.

Patients generally wear a hospital gown for the examination, and the lower part of the body will be covered with a sterile drape. In most cases, patients lie on their backs with knees raised and apart. A nurse or technician will clean the area around the urethral opening and apply a local anesthetic.

Patients receiving a ureteroscopy may receive a spinal or general anaesthetic. (If you know this will be the case, you will want to arrange a lift home after the test.)

The doctor will gently insert the tip of the cystoscope into the urethra and slowly glide it up into the bladder. Relaxing the pelvic muscles helps make this part of the test easier. A sterile liquid (water or saline) 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 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. 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.

After the test, patients may have a mild burning feeling when they urinate and may see small amounts of blood in their urine. (These problems should not last more than 24 hours. Tell your doctor if bleeding or pain is severe or if problems last more than a couple of days.)

Common prescriptions to relieve discomfort after the test include:

• Drink 32 fluid ounces (1 L) of water over 2 hours.
• Ask your doctor if you can take a warm bath to relieve the burning feeling.
• Hold a warm, damp washcloth over the urethral opening.

Some doctors will prescribe an antibiotic to take for 1 or 2 days to prevent an infection. However, recent trends have been to discourage this kind of prophylactic treatment (prescribing antibiotics as a preventative when there is no other evidence of infection) because it tends to increase the rate at which bacteria develop resistance to the antibiotic drug. (If you have signs of infection - including pain, chills or fever - call your doctor.)

External links & References

• Cystoscopy and Ureteroscopy on the National Institute of Diabetes and Digestive and Kidney Diseases website (http://kidney.niddk.nih.gov/kudiseases/pubs/cystoscopy/)

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."de:Cystoskopie