Cystoscopy

What is Cystoscopy?

A cystoscopy is an interventional diagnostic and therapeutic procedure to examine the interior of the bladder and urethra using a thin camera called a cystoscope. This test is intended to look at the abnormalities in the ureters, bladder, and urethra, to assist surgeries performed on the inside of the urinary tract.  Urological surgeons can also treat medical conditions using surgical tools passed through the cystoscope. Men, women, and children can undergo cystoscopy. It can be performed with local anesthesia as an outpatient procedure or under general anesthesia with hospital admission.

What is examined during cystoscopy?

The areas examined with cystoscopy are:

– The urinary bladder, which collects and stores the urine
– Urethra or urinary channel including prostate in men
– The two ureter tubes connecting the kidney and the bladder
 
Cystoscopy helps detect:
 
– Structural abnormalities
– Bladder stones
– Ulcerations inside the urethra
– Growth of cancer
– Prostate enlargement in men
 
Cystoscopy is very useful in finding abnormalities concerning urinary tract and bladder. Cystoscopy is well tolerated by most people. It allows the doctor to diagnose the medical condition and give treatment accordingly.

Why do I need a Cystoscopy?

Initially, an X-ray, CT scan or an MRI is recommended to determine the cause. If these tests are not helpful in diagnosis then cystoscopy is performed to view the inside of the urethra. Cystoscopy helps:
 
– Evaluate the condition of the urethra
– Diagnose diseases of the urinary tract
– Examine any abnormal growth, structures, polyps and various other problems concerning the bladder
– Evaluate blood in the urine

The following symptoms are indicative of the need for a cystoscopy.
 
– Painful urination
– Pelvic pain
– Blood in the urine
– Frequent urination
– Recurring bladder infections

How is Cystoscopy Performed?

A urological surgeon performs a cystoscopy. Doctors may use either a flexible cystoscope or a rigid one depending upon the procedure envisaged. Usually, a flexible cystoscope is used for minor procedures whereas a rigid cystoscope helps with a complete examination of the bladder as well as treatment. The test follows the below-mentioned procedure:
 
– The patient needs to empty the bladder before the procedure.

– On the treatment table, the patient is asked to lie on the back. A sedative, local anesthesia or general anesthesia is given.
 
– The specialist lubricates the scope with a gel and inserts it into the urethra. If the purpose of the test is an investigation, then a flexible scope does the job.

– In case surgical instruments need to be used, or a tissue sample for biopsy is needed, then a larger scope is used.
 
– The lens on the end of the cystoscope projects the internal picture on a monitor, which enables the Doctor to examine the urethra and the bladder. Since the lens has different angles, the urologist can get the entire view of the bladder.

– The bladder is inflated with a sterile solution to allow the doctor to get a clear picture. The patient can urinate after completing the procedure.

– If the doctor suspects unwanted growth inside the urethra, a sample for biopsy is taken. 

What procedures can be performed during a cystoscopy?

Your urologic surgeon may perform the following therapeutic procedures during cystoscopy

Cystolitholapaxy: The scope allows the Urologist to break and remove bladder stones.

Retrograde pyelogram: During this procedure, the specialist guides the thin tubes up to the kidneys. The radiocontrast agent is injected to view the blockages. This procedure allows the doctor to get a clearer picture of the reason for the blockage in the urine passage.

Cauterization: A sample of the lining of the bladder is taken to investigate abnormalities. The urologist may decide to treat minor abnormalities using a heat probe, which is called cauterization.

Transurethral resection of a bladder tumor: Doctors use a cystoscopy test to diagnose and stage tumors and also perform a transurethral resection of bladder tumor (TURBT) to get rid of early-stage bladder cancer.

Ureteroscopy: A thin tube called ureteroscope is inserted through the urethra, bladder, and the ureters to see what is blocking the urine.

Ureteral stents: Placement, replacement, or removal of stents is also performed. These stents keep the ureters open for the passing of urine. If the doctor finds improvement in kidney function, he may remove the stents.

