BPH

Cystoscopy: Purpose, Procedure, and Preparation

The urinary tract is an essential part of a person’s body. It helps with the removal of excess fluids from the body. It also ensures toxins can be expelled. The bladder is where urine accumulates.

The urine is collected from the kidneys. When a person empties their bladder, the urine is pushed out of the body through the urethra. 

Several conditions can affect the bladder, the urethra, and other parts of the urinary tract. This may lead to the development of lower urinary symptoms.

At times, symptoms can become severe. This may lead to urinary retention and even increase the risk of urinary tract infections. There is a higher risk of a bladder infection too. This will cause more than just mild discomfort. The infection may affect various parts of the urinary tract – including the bladder lining. 

A cystoscopy is a procedure sometimes performed in people with urinary symptoms. This is generally the procedure needed to determine if there is a problem with the urinary tract.

Patients should understand how the procedure works. We look at what a cystoscopy is. We will also share some essential details the patient should know about the procedure.

What Is Cystoscopy?

A cystoscopy is a medical procedure. Different types of cystoscopy procedures are done. The procedure is used to analyze the bladder wall in a patient. It can also help a doctor see the inside of the urethra. The procedure has several purposes and can assist in the diagnosis of certain conditions. 

The primary idea behind a cystoscopy is to produce a more direct visual presentation of the urinary tract. The Lichtleiter was the initial inspiration behind what we see today as the cystoscopy. This was a straightforward device developed in 1806 by a German surgeon1. The equipment used a candle, along with mirrors, to see into body cavities. It was adapted to allow doctors to see inside the urethra. 

Today, technology is significantly more advanced, and the procedure has become quite simple. 

A cystoscope is used in the procedure today. There are two different types of cystoscopes. A flexible cystoscopy is a common option. Another option is a rigid cystoscopy.

The cystoscope is essentially a hollow tube. The tube is inserted into the urethra. The procedure is relatively similar in both men and women. A lens is placed at the end of the cystoscope. This part goes into the urethra through the vagina or the tip of the penis. 

There are different ways that a cystoscopy can be done—the type of cystoscopy that is used needs to be considered first. The surgeon or doctor performing the procedure will be able to determine the best method to be used. 

In most cases, a flexible tube is used during the procedure. A testing room can be used to perform a cystoscopy on a patient. The doctor usually applies a numbing agent to the area where the tube will be implemented. The numbing agent is generally in the form of a jelly. It contains an anesthetic agent. This numbs the area to reduce discomfort. 

There are cases where the procedure is rather done in a hospital. In this scenario, the patient may be provided with general anesthesia. 

What Is A Cystoscopy Used For?

There are several reasons why a doctor may advise a patient to undergo a cystoscopy. Patients should understand why the test may be administered. This also helps the patient understand if they should expect this type of test with the symptoms they experience. 

In most cases, a doctor will request a cystoscopy to investigate the presence of certain symptoms. Symptoms that a doctor may find suspicious include:

A doctor may also use cystoscopy to investigate problems if the patient has frequent urinary tract infections.

It is also a diagnostic tool for certain conditions that affect the bladder. Some of these conditions include:

In men, a cystoscopy can sometimes reveal problems with the prostate too. This generally happens when the prostate gland causes the urethra to become narrower.

In this case, the man may have an enlarged prostate. The doctor may then perform additional tests. It will assist with the diagnosis of benign prostatic hyperplasia

There are also scenarios where a cystoscopy is used as part of a treatment protocol. A hollow tube is used during the procedure in most cases. Since the tube is hollow, certain tools can be passed through it. 

Small bladder tumors that develop in the bladder can sometimes be removed during such a procedure. A small blade is passed through the hollow tube. It is then used to cut the tumor out. The hollow tube is then also used to remove the tumor. 

A ureteroscopy is sometimes performed alongside the cystoscopy. This can help the doctor look at the ureters. These are small tubes that carry urine from the kidneys toward the bladder. Some conditions can affect the ureters too. The addition of a ureteroscopy can help the doctor look at the well-being of these tubes. 

What Are The Risks Of A Cystoscopy?

There are a few risks that have been associated with a cystoscopy. When done by a licensed surgeon, the chances of these complications will be lower. The specific risks tend to depend on the type of cystoscopy procedure that is done. 

Bleeding is a relatively common risk associated with the procedure. The patient may notice some blood in their urine following the procedure. This should fade quickly. In rare cases, severe bleeding has been reported. Patients are also concerned about a urethral stricture

Infection is another concern. When a cystoscopy was performed, there is a risk that bacteria and other germs may enter the patient’s urinary tract. This may lead to the development of an infection. There are a few risk factors that have been linked to an infection occurring after the procedure. People who smoke and older individuals are more likely to experience this complication. 

There is another common risk associated with a cystoscopy. This is pain2. Some people experience pain in their abdomen after they had the procedure. There is sometimes a burning sensation while the patient urinates. The pain symptoms will gradually start to fade after the procedure has been completed. 

