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Cystoscopy is one specific diagnostic procedure that allows a doctor to examine the inside of patient’s bladder and urethra. What exactly is a urethra? The urethra is the tube that drains urine from bladder to the outside of body. It is important to know that the whole exam is done using a viewing instrument called a cystoscope- a thin, smooth tube equipped with a bright light and lenses.

Types of cystoscopy

There are two main types of cystoscopy - flexible and rigid - differing in the flexibility of the cystoscope.

  • Flexible cystoscopy

It is important to know that flexible cystoscopy is carried out using local anesthesia on both sexes. In most cases- Lidocaine gel is used as an anaesthetic, instilled in the urethra.

Flexible cystoscope is a fibre optic instrument that can bend easily and has a movable tip that makes it easy to pass along the curves of the urethra. Patients should know that this is more commonly used particularly for diagnosis and for the follow up of most bladder tumors.

  • Rigid cystoscopy

There isn't anything so much different with this type of cystoscopy accept the fact that it can be performed under the same conditions, but under general anesthesia, particularly in male subjects, due to the discomfort caused by the probe. What exactly is rigid cystoscope? Well, it is a solid straight telescope, which has been in use for many years. It is used alone with a high intensity light source.

Indications for cystoscopy

Every patient should know that cystoscopy could be extremely useful for finding out what is causing symptoms such as blood in the urine or difficulties with urination, and certain bladder conditions. It enables the doctor to inspect the bladder lining very closely for abnormal growths, bulges, ulcers or stones. Patient should also know that, during the procedure, the doctor may also take a biopsy for examination in the laboratory.
Cystoscopy can be useful in identifying some of the following problems in the lower part of urinary tract:

  • Urinary stones  
  • An enlarged prostate gland
  • Inflammation caused by infection or injury
  • Pouches in the bladder
  • Growths that may or may not be cancerous
  • frequent urinary tract infections
  • blood in your urine  
  • loss of bladder control or overactive bladder
  • unusual cells found in urine sample
  • need for a bladder catheter
  • painful urination, chronic pelvic pain, or interstitial cystitis
  • urinary blockage such as stricture, or narrowing of the urinary tract

Cystoscopy can also be used to treat some conditions such as:

  • Remove a stone from the bladder. If a stone is trapped in a ureter - doctor may extend the cystoscope up into a ureter
  • Obtain a urine sample from each of the ureters.  
  • Remove small polyps or tumors from the lining of the bladder.
  • Insert a small tube into a narrowed ureter which helps the flow of urine if there is a narrowing.
  • Perform a special x-ray of the ureters and kidneys.  
  • Remove the prostate gland 


Preparations for the procedure

Before anything else- doctor should first review patient’s medical and surgical histories, current medications and history of allergies. It is recommended that patient drink plenty of fluids before the procedure. Depending on the reason for your cystoscopy, patient may also need to use enemas and laxatives to clear bowels. In most cases, patient will be awake during the procedure because only local anesthesia is being used!  

The procedure

Cystoscopy and bladder biopsy is performed by a urologist—a surgeon who specializes in treating problems affecting the urinary tract. After the painkillers wear off, you may experience back pain, bladder spasms, a need to urinate more often than usual. Good thing for patients is that this procedure is routinely performed as an outpatient or day case, with no overnight stay in hospital. This is because it is usually done under local anaesthetic, which is given in the form of a gel placed into the opening of the urethra. In most cases- a cystoscopy only takes about five minutes to perform. Important thing for patients to know is that it is necessary to empty the bladder just before having the procedure. Of course, the fact is also that the procedure can't start immediately because when anaesthetic jelly is used, it will be squeezed into the urethra using a syringe, and will take effect in five to ten minutes. Then the procedure begins! The cystoscope will then be carefully passed into the urethra. It is a bit complicated when it is a case of male patient! Men may be asked to try passing urine while the cystoscope is being inserted. This is simply to help relax the muscles. Because the bladder is empty- no urine will come out! Once the end of the cystoscope is in the bladder, sterile water will be passed through it to fill the bladder up and make the whole of the lining visible. A tiny light and lens on the cystoscope enable the doctor to see any abnormal growths or disease.  What's most important- this procedure is quick and painless. After the examination, the cystoscope is removed quickly and easily.


What to expect afterwards

Well, logically- because the bladder will be full of water, it will probably be necessary to pass urine again once the procedure is finished. 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. Good thing about this procedure is that most people feel ready to go home after a short rest in a full-length chair or on a bed and most people feel able to resume normal activities on the following day. There are some things that every patient should know.

It is normal to experience mild stinging on passing urine for a day or two after this procedure. Drinking plenty of water can help this, and can also prevent the development of infection or inflammation. The recommended amount is about three liters of water over the course of 24 hours. If blood is present in the urine, patient shouldn’t be scared because it is completely normal! Drinking a little extra water and resting for an hour or two will usually settle things down. However, it is important to contact the hospital or a GP immediately if any of the following occur:

  • the bleeding does not seem to have slowed down after 24 hours,
  • it becomes difficult to pass urine,
  • there are any signs of infection such as a high temperature, pain or persistent burning on passing urine

Every patient should ask his or her doctor when you to resume vigorous exercise and sexual activity. 

Possible side effects and complications

Cystoscopy is generally a safe procedure. Everyone should know that side-effects are the unwanted but usually mild and temporary effects of a successful procedure. When we talk about cystoscopy, then we should know that the possible side effects that could occur are:

  • a small amount of discomfort after the procedure – this will settle in a few hours,
  • temporary swelling of the urethra after the procedure – this should not last long, but a narrow tube (catheter) may need to be temporarily left in the bladder to drain urine until the swelling goes down,
  • a stinging sensation when passing urine for a couple of days after the procedure,
  • a small amount of blood in the urine – this is quite normal, especially if a biopsy is taken, and should clear up gradually within 48 hours

Complications are unexpected problems that can occur during or after the procedure. Most people are not affected. However, the possible complications of a cystoscopy include:

  • Development of a urinary tract infection or inflammation, which requires treatment with some antibacterial medications.
  • Very rarely, the urethra or bladder may be damaged or perforated. This can lead to bleeding and infection, which may require treatment with medicines or surgery.
  • In a few cases, the cystoscopy is not successful and has to be repeated.

Risk of perforation

Although it is extremely rare- every patient should know about one complication unique to cystoscopy. It is the risk of perforation or a tear. A perforation can occur anywhere along the urinary tract—the urethra, bladder, or ureter. Of course- the risk of perforation increases with the complexity of the procedure being performed. Good thing is that most of these perforations can be managed conservatively, without open surgery. Similarly, a catheter can be placed into the bladder to divert urine from the bladder and urethra while a perforation heals.

Risks of scar tissue

It is no secret that Cystoscopy procedures can also create scar tissue. This tissue can cause a stricture, or narrowing, in the urethra. Of course, it isn't difficult to assume that all this may cause difficulties during urination. Sometimes an additional cystoscopy procedure is necessary to remove the scar tissue. This complication is almost exclusive to males.


Are there any alternatives to cystoscopy?

Unfortunately- it may be essential to have a cystoscopy in order to diagnose some bladder conditions. The cystoscope enables the doctor to view parts of the urethra and bladder that tend not to show up well on x-rays and in some cases- it is irreplaceable! Another form of cystoscopy, using a rigid rather than a flexible instrument can be used for giving treatment to the bladder and urinary tract.