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Cystoscopy

Cystoscopy is a medical procedure to explore the bladder with a cytoscope, a small camera with magnification. The bladder is accessed by the cytoscope through the urethra. This procedure is used as a diagnostic tool for the medical provider.

Reasons for Procedure

There are several complaints from patients that would make this procedure a consideration of the medical provider. Patients that present with chronic urinary tract infections, decrease in bladder control, abnormal urine findings, pain in the area of the bladder or urethra, prostate enlargement or unusual growths would benefit from the procedure. A patient that is to use urinary catheters in the future might also be scoped to rule out any future problems and to fit with the proper size of catheter.

Any patient who presents with persistant kidney stones, large pieces of calcium that block the urinary system, might have the procedure as a diagnostic tool or an aid in removing the stones. Once the scope is placed in the urethra, it can remove any pieces with a tiny basket on the end or break up the stones so that the body can pass them out on its own. This special scope is called an urteroscope and is a smaller caliber than the typical cytoscope.

Types of the Procedure

The three types of the procedures are based on the equipment that is used. The cytopscope is either flexible, rigid or blue light and the one chosen is based on the reason for the procedure. The cystoscope has lenses that magnify the area so that the medical provider can see the image on a viewing piece at the other end, rather than exploratory surgery. The provider can see the inner surfaces of the urinary system without causing trauma to the area. The size of the scope can range from 9mm to the thickness of a pencil. Some scopes have the ability to have tools attached to the end to perform procedures as well.

With the flexible scope, the patient will receive local anesthesia whether male or female. A numbing gel will be placed on the area while the patient remains alert. Another type, the rigid, requires general anesthesia due to the pain during the procedure. The procedure is particularly more painful for the males because of the smaller diameter of their urethra, the tube that runs from the bladder to excrete urine.

The last type, the blue light, is for special circumstance. This procedure is performed on patients with possible cancer or abnormal growths. A photosensitizing agent is placed in the bladder before the blue light cystoscope is inserted. The photosensitive agent will accumulate in malignant cells rather than the non-malignant. This action will illuminate the growths for the examiner.

Procedure

The patient will be placed on the procedure table in a gown exposed from the waist down. The patient will need to place their legs open so that the urethra is accessible. The numbing medication, xylocaine, is placed in the urinary opening about 5-10 minutes before the procedure.  Some patients will be asked to give a urine sample before the procedure but no other restrictions are typical prior to the test.

A sterile drape will be placed across the patient’s body and all areas around the urethral opening will be cleaned by the technician in preparation. If the patient is to have the rigid cystoscope, then they would now receive the spinal or general anesthesia.

Once the area is numb or the patient is under sedation, the physican will insert the cystoscope into the urethral opening. The cystoscope will fill the bladder with sterile water at the physician’s control. Filling the bladder will stretch the walls for more thorough visual inspection. This part of the test might make the patient uncomfortable and give a feeling of needing to urinate. The physician will coach the patient on how to relax certain muscles to help reduce the amount of pain felt.

This procedure should only take a few minutes for the physician to inspect the walls and rule out blockages. If the physician does find a stone and decides to remove it, then it will extend the procedure. Or if the physician decides to take a biopsy after finding abnormal cells, then that will also lengthen the time. At the most, the procedure will take 15 -20 minutes.

Post Procedure Expectations

Any time a foreign object is introduced into the body, there is an inflammatory response. The body will try to protect the patient with the inflammatory response in the urethra. This response does have swelling involved so urinating after the event could be slightly painful. There might be small amounts of blood in the urine as well. Unfortunately, there is a possibility of chronic incontinence or bladder spasms with the rigid cystoscope and should be discussed with the patient prior to the procedure.

The patient should drink plenty of water afterwards and could seek some relief from the burning sensation with a warm bath or just warmth to the area.

Image Caption: A cystoscope in an operating theatre, prior to a cystoscopy. Credit: Michael Reeve/Wikipedia (CC BY-SA 3.0)

Cystoscopy


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