What is Cystoscopy?
Cystoscopy is the use of a scope (cystoscope) to examine the bladder. This is done either to look at the bladder for abnormalities or to help with surgery being performed on the inside of the urinary tract (transurethral surgery).
- Areas that can be examined include the following:
- Urethra or urinary channel, which includes the prostate in men
- Bladder, which collects and stores urine
- The 2 ureters, which are small internal tubes that conduct the urine made by each kidney into the bladder
- A urologic surgeon, or urologist, performs cystoscopy. The procedure involves looking at the urinary tract from the inside. Abnormalities can be detected in this manner, and surgical procedures can be performed.
- You would commonly have cystoscopy for the evaluation of blood in the urine. There are many other indications for the procedure, including the evaluation of difficulty or painful voiding, bladder or urethral tumors, bladder stones, and prostate surgery.
- Simple procedures can be performed in the doctor's office with only a local anesthetic. Most procedures, however, are performed in a hospital operating room as an outpatient. A variety of different anesthetics can be used to make the procedure as comfortable as possible.
Cystoscopy is generally a safe procedure. Serious complications are rare. As with any surgery, there is the risk of infection, bleeding, and complications from the anesthesia. In all but the simplest procedures, antibiotics are used before the surgery to reduce the incidence of urinary tract infection. Bleeding is generally controlled during the procedure with the use of cautery.
- A complication unique to cystoscopy is the risk of perforation or a tear. A perforation can occur anywhere along the urinary tract-the urethra or bladder.A Foley catheter (a flexible rubberized tube) can be placed into the bladder to divert urine from the bladder and urethra while a perforation heals.
- Cystoscopic procedures can also create scar tissue. This tissue can cause a stricture, or narrowing, in the urethra, which may cause difficulties during urination. Sometimes an additional cystoscopic procedure is necessary to remove the scar tissue. This complication is almost exclusive to males and most commonly results from urethral manipulation such as resection of the prostate.
- Men can sometimes experience pain and swelling in the testicles after an extensive procedure. This is called epididymitis, or epididymo-orchitis, depending on the portion of the testicle involved. This complication is rare.
- For a variety of reasons, urinary retention (inability to urinate) can occur after cystoscopy. This will generally require the placement of a catheter to drain the bladder.
- Swelling caused by the procedure can obstruct the flow of urine.
- The bladder can also become distended during the procedure, which temporarily weakens the voiding muscles.
- Anesthesia plays a significant role in the development of urinary retention as well. Even people who have surgery in areas of the body away from the urinary tract can have difficulty urinating after surgery.
Scott H Plantz, MD, FAAEM
Francisco Talavera, PharmD, PhD
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