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Cystoscopy is a test that allows your doctor to look at the interior lining of the bladder and the urethra. The cystoscope is a thin, lighted viewing instrument that is inserted into the urethra and advanced into the bladder. The cystoscope is inserted into your urethra and slowly advanced into the bladder while your doctor looks through the scope to examine the inside of the urethra. Your doctor then examines the inside of your bladder for stones, tumors, bleeding, and infection. Cystoscopy allows your doctor to look at areas of your bladder and urethra that usually do not show up well on X-rays. Tiny surgical instruments can be advanced through the cystoscope that allow your doctor to remove samples of tissue (biopsy) or samples of urine from each kidney. Cystoscopy can also be used to treat some bladder problems. Small bladder stones and some small growths can be removed by using tiny surgical instruments that slide through the cystoscope. This may eliminate the need for more extensive surgery. Why It Is DoneCystoscopy may be done to:
Evaluate symptoms that affect the urinary tract. These symptoms include blood in the urine (hematuria), painful urination (dysuria), urinary incontinence, urinary frequency or hesitancy, an inability to pass urine (retention), or a sudden and overwhelming need to urinate (urgency).
Evaluate problems of the urinary tract, such as frequent, repeated urinary tract infections or urinary tract infections that do not respond to treatment.
Define urinary tract anatomy. For example, cystoscopy can help your doctor determine the extent of blockage in the urethra caused by an enlarged prostate.
Evaluate problems that cannot be seen on X-ray or to further investigate problems detected by ultrasound or during intravenous pyelography, such as kidney stones or tumors.
Remove tissue samples for biopsy.
Remove foreign bodies.
Place ureteral catheters (stents) to help urine flow from the kidneys to the bladder.
Treat urinary tract problems. Special surgical instruments can be advanced through the cystoscope to treat certain problems. For example, cystoscopy can be done to remove urinary tract stones or growths, treat bleeding in the bladder, relieve obstructions in the urethra, or treat tumors with electrocautery or laser or local chemotherapy. Also, cystoscopy can be done to place a catheter in the ureter for an X-ray test called retrograde pyelography. While looking through the cystoscope into the bladder, your doctor threads a thin tube (catheter) through the cystoscope and into one of the ureters. A dye that shows up on an X-ray picture is injected through the catheter to fill and outline the ureter and the inside of the kidney
How To PrepareTell your doctor if you: - Have allergies to any medications, including anesthetics.
- Have had bleeding problems or take blood-thinning medication.
- Are or might be pregnant.
You will be asked to sign a consent form before the procedure. Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will indicate. Complete the medical test information form to help you understand the importance of the test. Cystoscopy can be performed with local, spinal, or general anesthesia. Discuss with your doctor which method is best for you and whether you should plan on staying overnight in the hospital. If you will not be staying in the hospital, arrange for someone to drive you home after the test. If a local anesthetic is used, you may eat and drink normally before the test. If a general or spinal anesthetic is used, do not eat or drink anything for at least 8 hours before the test.
You should empty your bladder just before the procedure. You may be given antibiotic pills to prevent a urinary tract infection that could be caused by the test. How It Is DoneCystoscopy is performed by a urologist, with one or more assistants. The procedure is done in a special testing room in a hospital or the doctor's office. You will need to take off all or most of your clothes, and you will be given a cloth or paper covering to use during the test. About an hour before the test, you may be given a sedative to help you relax. An intravenous (IV) needle may be placed in a vein in your arm to give you other medications and fluids. You will lie on your back on a special table with your knees bent, legs apart, and your feet or thighs may be supported by stirrups. If a flexible cystoscope is used, you will lie flat on your back instead of having your legs supported by stirrups. Your genital area is cleaned with an antiseptic solution, and your abdomen and thighs are covered with sterile cloths. An anesthetic gel may be injected into the urethra through a syringe to reduce discomfort if you are having local anesthesia only. If a general anesthetic is used, you will be put to sleep either with a medication given through an IV or by inhaling gases through a mask, or both methods may be used. If a local anesthetic is used, the anesthetic solution or jelly is inserted in your urethra. If a spinal anesthetic is used, the area on the back where the needle will be inserted is first numbed with a local anesthetic, then the needle is guided into the spinal canal and the anesthetic is injected. A spinal anesthetic may prevent movement of the legs until the anesthetic wears off. After the anesthetic takes effect, a well-lubricated cystoscope is inserted into your urethra and slowly advanced into your bladder. If your urethra has a spot that is too narrow to allow the scope to pass, other smaller