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DESCRIPTION
Cystoscopy is a diagnostic procedure used for the visual examination of the lower urinary tract and collection of a urine sample from the bladder. The examination is performed with a cystoscope, an optic instrument with a lighted tip. In addition to allowing visualization of the internal surface of the urethra and bladder, the cystoscope enables your health care provider to irrigate, suction, inject air, and access these structures with surgical instruments. During a cystoscopy, the health care provider may remove tissue for further examination and possibly treat any problems that may be detected.
Internally, a healthy urinary tract appears pink and smooth, with a moist mucosal lining. Some medical conditions may change the appearance of the lower urinary tract or cause bleeding. Other conditions may cause narrowing of the urethra, making it difficult for urine to empty from the bladder. Additionally, some diseases of the bladder may cause changes in its size, shape, position, and stability. Cystoscopy allows the health care provider to examine these structures in great detail, take pictures, and obtain a biopsy. It may be used to perform therapeutic procedures if necessary.
Other related procedures that may be used to diagnose problems of the urinary tract include kidney, ureters, and bladder (KUB) x-ray, computed tomography (CT scan) of the kidneys, cystometry, cystography, retrograde cystography, and pyelogram (antegrade, intravenous, or retrograde).
THE URINARY TRACT & FUNCTION
The body takes nutrients from food and converts them to energy. After the body has taken the food that it needs, waste products are left behind in the bowel and in the blood. The urinary system keeps the chemicals, such as potassium and sodium, and water in balance by removing a type of waste, called urea, from the blood. Urea is produced when foods containing protein, such as meat, poultry, and certain vegetables, are broken down in the body. Urea is carried in the bloodstream to the kidneys.
UT ANATOMY & PHYSIOLOGY
Urinary system parts and their functions:
- Two Kidneys: A pair of purplish-brown organs located below the ribs toward the middle of the back. Their function is to remove liquid waste from the blood in the form of urine, keep a stable balance of salts and other substances in the blood, and produce erythropoietin, a hormone that aids the formation of red blood cells. The kidneys remove urea from the blood through tiny filtering units called nephrons. Each nephron consists of a ball formed of small blood capillaries, called a glomerulus, and a small tube called a renal tubule. Urea, together with water and other waste substances, forms the urine as it passes through the nephrons and down the renal tubules of the kidney.
- Two Ureters: Narrow tubes that carry urine from the kidneys to the bladder. Muscles in the ureter walls continually tighten and relax forcing urine downward, away from the kidneys. If urine backs up, or is allowed to stand still, a kidney infection can develop. About every 10 to 15 seconds, small amounts of urine are emptied into the bladder from the ureters.
- Bladder: A triangle-shaped, hollow organ located in the lower abdomen. It is held in place by ligaments that are attached to other organs and the pelvic bones. The bladder's walls relax and expand to store urine, and contract and flatten to empty urine through the urethra. The typical healthy adult bladder can store up to two cups of urine for two to five hours.
- Two Sphincter Muscles: Circular muscles that help keep urine from leaking by closing tightly like a rubber band around the opening of the bladder nerves in the bladder - alert a person when it is time to urinate, or empty the bladder urethra - the tube that allows urine to pass outside the body.
TYPES OF CYSTOSCOPES
When a patient has a urinary problem, the health care provider may use a cystoscope to see the inside of the bladder and urethra. The urethra is the tube that carries urine from the bladder to the outside of the body. The cystoscope has lenses like a telescope or microscope. These lenses let the health care provider focus on the inner surfaces of the urinary tract. Some cystoscopes use optical fibres (flexible glass fibres) that carry an image from the tip of the instrument to a viewing piece at the other end. The cystoscope is as thin as a pencil and has a light at the tip. Many cystoscopes have extra tubes to guide other instruments for surgical procedures to treat urinary problems.
There are two main types of cystoscopy - flexible and rigid - differing in the flexibility of the cystoscope. Flexible cystoscopy is carried out using local anaesthesia on both sexes. Typically, lidocaine gel (such as the brand name Instillagel) is used as an anaesthetic, instilled in the urethra. Rigid cystoscopy can be performed under the same conditions, but is generally carried out under general anaesthesia, particularly in male subjects, due to the pain caused by the probe.
REASONS FOR PROCEDURE
A cystoscopy may be recommended when a disorder of the urinary tract is suspected. Urinary tract disorders may include structural problems that can lead to a blockage of urine flow or a back flow of urine. If untreated, structural problems may lead to potentially serious complications.
Blood in the urine (hematuria).
Inability to control urination (incontinence).
Painful urination.
Urinary-tract infection (UTI).
Congenital abnormalities of the urinary tract.
Traumatic injury of the urinary tract.
Cancer or tumors of the bladder or prostate gland.
Benign prostatic hypertrophy (BPH) - enlargement of prostate gland in men usually over 50 interfering or obstructing the bladder's ability to pass urine.
Polyp growths of normal tissue (usually benign).
Diverticula - pouches that form when a mucosal membrane pushed through a muscular membrane.
Bladder or kidney stones (calcium crystals) causing infection, inflammation, bleeding, blockage.
Tightening of the urethra or the uterus.
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RISK INCREASES WITH
Obesity.
Smoking.
Recent or chronic illness.
Sexually transmitted disease (STD).
Use of drugs such as: antihypertensives; muscle relaxants' tranquilizers; sleep inducers; insulin; sedatives; beta-adrenergic blockers; or cortisone.
Use of mind-altering drugs, including: narcotics; psychedelics; hallucinogens; marijuana; sedatives; hynotics; or cocaine.
