Cystoscopy

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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 Risks

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.

Cystoscopy Preparation

  • Depending on the type of procedure being performed, your doctor may prescribe antibiotics for you.
  • If the cystoscopy is going to be performed in the operating room with the use of anesthesia, the surgical department will contact you with instructions.
    • Most of the time, you must not take anything by mouth after midnight the evening before the cystoscopy. In recent years, however, some anesthesiologists have started to allow the consumption of certain liquids up to 4 hours before the procedure.
    • For procedures being done with only a local anesthetic, no fasting requirement is necessary.
    • Notify your doctor if you are taking any blood thinners, including warfarin (Coumadin), aspirin, and ibuprofen.

During the Cystoscopy Procedure

  • Two different types of cystoscopes can be used to perform the procedure: flexible and rigid.
    • The flexible scope can be used with the person lying flat, but can only be used for very minor procedures.
    • More frequently, the rigid cystoscope is used. This requires the person to be placed in a position similar to the way a woman is situated during a pelvic examination.
  • A local anesthetic is used. Sedation can be given by an anesthesiologist when the procedure is performed in an operating room. For prolonged procedures, general or spinal anesthesia is given.
  • Cystoscopy begins with thorough washing of the perineum (genital region).
  • Sterile drapes are applied. Then the cystoscope is lubricated and inserted into the urethra.
  • The urethra is examined as the scope is passed into the bladder. The bladder is drained and then filled with sterile water or an alternative solution. The bladder is examined as it is being filled and is periodically drained. During some procedures, the bladder is continuously irrigated.
  • The bladder is viewed directly through the cystoscope. A video camera can also be attached to the cystoscope so the images can be viewed on a television monitor. Different angled lenses on the end of the cystoscope allow the urologist to view the entire bladder.
  • The cystoscope has channels in it that allow the passage of instruments. This enables the urologist to perform transurethral procedures such as stone removal, prostate or bladder tumor resection, and cauterization. Cauterization involves the use of a small electric charge to stop bleeding.
  • When cystoscopy has been completed, fluid is drained from the bladder. Depending on the nature of the procedure being performed, a catheter may be left in place to continuously drain the bladder.

After the Cystoscopy Procedure

Most people undergoing cystoscopy will be able to go home the same day as the procedure. Recovery depends on the type of anesthesia. If only local anesthetic is used, you can go home immediately. For other people, a recovery period of 1-4 hours is necessary. During this observation period, the anesthetic will wear off, and you will need to be able to urinate prior to leaving.

Next Steps After Cystoscopy

You need to rest for 24 hours after the administration of anything but a local anesthetic. No driving or any other complex or dangerous tasks should be performed. Your doctor will instruct you on any physical limitations, including sexual activity. Even though the surgery is performed internally, there still may be a risk of bleeding with exertion. Take all antibiotics as prescribed.

When to Seek Medical Care for Cystoscopy Complications

Do not hesitate to call your doctor if you experience problems after the procedure.

  • It is common to experience some burning with urination, but this should go away quickly.
  • You may also see blood in the urine off and on for a couple of weeks. You need to call your doctor if you experience fever, excessive bleeding, urinary retention, or testicular pain.

At times, some of these situations could be managed at home but frequently will require immediate evaluation.

  • Fever after an operation such as cystoscopy can signal the onset of infection. Most often, either the urine or the kidneys or both will become infected. Urinary burning and frequency of urination are common symptoms of urinary tract infections. Some people may have only fever and vomiting. Pneumonia is a less frequent source of fever. Thrombophlebitis, an infection of the vein used for IV access during surgery, can also occur. Your doctor needs to be notified immediately if you develop a fever, even if you are already taking antibiotics. If the office is closed, you will frequently be referred to the Emergency Department for an evaluation.
  • Bleeding after cystoscopy is common. When you notice bleeding, rest and increase your fluid intake (unless you have a medical condition in which you should not). Notify your doctor at once if you feel that you are experiencing too much bleeding. An Emergency Department visit is generally necessary if your urine becomes so bloody that you could not read a newspaper through it or if you are passing blood clots in the urine. Your bladder may need to be washed out to remove the clots. You may need to be hospitalized to control the bleeding. Blood clots can block the flow of urine, causing urinary retention.
  • Acute urinary retention is a medical emergency. You should see your doctor or go to the Emergency Department. Do not wait long for your doctor to call you back because this condition can continue to become increasingly uncomfortable until the bladder is drained with a catheter.
  • Your doctor should be notified immediately if you experience testicular pain and swelling. You will likely need to be evaluated by a physician. Although this will usually reveal testicular inflammation or infection, torsion (a twisting of the testicle) needs to be ruled out.
REFERENCES:


1. Dairiki Shortliffe LM. Blood in the urine: Hematuria in infants and children. Stanford University School of Medicine. Department of Urology. Available at http://urology.stanford.edu/articles/bloodurine.html.


2. Health A to Z. How is bladder cancer diagnosed?. The Cancer Information Network. Available at http://www.cancerlinksusa.com/bladder/index.asp. Accessed June 9, 2000.

Medically reviewed by Michael Wolff, MD; American Board of Urology

REFERENCE:

"Diagnostic cystourethroscopy for gynecologic conditions"
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