Cystoscopy
Definition
Cystoscopy (cystourethroscopy) is a diagnostic procedure that uses an endoscope especially designed for urological use to examine the bladder, lower urinary tract, and prostate gland. It can also be used to collect urine samples, perform biopsies, and remove small stones.
Purpose
Cystoscopy is performed by urologists to examine the entire bladder lining and take biopsies of any questionable areas. Cystoscopy may be prescribed for patients who display the following:
- blood in the urine (hematuria)
- inability to control urination (incontinence)
- urinary tract infection
- signs of congenital abnormalities in the urinary tract
- suspected tumors in the bladder
- bladder or kidney stones
- signs or symptoms of an enlarged prostate
- pain or difficulty urinating (dysuria)
- disorders of or injuries to the urinary tract
- symptoms of interstitial cystitis
Blood and urine studies, in addition to x rays of the kidneys, ureters, and bladder, may be performed before a cystoscopy to obtain as much diagnostic information as possible. During the cystoscopy, a retrograde pyelogram may also be performed to examine the kidneys and ureters.
Precautions
Cystoscopy is a commonly performed procedure, but it is an invasive technique that involves small yet significant risk. If anesthesia is required, there is additional risk, particularly for people who are obese, smoke, or are in poor health. Those undergoing anesthesia must inform the doctor of any medications they are taking.
Description
A cystoscopy typically lasts from 10 to 40 minutes. The patient is asked to urinate before surgery. A well-lubricated flexible or rigid cystoscope (urethroscope) is inserted through the urethra into the bladder where a urine sample is taken. Fluid is then injected to inflate the bladder and allow the urologist to examine the entire bladder wall. The cystoscope uses a lighted tip for guidance and enables biopsies to be taken or small stones to be removed through a hollow channel in the cystoscope.
During a cystoscopy, the urologist may remove bladder stones or kidney stones, gather tissue samples, and perform x-ray studies. To remove stones, an instrument that resembles a tiny basket or grasper is inserted through the cystoscope so that small stones can be extracted through the scope's channel. For a biopsy, specially designed forceps are inserted through the cystoscope to pinch off a tissue sample. Alternatively, a small brush-like instrument may be inserted to scrape off some tissue. To perform x-ray studies such as a retrograde pyelogram, a dye is injected into the ureters by way of a catheter passed through the cystoscope. After completion of all needed tests, the cystoscope is removed.
Preparation
Cystoscopy can be performed in a hospital, doctor's office, or outpatient surgical facility. Spinal or general anesthesia may be used for the procedure. Distension of the bladder with fluid is particularly painful, and if it needs to be done, as in the case of evaluating interstitial cystitis, general anesthesia is required. Cystoscopy is typically performed on an outpatient basis, but up to three days of recovery in the hospital is sometimes required.
Aftercare
Patients who have undergone a cystoscopy are instructed to:
- take warm baths to relieve pain
- rest and refrain from driving for several days, especially if general anesthesia was needed
- expect any blood in the urine to clear up in one to two days
- avoid strenuous exercise during recovery
- postpone sexual relations until the urologist determines that healing is complete
Patients may be prescribed pain relievers and antibiotics following surgery. Minor pain may also be treated with over-the-counter, non-prescription drugs such as acetaminophen.
Complications
As with any surgical procedure, there are some risks involved with a cystoscopy. Complications may include profuse bleeding, a damaged urethra, a perforated bladder, a urinary tract infection, or an injured penis.
Patients should contact their physician if they experience any of the following symptoms following the procedure: pain, redness, swelling, drainage or bleeding from the surgical site; signs of generalized infection, which may include headache, muscle aches, dizziness or an overall ill feeling and fever; nausea or vomiting; or difficult or painful urination.
Results
A successful cystoscopy includes a thorough examination of the bladder and collection of urine samples for cultures. If no abnormalities are seen, the results are indicated as normal.
Cystoscopy allows the urologist to detect inflammation of the bladder lining, prostatic enlargement, or tumors. If these are seen, further evaluation or biopsies may be needed. Cystoscopy with bladder distention can also evaluate interstitial cystitis. Bladder stones, urethral strictures, diverticula, or congenital abnormalities can also be detected.
Health care team roles
Cystoscopy is performed in a hospital operating room, cystoscopy suite, or urologist's office, depending on the condition of the patient and the anesthesia required. If general anesthesia is required, an anesthesiologist is necessary to administer the anesthesia and monitor the patient. The cystoscopy procedure is performed by a urologist, urologic surgeon, or urogynecologist, with assistance from nurses experienced in urologic procedures. If x rays are taken during the procedure, a uroradiologist or radiologic technologist is required to operate the x-ray equipment. Biopsy tissue samples are sent to the clinical laboratory for examination by a pathologist.
KEY TERMS
Diverticula—A pouch or sac occurring normally or from a herniation or defect in a membrane. Cystoscopy can detect diverticula in the urinary tract.
Endoscopy—A minimally invasive procedure that involves examination of body organs or cavities using an endoscope (a lighted optical instrument used to see inside body cavities). A cystoscope is a type of endoscope.
Interstitial cystitis—A chronic inflammatory condition of the bladder involving symptoms of bladder pain, frequent urination, and burning during urination. Diagnosis is confirmed by cystoscopy with the bladder distended by fluid.
Retrograde pyelogram—A pyelography or x-ray technique in which radiopaque dye is injected into the kidneys through the ureters.
Ureter—The tube that carries urine from the kidneys to the bladder.
Urethra—The tube that carries urine from the bladder to outside the body. In females, the urethral opening is between the vagina and clitoris; in males the urethra travels through the penis, opening at the tip.
Urogynecologist—A physician that specializes in female medical conditions concerning the urinary and reproductive systems.
Uroradiologist—A radiologist who specializes in diagnostic imaging of the urinary tract and kidneys.
Resources
BOOKS
Buckman, Robert. "Bladder." In What You Really Need to Know About Cancer: A Comprehensive Guide for Patients and Their Families. Baltimore, MD: The Johns Hopkins University Press, 1997.
Segen, Joseph C., and Joseph Stauffer. "Cystoscopy." In The Patient's Guide to Medical Tests: Everything You Need to Know About the Tests Your Doctor Prescribes. New York: Facts On File, 1998.
Tierney, Lawrence M., Jr., Stephen J. McPhee, and Maxine A. Papadakis, eds. "Urology." In Current Medical Diagnosis and Treatment. Stamford, CT: Appleton & Lange, 1996.
PERIODICALS
Sant, Grannum R., and Philip M. Hanno. "Interstitial Cystitis: Current Issues and Controversies in Diagnosis." Urology 57, Supplement 6A (June 2001): 82-88.
ORGANIZATIONS
American Urological Association. 1120 North Charles Street, Baltimore, MD 21201. (410) 727-1100. 〈http://www.auanet.org〉.
Interstitial Cystitis Association. 51 Monroe Street, Suite 1402, Rockville, MD 20850. (301) 610-5300. 〈http://www.ichelp.org〉.
Society of Urologic Nurses and Associates. East Holly Avenue, Box 56, Pitman, NJ 08071-0056. (609) 256-2335. 〈http://suna.inurse.com/〉.
OTHER
"What is IC? Interstitial Cystitis Fact Sheet." Interstitial Cystitis Association. 〈http://www.ichelp.org/whatisic/ICFActSheet.html〉.