Signs of Serious Complications

Sometimes, the complications of a cystoscopy procedure may be more serious. Patients need to understand how they can recognize these complications.

Taking action and consulting the surgeon should be considered an urgent matter. Appropriate treatment can be provided to avoid the complications from causing severe and permanent damage. 

Some of the signs that may signal a serious complication include:

  • If the patient is unable to urinate after they had the procedure, this may signal a urinary blockage

  • Severe abdominal pain – especially when coupled with nausea.

  • Patients with a high fever and chills also need to contact their urologist

  • If the patient continues to feel a burning sensation when they urinate after two days following the procedure, they should also take this is a concerning matter. 

  • When there are blood clots in the patient’s urine, they should contact their doctor. 

  • The bright red blood that appears in urine is another concerning factor that patients should not ignore. 

Patients also need to take note of a recurrent urinary tract infection after the procedure. The patient’s urethra might have been damaged. This leads to a constant bacterial overgrowth in the lower urinary tract

How To Prepare For A Cystoscopy?

There are a few steps that patients should take to prepare for a cystoscopy. First of all, the patient should ensure they ask the doctor any questions they may have. The doctor who will perform the procedure will be able to answer any of the questions the patient asks. 

Some patients may be provided with antibiotics before they have the procedure. This is called prophylaxis. It is a common method that helps to reduce the risk of infection as a complication of surgery. If the patient is given antibiotics, they need to ensure they take it as prescribed. They will need to take the antibiotics for a few days before the procedure is done. 

There are cases where the patient will also be given antibiotics following the procedure. The patient should check with the doctor. 

Patients also need to ensure they listen closely to instructions given by the doctor. A doctor will sometimes want to conduct a urine test on the day of the procedure. In this case, the patient should avoid emptying their bladder too soon before going to the doctor’s office. The patient will be asked to provide a urine sample at the doctor’s office. 

Patients who will receive intravenous sedative drugs or when general anesthetics will be used need to understand that they will not be able to drive home after the procedure. If these methods are used, the patient should ensure they have someone to take them home afterward. 

What Happens During A Cystoscopy?

A cystoscopy is not a time-consuming procedure. In most cases, it will take around 15 minutes for the procedure to be completed. If the patient undergoes the procedure at a hospital, it may take a little longer. It is often done in the office instead3.

The patient should expect the procedure to be done in about half an hour in such a case. Extra time may be needed for the patient to recover from the anesthetics or sedative used during the procedure. 

Patients also need to ensure they understand exactly what to expect while the procedure is being done. The first step will usually be for the person to empty their bladder. The doctor may request a sample of the person’s urine. This may assist in performing certain urine tests

After the patient’s bladder is empty, the next step is to lay down on a flat table. The patient will sometimes be positioned with their knees bent. 

If the patient will receive anesthetics or a sedative is used during the procedure, then it will be administered before the cystoscopy starts. The patient will start to feel relaxed and perhaps even sleepy if a sedative is used. The medicine is usually administered through an intravenous route. 

The next step is for the cystoscope to be inserted into the urethra. The cystoscope is relatively thin, but some types of these devices may have a thicker tube. It is slowly pushed into the urethra. The doctor will look at a monitor while they move the cystoscope in the urethra. It will be pushed toward the bladder. A doctor performing the procedure will always be gentle, as this reduces the risk of causing damage to the urethra. 

A sterile solution is often added to the bladder during the procedure. This will give the doctor a better view of the bladder’s interior. In some cases, the doctor may take a sample of tissue from the bladder during the procedure. 

What Happens After A Cystoscopy?

What happens following the cystoscope depends on some things. If a patient received a sedative, they will usually need to return home – and not to work. Some people can return to their normal routine. This was generally the case when a sedative was not used during the procedure. 

The patient may be asked to remain in a recovery room for a while. This ensures the doctor can check up on the patient before they go home. If the patient experiences discomfort or pain, they should talk to the doctor. 

A warm cloth can be placed at the urethra’s opening. This may help to relieve the pain. Some people find that a warm bath helps too. 

Conclusion

A cystoscopy is sometimes needed to help a doctor see the inside of the bladder and urethra. The procedure is advised in cases where a person is expected to suffer from certain urinary tract conditions. While a simple procedure, some patients do feel a small amount of discomfort. This is due to the use of the cystoscope. Understanding what to expect beforehand ensures a person is more prepared when they undergo the procedure. 

Sources

  1. StatPearls [Internet]. (2020) Cystoscopy. [online] Available at: https://www.ncbi.nlm.nih.gov/books/NBK493180/
  2.  Urology International. (2006) When Does It Hurt? Pain During Flexible Cystoscopy in Men. [online] Available at: https://pubmed.ncbi.nlm.nih.gov/16679829/
  3. The Urologic Clinics of North America. (1988) Office Flexible Cystoscopy. [online] Available at: https://pubmed.ncbi.nlm.nih.gov/3055614/

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