instruments are inserted first to gradually enlarge the opening. Once the cystoscope is inside your bladder, solution (either sterile water or saline) is injected through the scope to help expand your bladder and to create a clear view. A medication may also be injected through the scope to reduce the risk of infection. Tiny instruments may be inserted through the scope to collect tissue samples for biopsy; the tissue samples then are sent to the laboratory for analysis. The cystoscope is usually in your bladder for only 2 to 10 minutes. However, the entire procedure may take from 5 to 45 minutes, or longer if X-ray tests called contrast studies (such as retrograde pyelography or cystourethrography) are also performed. A common but temporary side effect of this test is swelling in the urethra. A urinary catheter may be left in your bladder to help drain the urine until the swelling in your urethra has subsided. If a local anesthetic is used, you may be able to get up immediately after the test. If a general anesthetic is used, you will stay in the recovery room until you are awake and able to walk (usually an hour or less). You can eat and drink as soon as you are fully awake and can swallow without choking. If a spinal anesthetic was used, you will stay in the recovery room until sensation and movement below your chest returns (usually about an hour). How It FeelsMost people report that this procedure is not nearly as uncomfortable as they had expected. If a general anesthetic is used, you will feel nothing during the procedure, but after the anesthetic wears off your muscles may feel tired and achy. Some people experience nausea after receiving a general anesthetic. If a local anesthetic is used, you may feel a burning sensation or an urge to urinate when the instrument is inserted and removed. Also, when your bladder is irrigated with sterile water or saline, you may feel a cool sensation, an uncomfortable fullness, and an urgent need to urinate. Try to relax during the procedure by taking slow, deep breaths. Also, if the procedure is lengthy, lying on the table can become tiring and uncomfortable. If a spinal anesthetic is used, you may find it uncomfortable to lie curled up on your side while the anesthetic is injected. You will probably feel a brief stinging sensation when the anesthetic is injected. You may feel tired and have a slight backache the day after the test. RisksCystoscopy generally is a very safe procedure. If a general anesthetic is used, there is a small risk of death from the anesthetic (less than 1 in 3,000). There is no risk of loss of sexual function. The most common complication is a temporary swelling of the urethra, which may make it difficult to urinate. A catheter inserted in your bladder can help drain the urine until the swelling goes away. Bleeding sometimes occurs, but it usually stops on its own. A mild infection in the urinary tract may occur after cystoscopy, but it can usually be prevented or treated by taking antibiotics before and after the procedure. In rare cases, the infection can spread through the body, and in very rare circumstances, usually with seriously ill people, the infection can be life-threatening. Another rare complication is a puncture of the urethra or bladder by one of the instruments, which requires surgery to repair. After the procedureAfter the procedure, you may need to urinate frequently, with some burning during and after urination for a day or two. Drink lots of fluids to help minimize the burning and to prevent a urinary tract infection. A pinkish tinge to the urine is also common for several days after cystoscopy, particularly if a biopsy was performed. However, call your doctor immediately if: - Your urine remains red or you see blood clots after you have urinated several times.
- You are unable to pass urine 8 hours after the procedure.
- You develop a fever, chills, or severe pain in your flank or abdomen after the procedure. These may be signs of a kidney infection.
You develop signs of a urinary tract infection. These signs include: - Pain or burning upon urination.
- An urge to urinate frequently, but usually passing only small quantities of urine.
- Dribbling (inability to control urine release).
- Urine that is reddish or pinkish, foul-smelling, or cloudy.
- Pain or a feeling of heaviness in the lower abdomen.
ResultsCystoscopy is a test that allows the doctor to look at the interior lining of the bladder and the urethra. Your doctor may be able to discuss preliminary results with you right after the cystoscopy is completed. The results of a biopsy usually take several days to be available. Normal:The urethra, bladder, and ureters are normal. No polyps or other abnormal tissues, inflammation, bleeding, narrow areas (strictures), or structural abnormalities are seen. Abnormal:Cystoscopy may reveal inflammation or narrowing of the urethra because of previous infections or an enlarged prostate gland. Bladder tumors (cancerous or benign), polyps, ulcers, urinary stones, or inflammation of the bladder walls may also be observed. Sometimes abnormalities in the structure of the urinary tract present since birth (congenital) are seen.
In women, a cystoscopy may reveal genital prolapse (or pelvic organ prolapse), which occurs when the structures of the pelvis protrude into or outside of the vaginal canal. What Affects the TestA cystoscopy is usually not done if you have an acute infection of the bladder, prostate gland, or urethra. 2011-07-21
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