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Cystoscopy

Cystoscopy by Karen Schroeder, MS, RD, MEd

Anatomy and Physiology
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Your urinary system, or urinary tract, both produces urine and excretes it from the body. It includes the kidneys, ureters, bladder, and urethra.

As blood circulates, it passes through the kidneys where wastes and extra fluid are removed to create urine. The urine then moves down the ureters to be stored in the bladder, an expandable, balloon-shaped muscle. During urination, urine leaves the bladder through the urethra, and is expelled from the body.

In men, the prostate gland wraps around the urethra at the base of the bladder. Problems with the prostate, such as enlargement or infection, can cause problems with urination.

Reasons for Procedure
A cystoscopy is performed to diagnose conditions of the urinary tract. By allowing your doctor to view the interior of the urethra, bladder, and the openings of the ureters, a cystoscopy may investigate the following signs and symptoms: recurrent urinary tract infections, blood in the urine, incontinence, painful, frequent, or difficult urination, dribbling after urination, pelvic or flank pain.

These signs and symptoms may be due to the following conditions: an unusual growth, such as a polyp, cyst, or tumor, a stone in or near the bladder, chronic inflammation or infection, a stricture, or narrowing, of the urethra, enlargement of the prostate gland, ulcers in the bladder wall.

Treatments
Cystoscopy allows your doctor to view the inside of your urinary tract. In this procedure, a tube-like instrument, called a cystoscope, is inserted through the urethra and into the bladder. One end of the tube contains a light source and lenses, which project images through an eyepiece and onto a video monitor.

In addition to a cystoscopy, your doctor may also recommend doing a ureteroscopy. A ureteroscopy is a completely separate procedure from a cystoscopy and allows your doctor to look further into the lower part of the ureters. It is useful for diagnosing and managing stones stuck in this area.

Surgical tools can also be passed through the cystoscope or ureteroscope to perform simple procedures, such as: taking a tissue biopsy from the urethra, bladder, or ureters, taking a urine sample from the ureters, removing a polyp or stone, placing a stent in the ureter to relieve a blockage.

Stones in the bladder or lower part of the ureters can often be removed through simple procedures during a cystoscopy or ureteroscopy; stones that are stuck higher up in the ureters cannot. Such stones can be treated with a technique called extracorporeal shock wave lithotripsy, or ESWL. In this procedure, high-pitched sound waves break apart stones into smaller pieces, which are then able to pass through the urinary tract.

Other methods used to diagnosis urinary tract conditions include: ultrasound, which uses high-pitched sound waves to create images of the bladder, ureters, and kidneys; computerized tomography, or CT, in which a scanner uses advanced x-ray technology to create cross-sectional images; intravenous pyelogram, an x-ray test that takes images of a special dye as it passes from the bloodstream through the kidneys and is collected in the ureters and bladder; MRI scan, which uses powerful magnets, radio waves, and computers to create detailed images of the urinary tract.

Researchers are also experimenting with a new technique called virtual cystoscopy, which uses CT scans to create a 3-D image of the bladder's interior.

Procedure
In the days leading up to your procedure: arrange for a ride to and from your doctor's office. Drink plenty of fluids. If you regularly take medications, herbs, or dietary supplements, your doctor may have you temporarily discontinue them. Do not start taking any new medications, herbs, or dietary supplements without first consulting your doctor. You may need to use an enema or laxative to empty your bowels. You may be asked to shower with an antibacterial soap the morning of your procedure.

Most simple cystoscopies are done in the office using local anesthesia. Women will lie on their backs with their knees bent and apart, and their feet resting in stirrups, while men generally lie flat on their backs. An IV line may be inserted into your vein to provide medication.

Your doctor will begin by cleaning the urethral opening and applying a local anesthetic to numb the area. Once the area is numbed, he or she will gently insert the tip of the cystoscope into the urethra and slowly advance it up into the bladder.Loading image. Please wait...