DESCRIPTION OF PROCEDURE
BEFORE THE PROCEDURE
Your health care provider will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
The type of fasting required before the procedure will depend on the type of anesthesia that is to be used. Your health care provider will give you specific instructions regarding how to fast for the procedure. You may be given additional instructions about a special diet for one to two days prior to the procedure.
If you are pregnant or suspect that you are pregnant, you should notify your health care provider.
Notify your health care provider if you are sensitive to or are allergic to any medications, latex, iodine, tape, and anesthetic agents (local and general).
Notify your health care provider of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
Notify your health care provider if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
If local anesthesia is used, you will be awake during the procedure, but a sedative may be given before the procedure. You will need someone to drive you home afterwards.
If you suspect that you have a urinary tract infection, notify your health care provider, because this may be a contraindication for cystoscopy. Your health care provider may require that a urine sample be tested for infection before the procedure.
Based upon your medical condition, your health care provider may request other specific preparation.
DURING THE PROCEDURE
A cystoscopy may be performed on an outpatient basis or as part of your stay in the hospital. Procedures may vary, depending on your condition and your health care provider's practices. Generally, a cystoscopy follows this process:
The patient urinates before the procedure so that urine remaining in the bladder can be measured.
You will be asked to remove any clothing, jewelry, or other objects that may interfere with the procedure. If you are asked to remove clothing, you will be given a gown or wear.
An intravenous (IV) line may be inserted in your arm or hand. You may receive an IV sedative or anesthetic, depending on your specific situation and the type of scope used. If a sedative or anesthetic is given, your heart rate, blood pressure, breathing, and blood oxygen level will be continuously monitored during the procedure.
You will be positioned on the examination table on your back with your knees up and spread apart. Your feet will be placed in stirrups.
A topical anesthetic gel will be inserted into your urethra using a special catheter. This may be mildly uncomfortable until the area is numb.
Once the urethra is numb and/or the anesthesia has taken effect, the cystoscope is lubricated and inserted through the urethra into the bladder. You may experience some discomfort during the cystoscope insertion. As the cystoscope is passed through the urethra, the health care provider will inspect the mucosal layer for any abnormalities or obstructions. The cystoscope will be advanced until it reaches the bladder.
Once the cystoscope is in the bladder, the health care provider may instill sterile water or saline to help expand the bladder for better visualization and examination of the entire bladder wall. While the bladder is being filled, you may have the urge to urinate or feel mild discomfort.
The health care provider will examine the entire bladder for any abnormalities. A small device may be passed through the cystoscope to collect a tissue sample for a biopsy. A urine sample from the bladder may be collected.
Bladder or kidney stones are removed, if necessary. Tissue samples are gathered and lesions are treated, if necessary.
Catheters are passed through the cystoscope and guided to the openings into the ureters. A harmless dye is injected through the catheters into the ureters to perform the x-ray studies.
The cystoscope will be carefully removed from the urinary tract after the procure has been completed.
AFTER THE PROCEDURE
After the procedure, you may be taken to the recovery room for observation if sedation or anesthesia was used. Your recovery process will vary depending upon the type of sedation that is given. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home. Cystoscopy is usually done on an outpatient basis.
EXPECTED OUTCOME
Examination completed and urine sample collected successfully in virtually all cases. Allow about 4 days for recovery from surgery.
POSSIBLE COMPLICATIONS
As with any invasive procedure, complications can occur. Complications related to cystoscopy include, but are not limited to, the following:
- Excessive bleeding.
- Damage to the urethra.
- Perforation of bladder.
- Urinary tract infection.
- If male, injury to the penis.
If you are pregnant or suspect that you may be pregnant, you should notify your health care provider prior to the procedure. There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your health care provider prior to the procedure. Urinary tract infection may interfere with a cystoscopy.
POST PROCEDURE CARE
GENERAL MEASURES
You will be encouraged to drink extra fluids, which dilutes the urine and reduces urinary discomfort such as burning. Some burning with urination is normal after the procedure but should lessen over time.
You may notice blood in your urine for a period of time after the procedure. The amount of blood reduces gradually over one to two days.
A warm sitz or tub bath may be recommended to help alleviate urinary discomfort. Take warm baths for 10 to 15 minutes several times a day to relieve discomfort.
MEDICATION
Prescription pain medication should generally be required only for 2 to 7 days following the procedure.
Antibiotics as required to fight infection. Be sure take the antibiotic exactly as ordered.
Non-prescription drugs, such as acetaminophen, may be used for minor pain. Avoid aspirin or other certain pain medications that may increase the chance of bleeding. Use only recommended medications.
ACTIVITY
Avoid vigorous exercise for 2 weeks after surgery.
Resume sexual relations when follow-up medical examination determines that healing is complete.
Resume driving 2 days after the procedure.
DIET
No special diet. You may resume your usual diet unless your health care provider advises you differently. You should follow a healthy, balanced nutritional program for a healthy immune system and to regain and maintain a healthy urinary tract system and general health.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
Any of the following occur: Pain, swelling, redness, drainage, or bleeding increases in the surgical area. Continued burning with urination or blood in the urine.
You have any signs and symptoms of infection: fever and/or chills, body aches, headache, general ill feeling.
You experience nausea or vomiting.
You have painful or difficult urination. Inability to urinate.
Changes in urinary frequency or urgency.
Lower back pain.
New, unexplained symptoms develop. Drugs used for treatment may produce side effects.
Your health care provider may give you additional or alternative instructions after the procedure, depending on your particular situation.
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