Under general anesthesia, the time taken from the insertion of the scope to the removal is only a few minutes. It will take longer if the doctor finds a stone and decides to remove it. It does not take longer than 15 to 30 minutes for this procedure. But, the patient has to spend half a day or more to recover from the effects of anesthesia. Simple cystoscopy takes about an hour including the preparation.

What is the price for Cystoscopy in India?

The cost of a cystoscopy can be high and is dependent on the facilities provided such as operation theater costs, consultation, and cost of treatment. In India, the price for this procedure can vary between Rs. 20,000/- Rs. 2, 00,000 /-. 

When will I get the results?

Most often, the results are available for the patient on the same day, except for the biopsy result, which will take a week or even more.

What do the results mean?

Doctors interpret the results by looking at the images on the monitor connected to the lens. They may decide on removing the stones if any, or take a sample for a biopsy if they suspect tumor growth. Follow up appointment is necessary with the doctor after the procedure to interpret the result and to decide on the future course of treatment. If the biopsy report confirms cancer, then chemotherapy, radiation, or surgery or a combination of these is used for treatment.

Do I need to fast for a cystoscopy?

If cystoscopy is performed under general anesthesia, then it is important to be on an empty stomach. Do not eat or drink anything at least for 4 to 5 hours prior to the procedure. Fasting is not needed for cystoscopy performed under local anesthesia

What else do I need to know before cystoscopy?

It is imperative to inform your doctor about the medications being used especially blood thinners like Aspirin, Ibuprofen, and Warfarin. Information regarding any allergies or known reaction to medications must be passed on to your physician.

Cystoscopy is a painful procedure as it involves inserting a thin tube with a lens into the bladder. After the test, the urethra may be sore. You may experience a burning sensation during urination for a day. There could also be spots of blood in the urine. Consult the doctor if the symptoms last more than a day.

For a few days after the surgery, do not drive or perform complex activities. There will also be restrictions on physical activity of any form, including sexual activity. The risk of bleeding due to exertion is high.

What are the risks involved with cystoscopy?

You need to be aware of the risks, side effects and complications of cystoscopy

Risk of bleeding: Infections and complications may arise after a cystoscopy. To avoid potential infections, doctors start them on an antibiotic course before the procedure. The bladder can get damaged during cystoscopy causing blood in the urine. This requires immediate medical attention.

Scar tissue: During a cystoscopy, scar tissue can lead to a stricture or narrowing of the urethra. This will cause difficulties in urination. An additional cystoscopy may be done to remove the scar tissue. This kind of complication occurs in males.

Anesthesia: General anesthesia given for any kind of procedure can cause difficulty in urination.

Urinary tract infection: A most common complication of a cystoscope is urinary tract infection. Infection can develop in the bladder, kidney or the ureters. Factors that also contribute to an infection in the urinary tract are unusual anatomy of the body, advanced age, and smoking.

Urinary retention: In the case of urinary retention after the procedure, a catheter is inserted to drain the bladder. Swelling caused because of cystoscopy can temporarily obstruct the urine flow.

Rupture: During the procedure, there is a slight chance of a rupture occurring in the bladder.

Hyponatremia: This condition disturbs the natural balance of sodium in the body.

Epididymitis: This is a rare complication where men experience pain and swelling in the testicles after the procedure.

What are the serious complications associated with this procedure?

Some of the serious complications of cystoscopy that need immediate medical attention are as follows:

– Pain or burning sensation in the urine that lasts more than a day
– High fever associated with chills
– Abdominal pain and nausea which does not get better with the medicine
– Blood clots or bright red blood in the urine
– Inability or extreme difficulty to urinate
– Pain in the lower back or side

Is a Cystoscopy advisable during pregnancy?

Pregnant women need to discuss the pros and cons of cystoscopy with their health care provider. If cystoscopy has to be performed during pregnancy, Urologists surgeons use Flexible cystoscopy under local anesthesia, as this was found to be most beneficial.

Can a Cystoscopy be performed for newborns?

Specialists do perform cystoscopy on newborns with genito-urinary malformation. The availability of neonatal operative urethrocystoscope is a boon to many newborns with pathological genito-urinary conditions. Cystoscopy thus offers hope in effective diagnosis as well as treatment for newborns.

What are few dos and don’ts of cystoscopy?