By introducing a clear, sterile solution, your doctor will expand the bladder, making it easier to examine the mucosal lining. You may feel the urge to urinate, but will be asked to hold it until the procedure ends, which in a simple cystoscopy is usually not much longer than a minute.

Your doctor will carefully examine the lining of the bladder and urethra. He or she can look through the eyepiece on the cystoscope, as well as view images projected onto a video screen.

The decision to perform a ureteroscopy must be made before your procedure. A ureteroscopy requires a formal anesthetic and is almost never attempted in an office setting. During a ureteroscopy, your doctor may insert instruments through the ureteroscope to remove a stone or polyp, take a tissue biopsy, or place a stent in the ureter.

When your doctor is finished, the scope will be removed and you will be able to use the bathroom. Your doctor can tell you what was seen immediately after the test. If a biopsy was taken, results are usually available in a few days.

Risks and Benefits
Possible risks of a cystoscopy include: infection, bleeding, and/or rupture of the bladder wall.

A potential benefit of a cystoscopy is the accurate diagnosis of a variety of conditions affecting the urinary tract. Other benefits of a cystoscopy supplemented by other procedures, such as ureteroscopy, include: biopsy of tissue in the lower urinary tract, removal of stones or polyps, placement of a stent in the ureter to relieve a blockage.

In a cystoscopy, or any procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it's the most appropriate procedure for you.

After the Procedure
You will usually be able to go home soon after your cystoscopy. Your doctor will likely prescribe antibiotics to prevent an infection and may offer you medications to treat any lingering discomfort. Most patients may resume their normal activities directly following a cystoscopy, but there may be some restrictions depending on what additional procedures were performed.

After the procedure, you may feel burning or soreness, or notice some blood in your urine when you urinate. You may also need to urinate often. These symptoms should stop after 24 hours. You can help relieve discomfort and prevent an infection by drinking at least 6-8 glasses of water each day.

Be sure to call your doctor if you experience: signs of infection, including fever and chills, bleeding or pain that persists more than 24 hours after your procedure, bleeding with clots at any time, urgency or frequency of urination after 24 hours, inability to urinate or difficulty completely emptying your bladder, pain in your abdomen, side, or back, and/or nausea and vomiting.

Sources:

  • Bernhardt TM, Krause UW, Philipp C, Allhoff EP, Rapp-Bernhardt U. Virtual cystoscopy with reduced tube current: an alternative to cystoscopy? [Abstract]. Rofo. 2003;175:1106-1111. Available at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12886480&dopt=Abstract Accessed September 29, 2004.
  • Harvard Medical School's Consumer Health Information. Cystoscopy. Available at: http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/20747.html Accessed September 29, 2004.
  • The Harvard Medical School Family Health Guide. Cystoscopy. Available at: http://www.health.Harvard.edu/fhg/diagnostics/cysto/cysto.shtml Accessed September 27, 2004.
  • National Kidney and Urologic Diseases Information Clearinghouse. Cystoscopy and ureteroscopy. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/cystoscopy Accessed September 27, 2004.
  • National Kidney and Urological Diseases Information Clearinghouse. Interstitial cystitis. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/interstitialcystitis/ Accessed September 28, 2004.
  • National Kidney and Urologic Diseases Information Clearinghouse. Urinary incontinence in women. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/uiwomen/ Accessed September 28, 2004.
  • National Kidney and Urologic Diseases Information Clearinghouse. Urinary tract infections in adults. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/utiadult/ Accessed September 28, 2004.
  • National Kidney and Urologic Diseases Information Clearinghouse. What I need to know about urinary tract infections. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/uti_ez/index.htm Accessed September 28, 2004.
  • Tekes A, Macura KJ. MR imaging in the evaluation of benign pathologies of urinary bladder [Abstract]. Applied Radiology. 2004;33. Available at: http://www.appliedradiology.com/articles/Article.asp?ID=1036&IssueID=130 Accessed September 29, 2004.
  • U.S. National Library of Medicine. Cystoscopy. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/003903.htm Accessed September 28, 2004.


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